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Greffin K, Muehlan H, van den Berg N, Hoffmann W, Ritter O, Oeff M, Speerfork S, Schomerus G, Schmidt S. Measuring context that matters: validation of the modular Tele-QoL patient-reported outcome and experience measure. Qual Life Res 2023; 32:3223-3234. [PMID: 37458961 PMCID: PMC10522723 DOI: 10.1007/s11136-023-03469-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE A setting-sensitive instrument for assessing Quality of Life (QoL) in Telemedicine (TM) was unavailable. To close this gap, a content-valid "add-on" measure was developed. In parallel, a brief index was derived featuring six items that summarise the main content of the multidimensional assessment. After pre- and pilot-testing, the psychometric performance of the final measures was investigated in an independent validation study. METHODS The questionnaires were applied along with other standardised instruments of similar concepts as well as associated, yet disparate concepts for validation purposes. The sample consisted of patients with depression or heart failure, with or without TM (n = 200). Data analyses were aimed at calculating descriptive statistics and testing the psychometric performance on item, scale, and instrument level, including different types of validity and reliability. RESULTS The proposed factor structure of the multidimensional Tele-QoL measure has been confirmed. Reliability coefficients for internal consistency, split-half, and test-retest reliability of the subscales and index reached sufficient values. The Tele-QoL subscales and the index demonstrated Rasch scalability. Validity of both instruments can be assumed. Evidence for discriminant construct validity was provided. Known-groups validity was indicated by respective score differences for various classes of disease severity. CONCLUSION Both measures show convincing psychometric properties. The final multidimensional Tele-QoL assessment consists of six outcome scales and two impact scales assessing (un-)intended effects of TM on QoL. In addition, the Tele-QoL index provides a short alternative for outcome assessment. The Tele-QoL measures can be used as complementary modules to existing QoL instruments capturing healthcare-related aspects of QoL from the patients' perspective.
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Affiliation(s)
- Klara Greffin
- Department of Psychology, Chair of Health and Prevention, University of Greifswald, Greifswald, Germany.
| | - Holger Muehlan
- Department of Psychology, Chair of Health and Prevention, University of Greifswald, Greifswald, Germany
| | - Neeltje van den Berg
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Oliver Ritter
- Department of Cardiology, Nephrology and Pulmonology, Campus Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Michael Oeff
- Brandenburg City Hospital, Brandenburg an der Havel, Germany
| | - Sven Speerfork
- Clinic of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Georg Schomerus
- Clinic of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Silke Schmidt
- Department of Psychology, Chair of Health and Prevention, University of Greifswald, Greifswald, Germany
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Contributing to Global Health: Development of a Consensus-Based Whole Systems Research Strategy for Anthroposophic Medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:3706143. [PMID: 31781267 PMCID: PMC6875260 DOI: 10.1155/2019/3706143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/22/2019] [Accepted: 09/24/2019] [Indexed: 12/30/2022]
Abstract
Background Whole medicine and health systems like traditional and complementary medicine systems (T&CM) are part of healthcare around the world. One key feature of T&CM is its focus on patient-centered and multimodal care and the integration of intercultural perspectives in a wide range of settings. It may contribute to good health and well being for people as part of the Sustainable Development Goals of the United Nations. The authentic, rigorous, and fair evaluation of such a medical system, with its inherent complexity and individualization, imposes methodological challenges. Hence, we propose a broad research strategy to test and characterize its possible contribution to health. Methods To develop a research strategy for a specific T&CM system, Anthroposophic Medicine (AM), applying multimodal integrative healthcare based on a four-level concept of man, we used a three-phase consensus process with experts and key stakeholders, consisting of (1) premeeting methodological literature and AM research review and interviews to supplement or revise items of the research strategy and tailor them to AM research, (2) face-to-face consensus meetings further developing and tailoring the strategy, and (3) postmeeting feedback and review, followed by finalization. Results Currently, AM covers many fields of medical specialties in varied levels of healthcare settings, such as outpatient and inpatient; primary, secondary, and tertiary care; and health education and pedagogy. It is by definition integrated with conventional medicine in the public healthcare system. It applies specific medicines, nursing techniques, arts therapies, eurythmy therapy, rhythmical massage, counseling, and psychotherapy, and it is provided by medical doctors, nurses, therapists, midwives, and nutritionists. A research strategy authentic to this level of complexity should comprise items with a focus on (I) efficacy and effectiveness, divided into (a) evaluation of the multimodal and multidisciplinary medical system as a whole, or of complex multimodal therapy concept, (b) a reasonable amount of methodologically rigorous, confirmatory randomized controlled trials on exemplary pharmacological and nonpharmacological therapies and indications, (c) a wide range of interventions and patient-centered care strategies with less extensive formats like well-conducted small trails, observational studies, and high-quality case reports and series, or subgroup analyses from whole-system studies, or health service research; (II) safety; (III) economics; (IV) evidence synthesis; (V) methodologic issues; (VI) biomedical, physiological, pharmacological, pharmaceutical, psychological, anthropological, and nosological issues as well as innovation and development; (VI) patient perspective and involvement, public needs, and ethics; (VII) educational matters and professionalism; and (IX) disease prevention, health promotion, and public health. Conclusion The research strategy extends to and complements the prevailing hierarchical system by introducing a broad “evidence house” approach to evaluation, something many health technology assessment boards today support. It may provide transparent and comprehensive insight into potential benefits or risks of AM. It can serve as a framework for an evidence-informed approach to AM for a variety of stakeholders and collaborating networks with the aim of improving global health.
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Vohra S, Zorzela L, Kemper K, Vlieger A, Pintov S. Setting a research agenda for pediatric complementary and integrative medicine: A consensus approach. Complement Ther Med 2018; 42:27-32. [PMID: 30670252 DOI: 10.1016/j.ctim.2018.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/22/2018] [Accepted: 10/29/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Pediatric use of complementary medicine (CM) is common and offers numerous research questions about diverse therapies and conditions. Although research priorities for pediatric CM have been identified, there was a need to update in light of the rapid evolution of the field. METHODS Building on previous work, we conducted an international, consensus-based 4-step modified Delphi process to develop and refine a pediatric CM research agenda, including on-line questionnaires and an in-person meeting. Participants included health care professionals, researchers, and educators. RESULTS We received 376 responses; participants included conventional and CM providers, researchers, educators, administrators, and policy-makers from 15 countries (Australia, Bangladesh, Belgium, Canada, China, Germany, India, Israel, Italy, New Zealand, Norway, Sri Lanka, The Netherlands, United Kingdom, and United States). While it was recognized that each region must set their own priorities based on use, access, and expertise, a "minimum set" for a pediatric CM research agenda was identified. After three rounds of surveys, participants identified the highest priorities for pediatric CM research as: (i) safety of CM therapies for infants, children, and adolescents; (ii) conditions for which CM use is highly prevalent and for which conventional medicine lacks safe, cost-effective therapies; iii) therapies/therapists to be examined for quality and reproducibility of interventions, comparative and cost effectiveness, dose, etc.; and iv) identification of relevant outcomes and outcome measurement tools. CONCLUSIONS The results of our study identify that "first do no harm" is the leading research priority for pediatric CM research, followed by more research on effectiveness of CM therapies for conditions not safely and effectively treated with conventional care. In order to improve pediatric health care, interdisciplinary collaborative approaches are needed between CM and conventional providers and researchers.
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Affiliation(s)
- Sunita Vohra
- CARE Program, Dept of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
| | - Liliane Zorzela
- CARE Program, Dept of Pedaitric, University of Alberta, Edmonton, Canada.
| | - Kathi Kemper
- College of Medicine, Ohio State University, Columbus, OH, 43210, United States.
| | - Arine Vlieger
- Dept of Pediatrics, St Antonius Hospital, Nieuwegein, The Netherlands.
| | - Shay Pintov
- Dept of Pediatrics Kiboga District Government Hospital, Uganda.
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Kania-Richmond A, Metcalfe A. Integrative health care - What are the relevant health outcomes from a practice perspective? A survey. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:548. [PMID: 29273041 PMCID: PMC5741963 DOI: 10.1186/s12906-017-2041-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022]
Abstract
Background Integrative health care (IHC) is an innovative approach to health care delivery. There is increasing focus on and demand for the evaluation of IHC practices. To ensure such evaluations capture their full scope, a clear understanding of the types of outcomes relevant to an IHC approach is needed. The objective was to describe the health domains and health outcomes relevant to IHC practices in Canada. Methods An online survey of Canadian IHC clinics. Survey questions were informed by the IN-CAM Health Outcomes Database. Descriptive statistics were used to summarize the data. Chi square tests were used to compare responses between clinic types and patient groups served. Results Surveys were completed by 21 clinics (response rate: 50%). Physical, psychological, social, individualized and holistic were identified as applicable health domains by more than 90% of the clinics. Spiritual domain was the least relevant (70% of clinics). A number of relevant outcomes within each domain were identified. A core set of outcomes were identified and included: fatigue, anxiety, stress, and patient-provider relationship, and quality of life. Clinics with primarily conventional health practitioners were less likely to address overall well-being (p = 0.04), while clinics that provided care to a specialized patient population (i.e. cancer patients) or a mix of general and specialized patients were less likely to address religious practices (p = 0.04) or spiritual experiences (p = 0.007). Conclusions Outcomes across health domains should be considered in the evaluation of IHC models to generate an understanding of the full scope of effectiveness of IHC approaches. The core set of outcomes identified may facilitate this task. Ethics approval (Ethics ID REB14-0495) was received from the Conjoint Health Research Ethics Board at the University of Calgary. Electronic supplementary material The online version of this article (10.1186/s12906-017-2041-4) contains supplementary material, which is available to authorized users.
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Soltis-Jarrett V, Shea J, Ragaisis KM, Shell LP, Newton M. Integrated Behavioral Healthcare: Assumptions, Definition and Roles: Position Paper From the International Society of Psychiatric-Mental Health Nurses. Arch Psychiatr Nurs 2017; 31:433-439. [PMID: 28927505 DOI: 10.1016/j.apnu.2017.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/29/2017] [Accepted: 06/01/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Victoria Soltis-Jarrett
- Carol Morde Ross Distinguished Professor of Psychiatric-Mental Health Nursing, University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC 27599-7460, United States.
| | - Joyce Shea
- Fairfield University School of Nursing, Fairfield, CT 06824-5195, United States
| | | | | | - Marian Newton
- Eleanor Wade Custer School of Nursing, Shenandoah University, Winchester, VA 22601, United States
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Guidance for establishing an integrative oncology service in the Australian healthcare setting—a discussion paper. Support Care Cancer 2017; 26:471-481. [DOI: 10.1007/s00520-017-3851-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 07/31/2017] [Indexed: 12/11/2022]
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Hunter J, Leach M, Braun L, Bensoussan A. An interpretive review of consensus statements on clinical guideline development and their application in the field of traditional and complementary medicine. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:116. [PMID: 28212647 PMCID: PMC5316198 DOI: 10.1186/s12906-017-1613-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 01/27/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite ongoing consumer demand and an emerging scientific evidence-base for traditional and complementary medicine (T&CM), there remains a paucity of reliable information in standard clinical guidelines about their use. Often T&CM interventions are not mentioned, or the recommendations arising from these guidelines are unhelpful to end-users (i.e. patients, practitioners and policy makers). Insufficient evidence of efficacy may be a contributing factor; however, often informative recommendations could still be made by drawing on relevant information from other avenues. In light of this, the aim of this research was to review national and internationally endorsed consensus statements for clinical guideline developers, and to interpret how to apply these methods when making recommendations regarding the use of T&CM. METHOD The critical interpretive review method was used to identify and appraise relevant consensus statements published between 1995 and 2015. The statements were identified using a purposive sampling technique until data saturation was reached. The most recent edition of a statement was included in the analysis. The content, scope and themes of the statements were compared and interpreted within the context of the T&CM setting; including history, regulation, use, emerging scientific evidence-base and existing guidelines. RESULTS Eight consensus statements were included in the interpretive review. Searching stopped at this stage as no new major themes were identified. The five themes relevant to the challenges of developing T&CM guidelines were: (1) framing the question; (2) the limitations of using an evidence hierarchy; (3) strategies for dealing with insufficient, high quality evidence; (4) the importance of qualifying a recommendation; and (5) the need for structured consensus development. CONCLUSION Evidence regarding safety, efficacy and cost effectiveness are not the only information required to make recommendations for clinical guidelines. Modifying factors such as burden of disease, magnitude of effect, current use, demand, equity and ease of integration should also be considered. Uptake of the recommendations arising from this review are expected to result in the development of higher quality clinical guidelines that offer greater assistance to those seeking answers about the appropriate use of T&CM.
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Affiliation(s)
- Jennifer Hunter
- NICM, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751 Australia
- Menzies Centre for Health Policy, School of Medicine, University of Sydney, Sydney, Australia
| | - Matthew Leach
- Australian Research Centre in Complementary & Integrative Medicine, University of Technology Sydney, Sydney, Australia
| | - Lesley Braun
- NICM, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751 Australia
- Blackmores Institute, Sydney, Australia
- Monash/Alfred Psychiatric Research Centre, Monash University, Melbourne, Australia
| | - Alan Bensoussan
- NICM, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751 Australia
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Grant SJ, Frawley J, Bensoussan A. Process of care in outpatient Integrative healthcare facilities: a systematic review of clinical trials. BMC Health Serv Res 2015; 15:322. [PMID: 26264852 PMCID: PMC4534115 DOI: 10.1186/s12913-015-0976-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 07/24/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients currently integrate complementary medicine (CM) and allopathic, choosing a combination of therapies rather than a single therapy in isolation. Understanding integrative healthcare (IHC) extends beyond evaluation of specific therapies to encompass evaluations of multidisciplinary complex interventions. IHC is defined as a therapeutic strategy integrating conventional and complementary medical practices and practitioners in a shared care setting to administer an individualized treatment plan. We sought to review the outcomes of recent clinical trials, explore the design of the interventions and to discuss the methodological approaches and issues that arise when investigating a complex mix of interventions in order to guide future research. METHOD Five databases were searched from inception to 30 March 2013. We included randomized and quasi-experimental clinical trials of IHC. Data elements covering process of care (initial assessment, treatment planning and review, means for integration) were extracted. RESULTS Six thousand two hundred fifty six papers were screened, 5772 were excluded and 484 full text articles retrieved. Five studies met the inclusion criteria. There are few experimental studies of IHC. Of the five studies conducted, four were in people with lower back pain. The positive findings of these studies indicate that it is feasible to conduct a rigorous clinical trial of an integrative intervention involving allopathic and CM treatment. Further, such interventions may improve patient outcomes. CONCLUSIONS The trials in our review provide a small yet critical base from which to refine and develop larger studies. Future studies need to be adequately powered to address efficacy, safety and include data on cost effectiveness.
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Affiliation(s)
- Suzanne J Grant
- National Institute of Complementary Medicine, University of Western Sydney, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Jane Frawley
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Sydney, NSW, Australia.
| | - Alan Bensoussan
- National Institute of Complementary Medicine, University of Western Sydney, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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Defining integrative medicine in narrative and systematic reviews: A suggested checklist for reporting. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2014.11.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Building an Evidence-Base for TCM and Integrative East-West Medicine: A Review of Recent Developments in Innovative Research Design. J Tradit Complement Med 2014; 2:158-63. [PMID: 24716129 PMCID: PMC3942892 DOI: 10.1016/s2225-4110(16)30095-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
There are many challenges to developing an evidence base for Traditional Chinese Medicine and Integrative East-West Medicine. This article offers a review of these challenges alongside an introduction and review of several innovations in healthcare research that have successfully been applied to the study of Traditional Chinese Medicine and Integrative Medicine. Such innovations include developments in Whole Systems Research, Comparative Effectiveness Research, Health Services Research, and qualitative Social Sciences Research. Each of these approaches expands upon conventional approaches to clinical research and can also be combined with clinical trial data to yield a mixed-methods approach. We conclude with a commentary on the necessity for such mixed methods studies in the continued establishment of an evidence base for TCM and IM.
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Herman PM, Dodds SE, Logue MD, Abraham I, Rehfeld RA, Grizzle AJ, Urbine TF, Horwitz R, Crocker RL, Maizes VH. IMPACT--Integrative Medicine PrimAry Care Trial: protocol for a comparative effectiveness study of the clinical and cost outcomes of an integrative primary care clinic model. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:132. [PMID: 24708726 PMCID: PMC3984431 DOI: 10.1186/1472-6882-14-132] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 03/31/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Integrative medicine (IM) is a patient-centered, healing-oriented clinical paradigm that explicitly includes all appropriate therapeutic approaches whether they originate in conventional or complementary medicine (CM). While there is some evidence for the clinical and cost-effectiveness of IM practice models, the existing evidence base for IM depends largely on studies of individual CM therapies. This may in part be due to the methodological challenges inherent in evaluating a complex intervention (i.e., many interacting components applied flexibly and with tailoring) such as IM. METHODS/DESIGN This study will use a combination of observational quantitative and qualitative methods to rigorously measure the health and healthcare utilization outcomes of the University of Arizona Integrative Health Center (UAIHC), an IM adult primary care clinic in Phoenix, Arizona. There are four groups of study participants. The primary group consists of clinic patients for whom clinical and cost outcomes will be tracked indicating the impact of the UAIHC clinic (n = 500). In addition to comparing outcomes pre/post clinic enrollment, where possible, these outcomes will be compared to those of two matched control groups, and for some self-report measures, to regional and national data. The second and third study groups consist of clinic patients (n = 180) and clinic personnel (n = 15-20) from whom fidelity data (i.e., data indicating the extent to which the IM practice model was implemented as planned) will be collected. These data will be analyzed to determine the exact nature of the intervention as implemented and to provide covariates to the outcomes analyses as the clinic evolves. The fourth group is made up of patients (n = 8) whose path through the clinic will be studied in detail using qualitative (periodic semi-structured interviews) methods. These data will be used to develop hypotheses regarding how the clinic works. DISCUSSION The US health care system needs new models of care that are more patient-centered and empower patients to make positive lifestyle changes. These models have the potential to reduce the burden of chronic disease, lower the cost of healthcare, and offer a sustainable financial paradigm for our nation. This protocol has been designed to test whether the UAIHC can achieve this potential. TRIAL REGISTRATION Clinical Trials.gov NCT01785485.
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Affiliation(s)
| | - Sally E Dodds
- Arizona Center for Integrative Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Melanie D Logue
- University of Arizona College of Nursing, Tucson, AZ, USA
- Center for Health Outcomes & PharmacoEconomic Research (HOPE), University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Ivo Abraham
- Center for Health Outcomes & PharmacoEconomic Research (HOPE), University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Rick A Rehfeld
- Center for Health Outcomes & PharmacoEconomic Research (HOPE), University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Amy J Grizzle
- Center for Health Outcomes & PharmacoEconomic Research (HOPE), University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Terry F Urbine
- Center for Health Outcomes & PharmacoEconomic Research (HOPE), University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Randy Horwitz
- Arizona Center for Integrative Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Robert L Crocker
- Arizona Center for Integrative Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Victoria H Maizes
- Arizona Center for Integrative Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
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Weeks LC, Seely D, Balneaves LG, Boon HS, Leis A, Oneschuk D, Sagar SM, Verhoef MJ. Canadian integrative oncology research priorities: results of a consensus-building process. ACTA ACUST UNITED AC 2013; 20:e289-99. [PMID: 23904767 DOI: 10.3747/co.20.1378] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In Canada, many diverse models of integrative oncology care have emerged in response to the growing number of cancer patients who combine complementary therapies with their conventional medical treatments. The increasing interest in integrative oncology emphasizes the need to engage stakeholders and to work toward consensus on research priorities and a collaborative research agenda. The Integrative Canadian Oncology Research Initiative initiated a consensus-building process to meet that need and to develop an action plan that will implement a Canadian research agenda. METHODS A two-day consensus workshop was held after completion of a Delphi survey and stakeholder interviews. RESULTS FIVE INTERRELATED PRIORITY RESEARCH AREAS WERE IDENTIFIED AS THE FOUNDATION FOR A CANADIAN RESEARCH AGENDA: EffectivenessSafetyResource and health services utilizationKnowledge translationDeveloping integrative oncology models Research is needed within each priority area from a range of different perspectives (for example, patient, practitioner, health system) and in a way that reflects a continuum of integration from the addition of a single complementary intervention within conventional cancer care to systemic change. Strategies to implement a Canadian integrative oncology research agenda were identified, and working groups are actively developing projects in line with those strategic areas. Of note is the intention to develop a national network for integrative oncology research and knowledge translation. CONCLUSIONS The identified research priorities reflect the needs and perspectives of a spectrum of integrative oncology stakeholders. Ongoing stakeholder consultation, including engagement from new stakeholders, is needed to ensure appropriate uptake and implementation of a Canadian research agenda.
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Affiliation(s)
- L C Weeks
- Ottawa Integrative Cancer Centre, Ottawa, ON
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Hunter J, Leeder S. Patient questionnaires for use in the integrative medicine primary care setting—A systematic literature review. Eur J Integr Med 2013. [DOI: 10.1016/j.eujim.2013.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Integrative medicine outcomes: What should we measure? Complement Ther Clin Pract 2013; 19:20-6. [DOI: 10.1016/j.ctcp.2012.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 10/01/2012] [Accepted: 10/10/2012] [Indexed: 01/09/2023]
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Tusaie KR. Are advanced practice psychiatric mental health nurses prepared to deliver integrated care? Arch Psychiatr Nurs 2013; 27:1-2. [PMID: 23352019 DOI: 10.1016/j.apnu.2012.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 10/18/2012] [Indexed: 10/27/2022]
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Berger S, Braehler E, Ernst J. The health professional-patient-relationship in conventional versus complementary and alternative medicine. A qualitative study comparing the perceived use of medical shared decision-making between two different approaches of medicine. PATIENT EDUCATION AND COUNSELING 2012; 88:129-137. [PMID: 22306458 DOI: 10.1016/j.pec.2012.01.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 01/03/2012] [Accepted: 01/09/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To explore differences between conventional medicine (COM) and complementary and alternative medicine (CAM) regarding the attitude toward and the perceived use of shared decision-making (SDM) from the health professional perspective. METHODS Thirty guideline-based interviews with German GPs and nonmedical practitioners were conducted using qualitative analysis for interpretation. RESULTS The health professional-patient-relationship in CAM differs from that in COM, as SDM is perceived more often. Reasons for this include external context variables (e.g., longer consultation time) and internal provider beliefs (e.g., attitude toward SDM). German health care policy was regarded as one of the most critical factors which affected the relationship between GPs and their patients and their practice of SDM. CONCLUSION Differences between COM and CAM regarding the attitude toward and the perceived use of SDM are attributable to diverse concepts of medicine, practice context variables and internal provider factors. Therefore, the perceived feasibility of SDM depends on the complexity of different occupational socialization processes and thus, different value systems between COM and CAM. PRACTICE IMPLICATIONS Implementation barriers such as insufficient communication skills, lacking SDM training or obedient patients should be reduced. Especially in COM, contextual variables such as political restrictions need to be eliminated to successfully implement SDM.
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Affiliation(s)
- Stephanie Berger
- Independent Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.
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Galitesi CRL, Andrade FBD, Borges AFS. Pain and disease according to integral anthroposophical dentistry. Braz Oral Res 2012; 26 Suppl 1:57-63. [DOI: 10.1590/s1806-83242012000700009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 10/08/2012] [Indexed: 11/22/2022] Open
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