State of the science/evidence base for integrative modalities
Secondary Topic: Patient-Centered Outcomes Research
Tertiary Topic: Integrative medicine delivery models
Employing Evidence in Evaluating Complementary Therapies: Findings from an Ethnography of Integrative Pain Management at a Large Urban Pediatric Hospital
Isabel Roth, MS, DrPH (c), UTHealth School of Public Health, Houston, TX, United States; Joan Engebretson, DrPH, UTHealth School of Nursing, Houston, TX, United States; Sanghamitra M Misra, MD, Baylor College of Medicine, Houston, TX, United States; Paula Cuccaro, PhD; Rebecca Wells, PhD; Linda Highfield, PhD, UTHealth School of Public Health, Houston, TX, United States
Late Breaker: No
Ethnographies of integrative healthcare models have revealed intricate social, professional, and ideological challenges between biomedical practitioners and complementary therapists. The need for in-depth observation on the impact of integrative medical care on patients has been implicated as a promising future direction by past researchers. This study aimed to better understand the role evidence played in the process of integration of complementary and integrative therapies into a large urban pediatric hospital from the perspective of patients, caregivers, providers, and administrators through applied medical ethnography.
An ethnography was conducted over the course of 6 months in a large urban pediatric hospital in the Southern United States. At the time, the hospital was piloting an integrative medicine (IM) pain consult service. Purposive sampling was used to select providers, patients, administrators, and caregivers to follow as they engaged with the pain and IM services. Field observation and interviews were conducted with thirty-four participants. Thematic content analysis was used to analyze field notes, interview transcripts, and documents collected.
Analysis of the data revealed five themes regarding the role of evidence in the process of integration: Anecdotal Evidence and Personal Experience Effecting CIM Use, Open to Trying Whatever Works, Resistance to the Unfamiliar, Patients and Parents Trusting Doctors as Experts, and Importance of Scientific Evidence to Biomedicine. All themes address the role of evidence in relation to cultural acceptance of complementary therapies and correlate with three thought processes: critical thinking, relying on others for evidence, and reactionary thinking.
As biomedical environments seek to integrate IM into pain regimens, education and training is needed for providers, administrators, and families about the context and evidence for IM. In order to create a truly patient-centered healing encounter, families must be empowered to participate in the decision-making process and bring their own personal and cultural knowledge into their healthcare.