Employing Evidence in Evaluating Complementary Therapies: Findings from an Ethnography of Integrative Pain Management at a Large Urban Pediatric Hospital

Abstract

Background: Complementary and Integrative Medicine (CIM) shows positive clinical benefit with minimal side effects, yet, challenges to effective integration of CIM providers in biomedical health care settings remain. This study aimed to better understand the role evidence played in the process of integration of complementary therapies into a large urban pediatric hospital from the perspective of patients, caregivers, providers, and administrators through applied medical ethnography. Methods: 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 both the preexisting pain service and pilot IM pain services. Field observation and interviews were conducted with 34 participants. Thematic content analysis was used to analyze field notes, interview transcripts, and documents collected. Findings: 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 relationship to acceptance of complementary therapies and correspond with three thought processes: critical thinking, relying on others for evidence, and reactionary thinking. Conclusion: Both scientific and anecdotal evidence informed CIM use in this context. Biomedical environments seeking to integrate CIM into pain treatment regimens will need to engage all relevant stakeholders in building education, clinical training, and research programs that are critically informed about the context and evidence for CIM.

Quality Indicators of Pharmaceutical Care for Integrative Healthcare: A Scoping Review of Indicators Developed Using the Delphi Technique

“…e activities and services identified from the studies included in this scoping review broadly cover the different aspects of pharmaceutical services that could be offered in healthcare facilities providing integrated care. Such services might reflect the continuously expanding roles and responsibilities of pharmacists relevant to provision of collaborative, direct, and proactive care to patients, counselling/ educating patients on their diseases and therapeutic options, and resolving therapy related problems [15,16,21,22]. e present scoping review demonstrated that little efforts were focused on developing quality indicators of pharmaceutical services and, especially, those relevant to CAM in healthcare facilities adopting an integrated paradigm of healthcare delivery.…”

“…erefore, pharmacists are assuming continuously evolving roles and responsibilities. Such expanding roles and responsibilities have recently been backed and advocated by professional organizations in different nations like the United States, United Kingdom, Australia, and Canada [11][12][13][14][15]. With the passage of time, more roles and responsibilities are expected to unfold for pharmacists.…”

“…With the passage of time, more roles and responsibilities are expected to unfold for pharmacists. Because different CAM modalities are increasingly used in hospitalized patient settings as being either alternatives or complementary to conventional therapies [15,16], pharmacists and other healthcare providers are expected to provide larger volumes of healthcare services to patients receiving such modalities. As a result, integrative medicine is being taught to healthcare professionals including pharmacists and physicians [17][18][19][20].…”

“…In practice, the concept of pharmaceutical care includes provision of direct services to patients like taking history, education/counselling, designing therapeutic plans, documentation, following up with patients, and collaborations with other healthcare providers [21]. In integrative medicine paradigms, pharmacists can provide many services that might include designing and implementing therapeutic plans, ordering laboratory tests, screening for, identifying, explaining, and resolving adverse reactions, interactions, ineffective therapies, and counselling/educating patients how to benefit the most out of their therapies which might include medications and CAM modalities [15,16,22].…”

Comparative analysis of resource utilization in integrative anthroposophic and all German pediatric inpatient departments

“…During the last 20 years, the implementation of integrative approaches for children has grown [2,[5][6][7][8][9][10][11][12][13][14][15] worldwide: IM is used in pediatrics in the USA [9,11,[16][17][18][19], in Canada [20] and in Europe [5,8,[21][22][23][24][25] in private practices, outpatient-and inpatient-departments [23]. Current literature suggests that 30-50% of parents of children with acute or chronic diseases use IM for their children [26][27][28][29], while it seems to be used more frequently for children with chronic diseases in the US [16,[30][31][32][33][34][35].…”