Patients’ and clinicians’ expectations on integrative medicine Services for Diabetes: a focus group study

Abstract

Background: Difference of perspective between patients and physicians over integrative medicine (IM) research and service provision remains unclear despite significant use worldwide. We observed an exceptionally low utilisation of IM and potential underreporting in diabetes. We aimed to explore the barriers and recommendations regarding service delivery and research of IM service among diabetes patients and physicians. Methods: A 10-group, 50-participant semi-structured focus group interview series was conducted. Twenty-one patients with diverse severity of disease, comorbidities and education levels; and 29 physicians (14 conventional medicine (ConM) and 15 Chinese medicine (CM)) with diverse clinical experience, academic background and affiliation were purposively sampled from private and public clinics. Their perspectives were qualitatively analysed by constant comparative method. Results: Seven subthemes regarding barriers towards IM service were identified including finance, service access, advice from medical professionals, uncertainty of service quality, uncertainty of CM effect, difficulty in understanding CM epistemology and access to medical records. Patients underreported the use of CM due to the concern over neutrality of medical advice among physicians. Inconvenience of service access, frequent follow-up, use of decoction and long-term financial burden were identified as key obstacles among patients. Regarding research design, ConM physicians emphasised standardisation and reproducibility while CM physicians emphasised personalisation. Some CM-related outcome measurements were suggested as non-communicable. Both physicians acknowledged the discordance in epistemology should be addressed by pragmatic approach. Conclusion: Key obstacles of CAM clinical utilisation are different between patients. Further assessment on IM should be pragmatic to balance between standardisation, reproducibility and real-world practice. Evidence-based IM programs and research should merge with existing infrastructure.

Efficacy, safety and response predictors of adjuvant astragalus for diabetic kidney disease (READY): study protocol of an add-on, assessor-blind, parallel, pragmatic randomised controlled trial

“…Besides, we conducted a focus group interview series to explore the expectations of patients and clinicians (both conventional medicine and CM) to refine the study design for better clinical translation. 54 The major limitation of this trial is the open-label nature. The study subjects could not be masked due to the nature of treatment.…”

“…We conducted a focus group interview series to collate the experience and expectations of patients and clinicians (both conventional medicine and CM) on the study design (drug form, dosage, administration route, frequency, health services delivery and outcome measurement) for this trial. 54 The study results will be disseminated to diabetes patient groups and the participants via public workshops and talks.…”

SYmptom-Based STratification of DiabEtes Mellitus by Renal Function Decline (SYSTEM): A Retrospective Cohort Study and Modeling Assessment

“…GFR was selected as the dependent variable for the models as diabetic kidney disease (DKD) is the most prevalent and costly complication of diabetes with limited known progression risk factors ( 44 ). Prevention of renal function decline has been suggested as the top priority among diabetic patients in our previous focus group interview series ( 25 ). The efficiency of diagnostic models in predicting rate of renal function has clinical significance ( 46 ).…”

“…Chinese medicine (CM) has a long history in symptom-based disease management as biochemical and molecular investigations were not available at the time of theory development (23)(24)(25). Previous big data studies showed that add-on symptombased CM treatment led to reduced risk of end-stage kidney disease and mortality among chronic kidney disease (CKD) patients with diabetes (26)(27)(28).…”

“…Symptom could serve as an intuitive and non-invasive tool to predict and monitor clinical progression, especially for telemedicine. Previous study shows that retarding renal function decline is the priority among diabetic patients with no/early CKD ( 25 ). This study aimed to investigate the association between the presence of symptoms, SSs and renal function deterioration among diabetic patients, and to establish a synchronized symptom-based framework for stratifying diabetes based on the quality of different statistical models in predicting renal function.…”