Project to Enhance Research Literacy (PERL) - Achieving Competency in Evidence Informed Practice: A Resource Guide for Educators

EP3. Discuss contemporary issues in integrative practice research, including those relative to evaluating whole practices, whole systems, disciplines, patient-centered approaches and health outcomes. 

Overview 

The modalities, materials and practices of complementary and integrative healthcare (CIH) sometimes present research questions that go beyond the evaluation of conventional drugs and devices. Single agents are rarely used in everyday CIH practice, and combinations of treatments are the general rule. In fact, discipline-specific whole practices may assess the patient in ways that are not distinguished in conventional medical theory before applying lifestyle measures and specific therapeutics to improve health. This competency focuses on understanding research that is designed to take into account the differences between CIH and conventional healthcare systems. 

Goal- Understand research that is designed to take into account the differences between CIH and conventional healthcare systems.  

Learning Objectives

  • Define CIH discipline-specific whole practice research.
  • Summarize similarities and differences of CAM discipline-specific whole practice and pharmacological/biomedical research.
  • Discuss the implications of integrated medicine research combining both CIH and conventional practices.
  • Explain the challenges of evaluating whole practice CIH research and the limitations of research that does not address them.

Resources

Lewith, G., Jonas, W.B., Walach, H. (2010). Clinical research in complementary therapies: principles, problems and solutions (2nd ed.). Churchill Livingstone. ISBN: 978-0-443-06956-7. This book (for purchase) discusses various research methodologies as well as unique issues in research conducted in integrative environments. Chapters 3 & 7 both contain short summary sections on whole systems research.

Ahn, A. C., Nahin, R. L., Calabrese, C., Folkman, S., Kimbrough, E., Shoham, J., & Haramati, A. (2010). Applying principles from complex systems to studying the efficacy of CAM therapies. The Journal of Alternative and Complementary Medicine, 16(9), 1015-1022. A publication that explores the application of complexity theory to the study of integrative systems of health care, outlines challenges, and provides future suggestions for this field of study.

Verhoef, M. J., Vanderheyden, L. C., Dryden, T., Mallory, D., & Ware, M. A. (2006). Evaluating complementary and alternative medicine interventions: in search of appropriate patient-centered outcome measures. BMC Complementary and Alternative Medicine, 6(1), 38. This publication reviews the development of an outcome measures database for tools that account for a whole systems approach to research.

Ritenbaugh, C., Aickin, M., Bradley, R., Caspi, O., Grimsgaard, S., & Musial, F. (2010). Whole systems research becomes real: New results and next steps. The Journal of Alternative and Complementary Medicine, 16(1), 131-137. This publication details a roundtable discussion with those who have been conducting whole systems research, outlining successes and challenges to this type of study.

Thorpe, K. E., Zwarenstein, M., Oxman, A. D., Treweek, S., Furberg, C. D., Altman, D. G., ... & Chalkidou, K. (2009). A pragmatic-explanatory continuum indicator summary (PRECIS): a tool to help trial designers. Journal of Clinical Epidemiology, 62(5), 464-475. This publication reviews the development of a tool to classify study designs and includes discussion on the difference between these types of designs.

Fønnebø, V., Grimsgaard, S., Walach, H., Ritenbaugh, C., Norheim, A. J., MacPherson, H., ... & Aickin, M. (2007). Researching complementary and alternative treatments-the gatekeepers are not at home. BMC Medical Research Methodology, 7(1), 7. This publication discusses the challenges to the biomedical model of research when applied to integrative settings, and outlines a five phase process to better address the realities of CIH practice.

University of Minnesota Whole Systems Healing Modules These freely available online learning modules review the concepts of what is meant by whole systems in various contexts.

Classroom Activity 

Review the outcome measures provided in the In-CAM Health Outcomes Database. Discuss how these measurement domains might assist in whole systems research. For an additional activity, the class could be divided into small groups and secretly assign each group one of the health outcome domains. Without revealing the domain they were assigned, have the group present a short skit demonstrating an interview with a patient designed to elicit the health outcomes for that domain. The other groups can then guess the domain being examined. 

Vignette

Sara often attends grand rounds at her local hospital to help stay informed of professional developments. During a recent grand rounds, Sara shared how she has been utilizing the Consultation and Relational Empathy (CARE) questionnaire in her integrative practice. The feedback from this tool has raised her awareness of the multitude of factors that may influence patient outcomes. She is currently working on a chart review to examine the relationship between her perceived empathy levels and patient outcomes.