Complementary and alternative medicine (CAM) providers' views of chronic low back pain patients' expectations of CAM therapies: a qualitative study

Lisa M Schafer, Clarissa Hsu, Emery Rose Eaves, Cheryl Ritenbaugh, Judith Turner, Daniel C Cherkin, Colette Sims, Karen J Sherman, Lisa M Schafer, Clarissa Hsu, Emery Rose Eaves, Cheryl Ritenbaugh, Judith Turner, Daniel C Cherkin, Colette Sims, Karen J Sherman

Abstract

Background: Some researchers think that patients with higher expectations for CAM therapies experience better outcomes and that enthusiastic providers can enhance treatment outcomes. This is in contrast to evidence suggesting conventional medical providers often reorient patient expectations to better match what providers believe to be realistic. However, there is a paucity of research on CAM providers' views of their patients' expectations regarding CAM therapy and the role of these expectations in patient outcomes.

Methods: To better understand how CAM providers view and respond to their patients' expectations of a particular therapy, we conducted 32 semi-structured, qualitative interviews with acupuncturists, chiropractors, massage therapists and yoga instructors identified through convenience sampling. Interviews were recorded, transcribed and analyzed thematically using Atlas ti version 6.1.

Results: CAM providers reported that they attempt to ensure that their patients' expectations are realistic. Providers indicated they manage their patients' expectations in a number of domains- roles and responsibilities of providers and patients, treatment outcomes, timeframe for improvement, and treatment experience. Providers reported that patients' expectations change over time and that they need to continually manage these expectations to enhance patient engagement and satisfaction with treatment.

Conclusions: Providers of four types of CAM therapies viewed patients' expectations as an important component of their experiences with CAM therapy and indicated that they try to align patient expectations with reality. These findings suggest that CAM providers are similar in this respect to conventional medical providers.

References

    1. Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context effects on health outcomes: a systematic review. Lancet. 2001;357:757–762. doi: 10.1016/S0140-6736(00)04169-6.
    1. Thomas KB. General practice consultations: is there any point in being positive? Br Med J (Clin Res Ed) 1987;294:1200–1202. doi: 10.1136/bmj.294.6581.1200.
    1. Main CJ, Foster N, Buchbinder R. How important are back pain beliefs and expectations for satisfactory recovery from back pain? Best Pract Res Clin Rheumatol. 2010;2:205–217.
    1. Crow R, Gage H, Hampson S, Hart J, Kimber A, Thomas H. The role of expectancies in the placebo effect and their use in the delivery of health care: a systematic review. Health Technol Assess. 1999;3:1–96.
    1. Turner JA, Deyo RA, Loeser JD, Von Korff M, Fordyce WE. The importance of placebo effects in pain treatment and research. JAMA. 1994;271:1609–1614. doi: 10.1001/jama.1994.03510440069036.
    1. Bausell RB. Snake Oil Science. New York: Oxford University Press; 2007.
    1. Ernst E. Acupuncture–a critical analysis. J Intern Med. 2006;259:125–137. doi: 10.1111/j.1365-2796.2005.01584.x.
    1. Lynöe N. Is the effect of alternative medical treatment only a placebo effect? Scan J Soc Med. 1990;18:149–153.
    1. Beyerstein BL. Alternative medicine and common errors of reasoning. Acad Med. 2001;76:230–237. doi: 10.1097/00001888-200103000-00009.
    1. Shang A, Huwiler-Muntener K, Nartey L, Juni P, Dorig S, Sterne JA, Pewsner D, Egger M. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet. 2005;366:726–732. doi: 10.1016/S0140-6736(05)67177-2.
    1. Linde K, Witt CM, Streng A, Weidenhammer W, Wagenpfeil S, Brinkhaus B. et al.The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain. Pain. 2007;12:247–270.
    1. Myers SS, Phillips RS, Davis RB, Cherkin DC, Legedza A, Kaptchuk TJ. et al.Patient expectations as predictors of outcome in patients with acute low back pain. J Gen Intern Med. 2008;23:148–153. doi: 10.1007/s11606-007-0460-5.
    1. Lamb SE, Lall R, Hansen Z, Withers EJ, Griffiths FE, Szczepura A. et al.Design considerations in a clinical trial of a cognitive behavioural intervention for the management of low back pain in primary care: back skills training trial. BMC Musculoskelet Disord. 2007;8:14. doi: 10.1186/1471-2474-8-14.
    1. Goldstein MS, Morgenstern H, Hurwitz EL, Yu F. The impact of treatment confidence on pain and related disability among patients with low-back pain: results from the University of California, Los Angeles, low-back pain study. Spine J. 2002;2:391–399. doi: 10.1016/S1529-9430(02)00414-X. discussion 9-401.
    1. Kalauokalani D, Cherkin DC, Sherman KJ, Koepsell TD, Deyo RA. Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects. Spine. 2001;26:1418–1424. doi: 10.1097/00007632-200107010-00005.
    1. Sherman KJ, Cherkin DC, Ichikawa L, Avins AL, Delaney K, Barlow WE, Khalsa PS, Deyo RA. Treatment expectations and preferences as predictors of outcome of acupuncture for chronic back pain. Spine. 2010;35:1471–1477.
    1. Thomas KJ, MacPherson H, Thorpe L, Brazier J, Fitter M, Campbell MJ. et al.Randomized controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. BMJ. 2006;333:623. doi: 10.1136/bmj.38878.907361.7C.
    1. Galer BS, Schwartz L, Turner JA. Do patient and physician expectations predict response to pain-relieving procedures? Clin J Pain. 1997;13:348–351. doi: 10.1097/00002508-199712000-00013.
    1. Smeets RJ, Beelen S, Goossens ME, Schouten EG, Knottnerus JA, Vlaeyen JW. Treatment expectancy and credibility are associated with the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. Clin J Pain. 2008;24:305–315. doi: 10.1097/AJP.0b013e318164aa75.
    1. Smeets R. Active Rehabilitation for Chronic Low Back Pain: Cognitive-behavioral, Physical or Both? Maastricht: Maastricht University; 2006.
    1. Feinstein AR. Post-therapeutic response and therapeutic “style”: re-formulating the “placebo effect. J Clin Epidemiol. 2002;5:427–429.
    1. Pusic AL, Klassen AF, Snell L, Cano SJ, McCarthy C, Scott A, Cemal Y, Rubin LR, Cordeiro PG. Measuring and managing patient expectations for breast reconstruction: impact on quality of life and patient satisfaction. Expert Rev Pharmacoecon Outcomes Res. 2012;2:149–158.
    1. Bekker HL, Luther F, Buchanan H. Developments in making patients’ orthodontic choices better. J Orthod. 2010;3:217–224.
    1. Dmochowski RR, Newman DK. Impact of overactive bladder on women in the United States: results of a national survey. Curr Med Res Opin. 2007;23:65–76. doi: 10.1185/030079907X159533.
    1. Ralston JD, Revere D, Robins LS, Goldberg HI. Patients’ experience with a diabetes support programme based on an interactive electronic medical record: qualitative study. BMJ. 2004;328:1159–1162. doi: 10.1136/bmj.328.7449.1159.
    1. Doering LV, McGuire AW, Rourke D. Recovering from cardiac surgery: what patients want you to know. Am J Crit Care. 2002;11:333–343.
    1. Crabtree TD, Puri V, Bell JM, Bontumasi N, Patterson GA, Kreisel D, Krupnick AS, Meyers BF. Outcomes and perception of lung surgery with implementation of a patient video education module: a prospective cohort study. J Am Coll Surg. 2012;214:816–821. doi: 10.1016/j.jamcollsurg.2012.01.047. e2.
    1. Kearney M, Jennrich MK, Lyons S, Robinson R, Berger B. Effects of preoperative education on patient outcomes after joint replacement surgery. Orthop Nurs. 2011;30:391–396. doi: 10.1097/NOR.0b013e31823710ea.
    1. Shuldham C. A review of the impact of pre-operative education on recovery from surgery. Int J Nurs Stud. 1999;36:171–177. doi: 10.1016/S0020-7489(99)00010-3.
    1. Stone DA, Kerr C, Jacobson E, Conboy LA, Kaptchuk TJ. Patient expectations in placebo-controlled randomized clinical trials. J Eval Clin Pract. 2004;11:77–84.
    1. Bishop MD, Bialosky JE, Cleland JA. Patient expectations of benefit from common interventions for low back pain and effects on outcome: secondary analysis of a clinical trial of manual therapy interventions. J Man Manip Ther. 2011;19:20–25. doi: 10.1179/106698110X12804993426929.
    1. Barnes PM, Bloom B, Nahin R. Complementary and Alternative Medicine Use Among Adults and Children. United States National Health Statistics Report; 2008. p. 12.
    1. Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK. et al.Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478–491.
    1. Santaguida PL, Gross A, Busse J, Gagnier J, Walker K, Bhandari M, Raina P. Complementary and alternative medicine in back pain utilization report. Evid Rep Technol Assess (Full Report) 2009;177:1–221.
    1. Borkan J. In: Doing qualitative research. 2. Crabtree B, Miller W, editor. Thousand Oaks: Sage Publications; 1999. Immersion/crystallization; pp. 179–194.
    1. Greene KA, Harwin SF. Maximizing patient satisfaction and functional results. J Knee Surg. 2011;24:19–24. doi: 10.1055/s-0031-1275389.
    1. Caspi O. In: Integrative Medicine. Rakel D, editor. Philadelphia: Saunders; 2003. Activating the Healing Response; pp. 703–710.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe