Moments of 'touch' as a way for mental support in Traditional Chinese Medicine consultations: Analysis of the interactional process of co-constructing understanding of the patient's body conditions in Hong Kong

Management of Polycystic Ovarian Syndrome: A Qualitative Inquiry among Complementary and Alternative Medicine Practitioners in South Africa

BACKGROUND

 Polycystic ovarian syndrome (PCOS) is a complex reproductive endocrinopathy affecting 4-20% of females of reproductive age. PCOS and its consequent complications such as infertility, diabetes mellitus and cardiovascular disease significantly impact clinical management. Complementary and alternative medicine (CAM), including homeopathy, is gaining recognition in PCOS management. There remains a paucity of formal protocols for managing PCOS within homeopathy and other CAM systems.

AIMS/OBJECTIVES

 This study aimed to explore and document existing therapeutic practices in the management of PCOS from diagnosis to treatment used by practitioners within various disciplines of CAM: viz., homeopathy, ayurveda, unani tibb, traditional Chinese medicine (TCM) and naturopathy, in the context of their unique philosophical background.

METHODS

 In this explorative, descriptive study, data were collected from CAM practitioners in eThekwini Municipality, KwaZulu Natal, South Africa, using semi-structured interviews and analysed using Tesch's and Creswell's methods for qualitative analysis.

RESULTS

 Four themes emerged from the data, namely: CAM philosophical perspectives on PCOS, contributing factors, diagnosis of PCOS, and management of PCOS. Five sub-themes emerged: clinical diagnosis of PCOS, CAM-specific characterisation of PCOS, CAM-specific treatment of PCOS, adjunctive therapies, and lifestyle interventions. Homeopathic management comprised several prescribing methods, the most common ones being miasmatic/constitutional, keynote and clinical, alongside adjunctive therapies and lifestyle interventions. Other CAM modalities adopted similar holistic approaches.

CONCLUSIONS

 This paper offers a comprehensive exploration of the perceptions, clinical investigations and management practices in PCOS by homeopaths and four other CAM modalities - ayurveda, unani tibb, TCM and naturopathy - as documented in the study. Homeopaths and other CAM practitioners employed CAM-specific therapies, along with adjunctive therapies and lifestyle interventions, adopting holistic approaches. Enhancing the quality of life through emotional counselling, stress reduction and lifestyle improvements emerged as shared objectives across modalities. Our findings underscore the need to further explore inter-disciplinary collaboration in PCOS management among registered CAM practitioners, with the potential to expand the scope of comprehensive care for PCOS patients.

An exploratory study of communication training for Chinese medicine practitioners in Hong Kong to integrate patients' conventional medical history

BACKGROUND

Despite Traditional Chinese medicine's (TCM) historical roles in Chinese society, few research has been investigated the nature of TCM practitioner-patient interactions. Improved communication skills among TCM practitioners will result higher-quality interactions and better clinical outcomes.

METHODS

To investigate the changes in TCM practitioners' communication practices after communications training focused on promoting their awareness of integrating a patient's medical history from conventional medicine in TCM treatment, Eight registered Cantonese-speaking TCM practitioners in Hong Kong were randomly recruited from local clinics and randomised into control (n = 12) and experimental groups (n = 12), with a total of 24 consultations. The experimental group was given training focused on patient-centred communication, with an internationally recognised and communication framework validated in global consultation settings (i.e. the Calgary-Cambridge Guide) on how to take a patient's medical history from conventional medicine and communicate diagnosis and treatment plans. Consultations before and after training were audio-recorded and rated. The efficacy of the training was evaluated by comparing the two groups before training (pre-test), immediately after training (post-test) and after a 3-month delay (delayed post-test). Using validated scales, the primary outcomes were measured for the practitioners' clinical communication skills and the quality of interactions.

RESULTS

The communication training significantly improved the TCM providers' patient-centred communication and communication proficiency. The results indicate that the team developed an effective communication model for integrating TCM and conventional medicine in Hong Kong. The framework helps trained TCM practitioners to integrate their patients' conventional medical history when delivering patient care. The findings shed light on how interpersonal relationships between TCM practitioners and patients can be constructed after communication training to better care for patients' psychological concerns in addition to their physical needs.

CONCLUSION

Trained TCM practitioners can provide an integrated model that takes patients' conventional medical history into account when delivering a holistic patient-centred care. The findings can enhance our understanding of better ways to train the future TCM practitioners and to develop a continuing professional training for the current TCM practitioners to expand our understanding of TCM communication in acute clinical contexts and, thus offer a firm evidence-based foundation upon which to develop communication strategies that improve their clinical cpractices.

The active participation of elderly patients in traditional Chinese medicine consultations as means to creating a community of practice: A case study in Hong Kong

Despite its historic role in Chinese society and its popularity with an elderly Chinese population, limited research has explored the discursive practices of Traditional Chinese Medicine (TCM). Our analysis of practitioner–patient interactions illustrated the reasons why TCM is widely welcomed by a specific patient group. This paper adopted the concept of Community of Practice (CoP) as a theoretical framework to document how patients interact with TCM practitioners to construct meaning through a process of participation and reification. This study aimed to explore how patients in a medical consultation context developed an understanding of their conditions and how they strategically used medical terminology to enact meaningful exchanges to realise their CoP. An inductive qualitative discourse analysis was conducted to for nine elderly patients (i.e., age > 65) in Hong Kong to demonstrate the role that a CoP played in a joint process of knowledge construction to promote a patient-centred practice and foster the active participation of the patients. TCM practitioners can develop specific communication skills to promote their patients’ CoP, which will improve patient-centred care, empower patients to actively engage in their treatments and result in higher levels of patient satisfaction.

Classifying knowledge used in complementary medicine consultations: a qualitative systematic review

Background

Complementary Medicine (CM) is widely used internationally but there is limited understanding of the forms of knowledge CM practitioners use in their clinical practice and how they use this knowledge in interactions with patients. This review aims to synthesise the existing evidence on the forms of knowledge that are mobilised, and the role of this knowledge in the interactions between practitioners and patients during CM consultations. It considered a diverse range of CM practice areas to develop a classification of CM practitioners’ knowledge use in consultations.

Methods

Systematic searches of health and sociology databases were conducted using core concepts, including complementary and alternative medicine, practitioners, and knowledge. Articles were included where they reported on data from recorded CM practitioner and patient consultations and offered insights into the types and applications of knowledge used in these consultations. 16 unique studies were included in the review. Data were extracted, coded and analysed thematically.

Results

Results demonstrate that diverse sources of knowledge were mobilised by practitioners, predominantly derived from the patients themselves –their bodies and their narratives. This reflected principles of patient-centredness. The use of discipline specific forms of knowledge and references to biomedical sources illustrated ongoing efforts towards legitimacy for CM practice.

Conclusion

CM practitioners are navigating tensions between what some might see as competing, others as complementary, forms of knowledge. The classification system provides a useful tool for promoting critically reflective practice by CM practitioners, particularly in relation to self-assessment of knowledge translation and patient interactions.

Navigating communication between conventional medicine and traditional Chinese medicine: a case study of cancer patients in Hong Kong

BACKGROUND

Traditional Chinese medicine (TCM) is a growing phenomenon worldwide. Despite its historical role in Chinese society, however, few studies have explored the nature of communication among patients with cancer who receive TCM care in addition to conventional medicine. If TCM practitioners acquire adequate knowledge to understand the needs and communication issues for their patients with cancer, particularly those who are simultaneously receiving conventional medicine, this will lead to better quality of care and clinical outcomes, such as high patient satisfaction and treatment compliance.

OBJECTIVES

To fill this knowledge gap, this study explored the nature of communication among patients with cancer in Hong Kong who receive TCM treatment in addition to conventional medicine.

PARTICIPANTS

We conducted in-depth interviews with 20 patients, 5 oncologists and 5 TCM practitioners to elicit their views on TCM treatments.

METHOD

We adopted a qualitative approach using an interpretative phenomenological analysis.

RESULTS

Based on the themes that emerged from our interview transcripts, we outlined communication priorities when advising patients with cancer who are receiving both TCM and conventional medical care. We developed a framework to train TCM practitioners to better integrate their patients' conventional medical history when delivering patient care.

CONCLUSIONS

Our study findings inform communication priorities when caring for patients who opt for TCM care in addition to conventional treatments. In addition, they provide useful information for developing future clinical research studies to explore integrated approaches between TCM and conventional medicine in treating patients with cancer.