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

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

doi:10.1186/1472-6882-12-234

Abstract

BackgroundSome 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.MethodsTo 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.ResultsCAM 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.ConclusionsProviders 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.

Highlights

Some researchers think that patients with higher expectations for complementary and alternative medicine (CAM) therapies experience better outcomes and that enthusiastic providers can enhance treatment outcomes
As part of a study to develop a validated questionnaire for assessing expectations of patients initiating CAM therapies for chronic back pain, we interviewed experienced CAM providers concerning their perceptions of what patient expectations are when they seek CAM therapy and how they attempt to manage these expectations
Despite the variability in the CAM therapies studied, findings related to patient expectations were remarkably similar across the four CAM provider types

Summary

Introduction

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. Before a surgical procedure some providers educate patients about the process and possible outcomes in terms of timeframes for changes, level of pain reduction, and pain medicine requirements [27,28,29] Such management of patients’ expectations has been shown to be associated with increased patient satisfaction, enhanced patient engagement in treatment, and improved quality of care [23,24,25,26]. These findings illustrate the importance of increased understanding of the concept of patient expectations related to a treatment and how they may be influenced by providers

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Results

Conclusion