Defining Health: Do Practitioners from Different Complementary and Alternative Medicine (CAM) Disciplines Focus on Different Patient Outcomes?

Abstract

Purpose: To determine whether practitioner-endorsed and practitioner-suggested items for a patient-centered complementary and alternative medicine (CAM) outcomes questionnaire that became the Self-Assessment of Change instrument (developed under the NIH-NCCAM grant R01AT0033214) differ by CAM discipline.Methods: In-depth semi-structured interviews (n=24), one focus group (n=4), and two group discussions (n=108) were conducted with a convenience sample of CAM practitioners, including naturopathic physicians, Traditional Chinese Medicine practitioners, massage therapists, homeopaths, and energy healers. Qualitative analysis focused on patient outcomes practitioners said they observed in their practice. Outcome items and related comments by practitioners were further distilled for similarities and contrasts by practitioner type. These were then organized into the following pre-existing domains established by the research team: Physical, Cognitive, Emotional, Social, Spiritual, and Whole Person (outcomes that transcend any single outcome domain or construct). Overarching themes that encompassed outcome items were derived when possible.Results: Considerable overlap was observed among practitioners from different CAM disciplines with regard to types of patient outcomes assessed.Conclusions: Practitioner data assembled from multiple sources suggest outcome measures derived from a single CAM tradition are likely to overlap considerably with other CAM systems, with some non-generalizable items possible. These data enhance our understanding of diverse issues in questionnaire development, and suggest the need for a few tailored items to capture outcomes for specific CAM disciplines.