Abstract
BackgroundComplementary and alternative medicine (CAM) use is often not disclosed by patients, and can be unfamiliar to health care professionals. This may lead to underuse of beneficial CAM therapies, and overuse of other CAM therapies with little proven benefit or known contraindications. No prior research has thoroughly evaluated the credibility of knowledge-based resources. The purpose of this research was to assess the quantity and quality of CAM guidelines.MethodsA systematic review was conducted to identify CAM guidelines. MEDLINE, EMBASE and CINAHL were searched in January 2016 from 2003 to 2015. The National Guideline Clearinghouse, National Center for Complementary and Integrative Health web site, and two CAM journals were also searched. Eligible guidelines published in English language by non-profit agencies on herbal medicine, acupuncture, or spinal manipulation for adults with any condition were assessed with the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument.ResultsFrom 3,126 unique search results, 17 guidelines (two herbal medicine, three acupuncture, four spinal manipulation, eight mixed CAM therapies) published in 2003 or later and relevant to several clinical conditions were eligible. Scaled domain percentages from highest to lowest were clarity of presentation (85.3 %), scope and purpose (83.3 %), rigour of development (61.2 %), editorial independence (60.1 %), stakeholder involvement (52.0 %) and applicability (20.7 %). Quality varied within and across guidelines. None of the 17 guidelines were recommended by both appraisers; 14 were recommended as Yes or Yes with modifications.ConclusionsGuidelines that scored well could be used by patients and health care professionals as the basis for discussion about the use of these CAM therapies. In future updates, guidelines that achieved variable or lower scores could be improved according to specifications in the AGREE II instrument, and with insight from a large number of resources that are available to support guideline development and implementation. Future research should identify CAM therapies other than those reviewed here for which guidelines are available. Research is also needed on the safety and effectiveness of CAM therapies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-016-1410-8) contains supplementary material, which is available to authorized users.
Highlights
Complementary and alternative medicine (CAM) use is often not disclosed by patients, and can be unfamiliar to health care professionals
The National Center for Complementary and Integrative Health (NCCIH) further defines a non-mainstream practice used together with conventional medicine as “complementary”, a nonmainstream practice used in place of conventional medicine as “alternative”, and the coordinated delivery or use of conventional and complementary approaches as “integrative” [6]
By describing the quantity and quality of CAM guidelines, this study revealed that few CAM guidelines are available to support informed and shared decision-making among patients and health care professionals
Summary
Complementary and alternative medicine (CAM) use is often not disclosed by patients, and can be unfamiliar to health care professionals. Many health care professionals were not exposed to CAM in their medical training [23], are unfamiliar with CAM therapies, and find it challenging to discuss use or disuse of CAM with their patients [24, 25] This is exacerbated by the fact that CAM is comprised of many different and unrelated types of therapies and schools of thought about their use [26]; and the reliability of evidence about safety and effectiveness varies between CAM therapies [27,28,29]. Patients and health care professionals may benefit from credible, knowledge-based resources upon which to base discussions and decisions about use of CAM
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