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Byline: Marja J. Verhoef, PhD (Departments of Community Health Sciences and Medicine, University of Calgary, Calgary, AB, mverhoef@ucalgary.ca); Andrea Mulkins, MSc (Tzu Chi Research Group, Vancouver, BC); Linda E. Carlson, [...]

Introduction: The literature identifies significant inequalities in the health status of rural and Aboriginal populations, compared with the general population. Providing rural primary care physicians with public health skills could [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ctim.2005.04.002 Byline: Andrea L. Mulkins (a), Joanna Eng (a), Marja J. Verhoef (b) Abstract: The objective of this study was to assess what factors the Tzu Chi Institute (TCI) practitioners identified as supports and barriers to providing care within an integrative health care setting. Author Affiliation: (a) Tzu Chi Research Group, Vancouver, BC (b) Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1 Article Note: (footnote) [star] Sources of Support: Funding was provided through grants from both the Samueli Institute for Information Biology and the Tzu Chi Foundation.

Abstract Background Integrative health care (IHC) is an interdisciplinary blending of conventional medicine and complementary and alternative medicine (CAM) with the purpose of enhancing patients' health. In 2006, we designed a study to assess outcomes that are relevant to people using such care. However, we faced major challenges in conducting this study and hypothesized that this might be due to the lack of a research climate in these clinics. To investigate these challenges, we initiated a further study in 2008, to explore the reasons why IHC clinics are not conducting outcomes research and to identify strategies for conducting successful in-house outcomes research programs. The results of the latter study are reported here. Methods A total of 25 qualitative interviews were conducted with key participants from 19 IHC clinics across Canada. Basic content analysis was used to identify key themes from the transcribed interviews. Results Barriers identified by participants fell into four categories: organizational culture, organizational resources, organizational environment and logistical challenges. Cultural challenges relate to the philosophy of IHC, organizational leadership and practitioner attitudes and beliefs. Participants also identified significant issues relating to their organization's lack of resources such as funding, compensation, infrastructure and partnerships/linkages. Environmental challenges such as the nature of a clinic's patient population and logistical issues such as the actual implementation of a research program and the applicability of research data also posed challenges to the conduct of research. Embedded research leadership, integration of personal and professional values about research, alignment of research activities and clinical workflow processes are some of the factors identified by participants that support IHC clinics' ability to conduct outcomes research. Conclusions Assessing and enhancing the broader evaluation culture of IHC clinics prior to implementing outcomes research may be a critical step towards ensuring productive and cost-effective research programs. However, as IHC clinics are often complex systems, a whole systems approach to research should be used taking into account the multidimensional and complex nature of such treatment systems so that the results are useful and reflect real life.

The article examines the use of complementary and alternative medicine used by cancer patients for their treatment and mentions the decision making pathway of the treatment course for their illness. It mentions the five pathways identified in the research as well as the factors that impact these pathways. It also mentions the use of mixed-methods pilot study for the research.