期刊论文详细信息
BMC Complementary and Alternative Medicine
Patients’ preconceptions of acupuncture: a qualitative study exploring the decisions patients make when seeking acupuncture
George T Lewith1  Felicity L Bishop2 
[1] Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK;Centre for Applications of Health Psychology, Faculty of Social and Human Sciences, Building 44 Highfield Campus, University of Southampton, Southampton, SO17 1BJ, UK
关键词: Treatment seeking;    Patient preference;    Qualitative research;    Illness behaviour;    Health knowledge attitudes practice;    Expectations;    Complementary medicine;    Health care utilisation;    Acupuncture;    Context;    Placebo;   
Others  :  1229962
DOI  :  10.1186/1472-6882-13-102
 received in 2012-10-16, accepted in 2013-05-09,  发布年份 2013
PDF
【 摘 要 】

Background

Like any other form of healthcare, acupuncture takes place in a particular context which can enhance or diminish treatment outcomes (i.e. can produce contextual effects). Patients’ expectations of acupuncture might be an important component of contextual effects, but we know relatively little about the origins and nature of patients’ expectations or wider preconceptions about acupuncture. Our aim was to identify the processes the underpin patients’ decisions to try acupuncture and thus begin to tease out the origins and nature of patients’ preconceptions.

Methods

One-off semi-structured interviews were conducted with a purposive, varied sample of 35 adults who had tried acupuncture for various conditions. Interviews explored people’s experiences of acupuncture treatment and techniques from framework and inductive thematic analysis were used to relate the data to the research question.

Results

We identified four distinct processes within participants’ accounts of deciding to try acupuncture: establishing a need for treatment, establishing a need for a new treatment, deciding to try acupuncture, and finding an acupuncturist. Family, friends and health care professionals played a role in these processes, providing support, advice, and increasing people’s general familiarity with acupuncture. When they came to their first acupuncture appointment, participants had hopes, concerns, and occasionally concrete expectations as to the nature of acupuncture treatment and its likely effects.

Conclusions

Existing theories of how context influences health outcomes could be expanded to better reflect the psychological components identified here, such as hope, desire, optimism and open-mindedness. Future research on the context of acupuncture should consider these elements of the pre-treatment context in addition to more established components such as expectations. There appears to be a need for accessible (i.e. well-disseminated), credible, and individualised, patient-centred materials that can allay people’s concerns about the nature of acupuncture treatment and shape realistic hopes and expectations.

【 授权许可】

   
2013 Bishop and Lewith; licensee BioMed Central Ltd.

【 预 览 】
附件列表
Files Size Format View
20151103074647814.pdf 525KB PDF download
Figure 1. 57KB Image download
【 图 表 】

Figure 1.

【 参考文献 】
  • [1]Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J: Influence of context effects on health outcomes: a systematic review. Lancet 2001, 357:757-762.
  • [2]Kleijnen J, de Craen AJM, van Everdingen J, Krol L: Placebo effect in double-blind clinical trials: a review of interactions with medications. Lancet 1994, 344:1347-1349.
  • [3]Kaptchuk TJ: The placebo effect in alternative medicine: Can the performance of a healing ritual have clinical significance? Ann Intern Med 2002, 136:817-825.
  • [4]Linde K, Niemann K, Schneider A, Meissner K: How large are the nonspecific effects of acupuncture? A meta-analysis of randomized controlled trials. BMC Med 2010, 8:75. BioMed Central Full Text
  • [5]Kaptchuk TJ, Stason WB, Davis RB, Legedza ATR, Schnyer RN, Kerr CE: Sham device v inert pill: randomised controlled trial of two placebo treatments. BMJ 2006, 332:391-394.
  • [6]Lewith GT, White PJ, Kaptchuk TJ: Developing a research strategy for acupuncture. Clin J Pain 2006, 22:632-638.
  • [7]Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE: Acupuncture for chronic pain: Individual patient data meta-analysis. Arch Intern Med 2012, 172:1444-53.
  • [8]Paterson C, Dieppe P: Characteristic and incidental (placebo) effects in complex interventions such as acupuncture. BMJ 2005, 330:1202-1205.
  • [9]Paterson C, Britten N: Acupuncture as a complex intervention: a holistic model. J Altern Complement Med 2004, 10:791-801.
  • [10]Verhoef MJ, Lewith G, Ritenbaugh C, Thomas K, Boon H, Fonnebo V: Whole systems research: moving forward. Focus Altern Complement Ther 2004, 9:87-90.
  • [11]Miller FG, Kaptchuk TJ: The power of context: reconceptualizing the placebo effect. J R Soc Med 2008, 101:222-225.
  • [12]Witt CM, Schützler L, Lüdtke R, Wegscheider K, Willich SN: Patient Characteristics and Variation in Treatment Outcomes: Which Patients Benefit Most From Acupuncture for Chronic Pain? Clin J Pain 2011, 27:550-555.
  • [13]Sherman K, Cherkin D, Ichikawa L, Avins A, Barlow W, Khalsa P: Characteristics of patients with chronic back pain who benefit from acupuncture. BMC Musculoskelet Disord 2009, 10:114. BioMed Central Full Text
  • [14]Witt CM, Jena S, Brinkhaus B, Liecker B, Wegscheider K, Willich SN: Acupuncture for patients with chronic neck pain. Pain 2006, 125:98-106.
  • [15]Witt CM, Jena S, Selim D, Brinkhaus B, Reinhold T, Wruck K: Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain. Am J Epidemiol 2006, 164:487-496.
  • [16]Colagiuri B, Smith CA: A Systematic Review of the Effect of Expectancy on Treatment Responses to Acupuncture. eCAM 2012, 12. Article ID 857804
  • [17]Kalauokalani D, Cherkin DC, Sherman KJ, Koepsell TD, Deyo RA: Lessons from a trial of acupuncture and massage for low back pain. Spine 2001, 26:1418-1424.
  • [18]Linde K, Witt CM, Streng A, Weidenhammer W, Wagenpfeil S, Brinkhaus B: The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain. Pain 2007, 128:264-271.
  • [19]Sherman KJ, Cherkin DC, Ichikawa L, Avins AL, Delaney K, Barlow WE: Treatment expectations and preferences as predictors of outcome of acupuncture for chronic back pain. Spine 2010, 35:1471-1477.
  • [20]Pariente J, White P, Frackowiak RSJ, Lewith G: Expectancy and belief modulate the neuronal substrates of pain treated by acupuncture. NeuroImage 2005, 25:1161-1167.
  • [21]So DW: Acupuncture outcomes, expectations, patient–provider relationship, and the placebo effect: Implications for health promotion. Am J Public Health 2002, 92:1662-1667.
  • [22]Crow R, Gage H, Hampson S, Hart J, Kimber A, Thomas H: The role of expectancies in the placebo effect and their use in the delivery of health care: a systematic review. Health Technol Assess 1999., 3
  • [23]Di Blasi Z, Kleijnen J: Context effects. Powerful therapies or methodological bias? Eval Health Prof 2003, 26:166-179.
  • [24]Patton MQ: Qualitative Research & Evaluation Methods. 3rd edition. Thousand Oaks, CA: Sage; 2001.
  • [25]Glaser BG, Strauss A: The discovery of grounded theory. In In The discovery of grounded theory.. Edited by Glaser BG, Strauss A. London: Weidenfeld and Nicolson; 1967:1-18.
  • [26]Sandelowski M: Focus on qualitative methods. Sample size in qualitative research. Research in Nursing & Health 1995, 18:179-183.
  • [27]Ritchie J, Spencer L: Qualitative data analysis for applied policy research. In Analyzing Qualitative Data. Edited by Bryman A, Burgess RG. London: Routledge; 1994:173-194.
  • [28]Joffe H, Yardley L: Content and thematic analysis. In Research methods for clinical and health psychology. Edited by Marks DF. London: Sage; 2004:56-68.
  • [29]Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psychol 2006, 3:77-101.
  • [30]Leventhal H, Benyamini Y: Lay beliefs about health and illness. In Cambridge Handbook of Psychology, Health and Medicine. Edited by Baum A, Newman S, Weinman J, West R, McManus C. Cambridge: Cambridge University Press; 1997:131-135.
  • [31]Leventhal H, Benyamini Y, Brownlee S, Diefenbach M, Leventhal E, Patrick-Miller L: Illness representations: Theoretical Foundations. In Perceptions of health and illness: Current research and applications. Edited by Petrie KJ, Weinman J. Amsterdam: Harwood; 1997:19-45.
  • [32]Vincent C, Furnham A: Why do patients turn to complementary medicine? An empirical study. Br J Clin Psychol 1996, 35:37-48.
  • [33]Evans M, Shaw A, Thompson EA, Falk S, Turton P, Thompson T: Decisions to use complementary and alternative medicine (CAM) by male cancer patients: information-seeking roles and types of evidence used. BMC Complement Altern Med 2007, 7:25. BioMed Central Full Text
  • [34]Verhoef MJ, Mulkins A, Carlson LE, Hilsden RJ, Kania A: Assessing the role of evidence in patients’ evaluation of complementary therapies: A quality study. Integr Cancer Ther 2007, 6:345-353.
  • [35]Ajzen I: The theory of planned behavior. Organ Behav Hum Decis Process 1991, 50:179-211.
  • [36]Bishop FL, Massey Y, Yardley L, Lewith GT: How patients choose acupuncturists: A mixed-methods project. J Altern Complement Med 2011, 17:19-25.
  • [37]Kelner M, Wellman B: Health care and consumer choice: Medical and alternative therapies. Soc Sci Med 1997, 45:203-212.
  • [38]Walker G, de Valois B, Young T, Davies R, Maher J: The experience of receiving Traditional Chinese Acupuncture: A qualitative study involving women with breast cancer having treatment for the menopausal symptoms associated with Tamoxifen. European Journal of Oriental Medicine 2004, 4:59-65.
  • [39]Billhult A, Stener-Victorin E: Acupuncture with manual and low frequency electrical stimulation as experienced by women with polycystic ovary syndrome: a qualitative study. BMC Complement Altern Med 2012, 12:32. BioMed Central Full Text
  • [40]Bernstein KS: The experience of acupuncture for treatment of substance dependence. J Nurs Scholarsh 2000, 32:267-272.
  • [41]Conboy L, Quilty MT, Kerr C, Shaw J, Wayne P: A qualitative analysis of adolescents’ experiences of active and sham Japanese-style acupuncture protocols administered in a clinical trial. J Altern Complement Med 2008, 14:699-705.
  • [42]Stewart-Williams S, Podd J: The placebo-effect: Dissolving the expectancy versus conditioning debate. Psychol Bull 2004, 130:324-340.
  • [43]Kirsch I: Response expectancy theory and application: A decennial review. Appl Prev Psychol 1997, 6:69-79.
  • [44]Snyder CR, Harris C, Anderson JR, Holleran SA, Irving LM, Sigmon ST: The will and the ways: Development and validation of an individual-differences measure of hope. J Pers Soc Psychol 1991, 60:570-585.
  • [45]Morton DL, Watson A, El-Deredy W, Jones AKP: Reproducibility of placebo analgesia: Effect of dispositional optimism. Pain 2009, 146:194-198.
  • [46]Price DD, Finniss DG, Benedetti F: A comprehensive review of the placebo effect: Recent advances and current thought. Annu Rev Psychol 2008, 59:565-590.
  • [47]Colloca L, Miller FG: How placebo responses are formed: a learning perspective. Philosophical Transactions of the Royal Society B: Biological Sciences 2011, 366:1859-1869.
  • [48]Kelley JM, Lembo AJ, Ablon JS, Villanueva JJ, Conboy LA, Levy R: Patient and Practitioner Influences on the Placebo Effect in Irritable Bowel Syndrome. Psychosom Med 2009, 71:789-797.
  • [49]Sirois F: Motivations for consulting complementary and alternative medicine practitioners: A comparison of consumers from 1997–8 and 2005. BMC Complement Altern Med 2008, 8:16. BioMed Central Full Text
  • [50]Richardson J: What patients expect from complementary therapy: A qualitative study. Am J Public Health 2004, 94:1049-1053.
  • [51]MacPherson H, Thomas K: Self-help advice as a process integral to traditional acupuncture care: Implications for trial design. Complement Ther Med 2008, 16:101-106.
  • [52]MacPherson H, Thorpe L, Thomas K: Beyond needling - therapeutic processes in acupuncture care: a qualitative study nested within a low-back pain trial. J Altern Complement Med 2006, 12:873-880.
  • [53]White AR, Cummings MJ, Hopwood V, MacPherson H: Informed Consent for Acupuncture - An Information Leaflet Developed by Consensus. Acupunct Med 2001, 19:123-129.
  文献评价指标  
  下载次数:8次 浏览次数:12次