Measuring Patient Expectations for CAM Therapies

衡量患者对 CAM 疗法的期望

• 批准号: 8212278
• 负责人: KAREN J SHERMAN
• 金额: $ 44.68万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-12-01 至 2014-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8212278
• 关键词: Acupuncture procedure; Affect; Attitude; Back Pain; Belief; Caring; Chronic low back pain; Clinical Research; Clinical Trials; Communities; Complementary Medicine; Complementary and alternative medicine; Conceptual Domain; Conflict (Psychology); Data; Data Analyses; Development; Ensure; Foundations; Intervention; Interview; Knowledge; Link; Massage; Measures; Modeling; Outcome; Pain; Participant; Patient Care; Patients; Persons; Phase; Physical therapy exercises; Population; Population Heterogeneity; Process; Property; Provider; Psychometrics; Qualitative Methods; Qualitative Research; Questionnaire Designs; Questionnaires; Randomized; Research; Research Methodology; Research Personnel; Symptoms; Techniques; Testing; Theoretical model; Therapeutic; Time; Translating; Treatment Effectiveness; Treatment outcome; Validity and Reliability; Work; Yoga; chiropracty; chronic back pain; chronic pain; clinical practice; conventional therapy; efficacy trial; expectation; experience; improved; instrument; patient expectation; psychologic; public health relevance; sound; success; tool

DESCRIPTION (provided by applicant): Many clinicians and researchers believe that patients who expect that a specific treatment will relieve their symptoms will be more likely to benefit from that treatment. However, analyses of data from clinical trials evaluating complementary and alternative medicine (CAM) treatments for chronic back pain have not consistently found pre-treatment expectations to be predictive of superior outcomes. Interpretation of these conflicting results has been complicated by the absence of an adequate conceptual model of how patient expectations might affect treatment outcomes and the lack of a validated questionnaire for capturing patient expectations. To help advance understanding of the relationship between expectations and treatment outcomes, this application proposes to systematically develop and validate a questionnaire to assess patient expectations of CAM therapies for chronic back pain. Phase I of this 3-phase project will focus on gaining a comprehensive understanding of the issues underlying the concept of treatment expectations. This will involve conducting interviews to collect qualitative information about expectations from patients with back pain as well as from providers of four CAM therapies commonly used for back pain (acupuncture, chiropractic, massage, yoga). Rigorous qualitative research methods will be used to analyze this interview data in order to identify key conceptual domains associated with the development of expectations. The results of these analyses will then be used to create a conceptual model about how patient expectations of treatment success develop and change after initiation of treatment. Phase II activities will focus on developing a questionnaire to assess patient expectations and Phase III will feature testing the psychometric properties of the questionnaire (e.g., reliability and validity). The questionnaire will be tested in diverse clinical and research populations. This project is expected to result in the creation of a psychometrically sound questionnaire that can be used by the CAM and conventional research communities to measure the importance of patient expectations of treatment outcomes in clinical trials of non-pharmacologic treatments for chronic back pain. Development of a conceptual model for understanding the relationship between patient expectations and treatment outcomes and creation of a valid and reliable questionnaire for assessing patient expectations will provide valuable tools for future research on how context effects influence treatment outcomes. Such research has the potential to improve understanding of how to most effectively translate the results of randomized efficacy trials into clinical practice. PUBLIC HEALTH RELEVANCE: In order to improve care for persons with chronic back pain, a better understanding of how patient's beliefs about the effectiveness of the treatments they receive is needed. This project will develop a questionnaire to measure such expectations for complementary medicine (CAM) treatments. This questionnaire will provide researchers with a valuable tool for determining how patient expectations affect outcomes and for exploring the potential for using this knowledge to improve patient care.

描述（由申请人提供）：许多临床医生和研究人员认为，期望特定治疗能够缓解症状的患者更有可能从该治疗中受益。然而，对评估慢性背痛补充和替代医学 (CAM) 治疗的临床试验数据进行分析，并未一致发现治疗前的预期能够预测良好的结果。由于缺乏关于患者期望如何影响治疗结果的充分概念模型，并且缺乏用于捕获患者期望的经过验证的调查问卷，因此对这些相互矛盾的结果的解释变得复杂。为了帮助加深对期望与治疗结果之间关系的理解，本申请建议系统地开发和验证一份调查问卷，以评估患者对慢性背痛 CAM 疗法的期望。这个三阶段项目的第一阶段将侧重于全面了解治疗期望概念背后的问题。这将涉及进行访谈，收集有关背痛患者以及四种常用于背痛的 CAM 疗法（针灸、脊椎按摩疗法、按摩、瑜伽）提供者的期望的定性信息。将使用严格的定性研究方法来分析访谈数据，以确定与期望发展相关的关键概念领域。然后，这些分析的结果将用于创建一个概念模型，用于了解患者对治疗成功的期望在治疗开始后如何发展和变化。第二阶段的活动将侧重于开发一份问卷来评估患者的期望，第三阶段的活动将测试问卷的心理测量特性（例如，可靠性和有效性）。该问卷将在不同的临床和研究人群中进行测试。该项目预计将创建一份心理测量学上合理的调查问卷，CAM 和传统研究团体可以使用该调查问卷来衡量患者对慢性背痛非药物治疗临床试验中治疗结果的期望的重要性。开发用于理解患者期望与治疗结果之间关系的概念模型，并创建用于评估患者期望的有效且可靠的问卷，将为未来研究背景效应如何影响治疗结果提供有价值的工具。此类研究有可能提高对如何最有效地将随机疗效试验结果转化为临床实践的理解。 公共卫生相关性：为了改善对慢性背痛患者的护理，需要更好地了解患者对其所接受治疗的有效性的看法。该项目将制定一份调查问卷来衡量对补充医学（CAM）治疗的期望。该调查问卷将为研究人员提供一个有价值的工具，用于确定患者期望如何影响结果，并探索利用这些知识改善患者护理的潜力。