Misaligned Expectations on Integrative Medical Service for Diabetes and Diabetic Kidney Disease – A Comparative Focus Group Series of Patients and Physicians

Abstract

Purpose: Despite increasing volume of evidence on the efficacy of integrative medicine (IM), we continue to encounter patients covering the use of IM which imposes a threat to clinical management. Discrepancy of perspective between patients and physicians over IM research and service provision remains unclear. We sought to explore the barriers and recommendations regarding IM service implementation among diabetes patients and physicians. Methods: A 10-group, 50-participants semistructured focus group interview series was conducted. Twenty-one patients with diverse severity of disease, comorbidities, and education levels and 29 physicians (14 western medicine [WM] and 15 Chinese medicine [CM]) with diverse clinical experience, academic background, and affiliation were purposively sampled from private and public clinics.The perspectives were qualitatively analyzed by constant comparative method with grounded theory approach. Results: Seven subthemes regarding barriers toward IM service were identified including finance, service access, advice from medical professionals, uncertainty of service quality, uncertainty of CM effect, difficulty in understanding CM epistemology, and access to medical records. Patients underreported the use of CM and disregarded medical advice due to the concern over neutrality of medical advice and mutual understanding among both WM and CM physicians. Practical issues including inconvenience of access to service, frequent follow-up, use of decoction and long-term financial burden were identified as key obstacles among patients. Regarding research design, WM physicians emphasized standardization and reproducibility, while CM physicians emphasized personalization. Some CM-related outcome measurements were suggested as abstract and noncommunicable by patients and WM physicians. Physicians from both sides acknowledged the discordance in epistemology should be addressed by a more pragmatic approach in clinical evaluation. Conclusion: Further assessment on IM should be pragmatic to balance between standardization, reproducibility, and real-world practice. Evidence-based IM programs should merge with existing infrastructure. Treatment modality should be user-friendly and affordable for patients with chronic condition.