The Expectation, Concern, and Experience of patients towards Integrative Chinese-western Medicine for Diabetic Kidney Disease: A qualitative study

Abstract

Background: Emerging data suggest that Chinese medicine could reduce the risk of end-stage renal kidney disease among chronic kidney disease patients by 59% in a six-year period. However, a recent cross-sectional study in Hong Kong found that only 20% of diabetic kidney disease (DKD) patients have consulted a Chinese medicine practitioner. The experience and concerns regarding integrative Chinese-western medicine management among DKD patients remains unknown and undocumented. Methods: Focus group interviews with DKD patients were conducted to explore their experience and concerns. Patients with different age group, gender, stage of chronic kidney disease, comorbidity, knowledge and usage of western and Chinese medicine and history of herbal toxicity were purposively sampled. A trained moderator conducted the interview based on an adaptive semi-structured interview guide. Audiotaped interviews were transcribed verbatim and analysed by framework analysis by two independent researchers. Results: The interview covered the scopes regarding 1) barrier towards integrative service, 2) motivation to seek alternative and complementary treatment, 3) experience in the use of Chinese medicine and 4) preferred mode of integrative service. Data saturation was observed at the third round of interview. Twenty-one patients with a wide spectrum of demographics were interviewed. Two to six key themes were identified under each scope with specific examples from DKD patients. Overall, patients with severe DKD tend to seek alternative options for disease management. However, the efficacy, safety, finance, convenience of access and lack of referral channels were key barriers in consulting integrative service. Organisational support from the government plays a critical role in enhancing patient’s confidence in utilising integrative service. Conclusions: Our findings document specific expectation and concerns from DKD patients over the access of integrative medicine for the future consideration of health service provision and research design. Funding support: The University of Hong Kong and Hong Kong Society of Nephrology Research Grant