Patient-shared knowledge and information in clinical decision-making : an international survey of the perspectives and experiences of naturopathic practitioners

Introduction Most knowledge translation models pay relatively little attention to patient-held knowledge and are largely based on the premise that researchers and clinicians hold all valuable knowledge, and patients are passive recipients of such knowledge. Counter to this clinician- and researcher-centred lens is a growing interest and awareness of patients as experts in their health. While naturopathic medicine is described and experienced as a patient-centred system of traditional medicine, the position of patient-held knowledge is unclear particularly when considered alongside their use of other more objective forms of knowledge such as research evidence. Methods This international online cross-sectional survey aimed to explore naturopathic practitioners’ perceptions of the value and contribution of patient-shared knowledge and information within the context of naturopathic clinical consultations. Results The survey was completed by 453 naturopathic practitioners (response rate: 74.3%). Approximately two-thirds (68.2%) of respondents reported using information shared by the patient. Most rated ‘information provided by the patient’ as either ‘extremely important’ (60.7%) or ‘very important’ (31.4%) to patients. Highest levels of trust were reported for information provided by the patient (‘completely’: 9.9%; ‘a lot’: 53.6%). Most practitioners indicated they trusted knowledge and information derived from the patient’s personal health history ‘completely’(n=79; 21.8%) or ‘a lot’(n=226; 62.4%) from the patient’s perspective of living with a health condition (‘completely’[n=63, 17.4%]; ‘a lot’[n=224, 61.9%]). Patients were the highest ranked stakeholder group (mean: 1.5) perceived to influence NP use of patient experience of living with a health condition to inform clinical decision-making. Conclusion Researchers and policy makers are increasingly focused on the value of the ‘expert patient’ in clinical decision-making, yet health professionals’ report challenges and, in some cases, resistance to meaningfully engaging with patient-shared knowledge in practice. However, our study has found patient-shared knowledge – inclusive of patient experience of their health condition – is among the knowledge used and trusted by naturopathic practitioners to inform their clinical decision-making. This study both offers insights into the knowledge translation behaviours of an under-researched health profession and provides a novel contribution to the wider aim of adopting patient shared knowledge into clinical care more generally.Publisher PDFPeer reviewe

Common variation near CDKN1A, POLD3 and SHROOM2 influences colorectal cancer risk

We performed a meta-analysis of five genome-wide association studies to identify common variants influencing colorectal cancer (CRC) risk comprising 8,682 cases and 9,649 controls. Replication analysis was performed in case-control sets totaling 21,096 cases and 19,555 controls. We identified three new CRC risk loci at 6p21 (rs1321311, near CDKN1A; P = 1.14 × 10(-10)), 11q13.4 (rs3824999, intronic to POLD3; P = 3.65 × 10(-10)) and Xp22.2 (rs5934683, near SHROOM2; P = 7.30 × 10(-10)) This brings the number of independent loci associated with CRC risk to 20 and provides further insight into the genetic architecture of inherited susceptibility to CRC.Swedish Research Council et al.Manuscrip

Naturopaths’ behaviours, attitudes and perceptions towards the use of knowledge and information sources

BackgroundPrimary care professions practicing traditional medicine systems, such as naturopathy, may have an increased need to use critical thinking to integrated diverse knowledge sources in response to the complex ‘messiness’ of clinical practice. The degree to which the varied knowledge types used by naturopathic practitioners align with evidence-based practice principles remains unexplored.Aims and objectivesTo investigate naturopathic practitioners’ behaviours, perceptions and attitudes towards their use of knowledge and information sources.MethodsAn online cross-sectional survey study administered in five languages to the international naturopathic profession. Descriptive statistics were prepared using Stata 16.1.FindingsSurvey respondents (n=453) represented all world regions. The most common type of knowledge used to inform clinical practice was developed through clinical experience (86.2%) or during initial clinical training (81.2%). The most used information sources were scientific journals (80.4%), conferences or other professional events (78.2%), modern naturopathic clinical textbooks (74.6%), laboratory, pathology or radiology tests (74.0%), or professional journals for clinicians (73.5%). The greatest trust in knowledge acquired from information sources was attributed to information from laboratory, pathology or radiology tests. The greatest importance was placed on information based on the patient’s perspective of living with their health condition.Discussion and conclusionsNaturopathic practitioners do not appear to have a strong level of trust for any particular information source, despite variations in trust between sources. Further, their philosophies and principles may promote the importance naturopathic practitioners place on non-research information sources such as patient experience and add further complexity to clinical decision-making processes for naturopathic practitioners

Patient-shared knowledge and information in clinical decision-making:an international survey of the perspectives and experiences of naturopathic practitioners

IntroductionMost knowledge translation models pay relatively little attention to patient-held knowledge and are largely based on the premise that researchers and clinicians hold all valuable knowledge, and patients are passive recipients of such knowledge. Counter to this clinician- and researcher-centred lens is a growing interest and awareness of patients as experts in their health. While naturopathic medicine is described and experienced as a patient-centred system of traditional medicine, the position of patient-held knowledge is unclear particularly when considered alongside their use of other more objective forms of knowledge such as research evidence.Methods This international online cross-sectional survey aimed to explore naturopathic practitioners’ perceptions of the value and contribution of patient-shared knowledge and information within the context of naturopathic clinical consultations. Results The survey was completed by 453 naturopathic practitioners (response rate: 74.3%). Approximately two-thirds (68.2%) of respondents reported using information shared by the patient. Most rated ‘information provided by the patient’ as either ‘extremely important’ (60.7%) or ‘very important’ (31.4%) to patients. Highest levels of trust were reported for information provided by the patient (‘completely’: 9.9%; ‘a lot’: 53.6%). Most practitioners indicated they trusted knowledge and information derived from the patient’s personal health history ‘completely’(n=79; 21.8%) or ‘a lot’(n=226; 62.4%) from the patient’s perspective of living with a health condition (‘completely’[n=63, 17.4%]; ‘a lot’[n=224, 61.9%]). Patients were the highest ranked stakeholder group (mean: 1.5) perceived to influence NP use of patient experience of living with a health condition to inform clinical decision-making. Conclusion Researchers and policy makers are increasingly focused on the value of the ‘expert patient’ in clinical decision-making, yet health professionals’ report challenges and, in some cases, resistance to meaningfully engaging with patient-shared knowledge in practice. However, our study has found patient-shared knowledge – inclusive of patient experience of their health condition – is among the knowledge used and trusted by naturopathic practitioners to inform their clinical decision-making. This study both offers insights into the knowledge translation behaviours of an under-researched health profession and provides a novel contribution to the wider aim of adopting patient shared knowledge into clinical care more generally

Additional file 1 of Patient-shared knowledge and information in clinical decision-making: an international survey of the perspectives and experiences of naturopathic practitioners

Additional file 1

Precision medicine: Look to the mice.

Science 2015 Jul 24; 349(6246):390

Traditional, complementary and integrative healthcare: global stakeholder perspective on WHO’s current and future strategy

As the ‘WHO Traditional Medicine Strategy: 2014–2023’ is entering its final phase, reflection is warranted on progress and the focus for a new strategy. We used WHO documentation to analyse progress across the objectives of the current strategy, adding the role of traditional, complementary and integrative healthcare (TCIH) to address specific diseases as a dimension absent in the current strategy. Our analysis concludes on five areas. First, TCIH research is increasing but is not commensurate with TCIH use. TCIH research needs prioritisation and increased funding in national research policies and programmes. Second, WHO guidance for training and practice provides useful minimum standards but regulation of TCIH practitioners also need to reflect the different nature of formal and informal practices. Third, there has been progress in the regulation of herbal medicines but TCIH products of other origin still need addressing. A risk-based regulatory approach for the full-range of TCIH products seems appropriate and WHO should provide guidance in this regard. Fourth, the potential of TCIH to help address specific diseases is often overlooked. The development of disease strategies would benefit from considering the evidence and inclusion of TCIH practices, as appropriate. Fifth, inclusion of TCIH in national health policies differs between countries, with some integrating TCIH practices and others seeking to restrict them. We encourage a positive framework in all countries that enshrines the role of TCIH in the achievement of universal health coverage. Finally, we encourage seeking the input of stakeholders in the development of the new WHO Traditional Medicine Strategy