| Factors that influence practitioners' interpretations of evidence from alternative medicine trials: a factorial vignette experiment embedded in a national survey. | |
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MedLine Citation:
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PMID: 20355265 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Clinical trial evidence in controversial areas such as complementary and alternative medicine (CAM) must be approached with an open mind. OBJECTIVE: To determine what factors may influence practitioners' interpretation of evidence from CAM trials. Research DESIGN: In a mailed survey of 2400 US CAM and conventional medicine practitioners we included 2 hypothetical factorial vignettes of positive and negative research results for CAM clinical trials. Vignettes contained randomly varied journal (Annals of Internal Medicine vs. Journal of Complementary and Alternative Medicine) and CAM treatment type (acupuncture, massage, glucosamine, meditation, and reiki). Response items also included randomly varied patient circumstances-chronic refractory symptoms and the patient requesting CAM. MEASURES: All practitioners rated the effectiveness and their willingness to recommend the therapy for a described patient. We used logistic regression to determine the independent influence of the 4 factors on respondents' effectiveness and legitimacy judgments. RESULTS: A total of 1561 practitioners responded (65%). Relative to Reiki, conventional medicine practitioners were most willing to recommend glucosamine (OR = 3.0; 95% CI [1.6-5.4]), than massage (1.9 [1.1-3.3]), acupuncture (1.3 [0.8-2.2]), and meditation (1.2 [0.7-2.0]). CAM practitioners rated acupuncture as effective more than other CAM therapies (OR = 5.8 [2.6-12.8] compared with Reiki), and were more willing to recommend acupuncture (OR = 12.3 [4.8-31.8]). When presented evidence of inefficacy, CAM practitioners were most willing to recommend acupuncture relative to other CAM therapies (OR = 15.5 [9.0-26.9]). CONCLUSIONS: Practitioners' judgments about CAM trial evidence depend on the type of treatments reported. Confirmation bias may play a role in the clinical translation of new evidence from clinical trials. |
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Authors:
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Jon C Tilburt; Franklin G Miller; Sarah Jenkins; Ted J Kaptchuk; Brian Clarridge; Dragana Bolcic-Jankovic; Ezekiel J Emanuel; Farr A Curlin |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Medical care Volume: 48 ISSN: 1537-1948 ISO Abbreviation: Med Care Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-03-30 Completed Date: 2010-04-12 Revised Date: 2012-03-08 |
Medline Journal Info:
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Nlm Unique ID: 0230027 Medline TA: Med Care Country: United States |
Other Details:
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Languages: eng Pagination: 341-8 Citation Subset: IM |
Affiliation:
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Department of Bioethics, National Institutes of Health, Bethesda, MD 20892, USA. tilburt.jon@mayo.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Anecdotes as Topic Attitude of Health Personnel* Chronic Disease / therapy Clinical Trials as Topic* Complementary Therapies / utilization* Evidence-Based Medicine Female Humans Judgment Male Middle Aged Patient Preference Physicians / psychology* Questionnaires |
| Grant Support | |
ID/Acronym/Agency:
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1 K23 AT002749/AT/NCCAM NIH HHS; K24 AT004095/AT/NCCAM NIH HHS; K24 AT004095-03/AT/NCCAM NIH HHS; Z99 CL999999/CL/CLC NIH HHS |
| Comments/Corrections | |
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