Methodological complexities associated with systematic review of healing relationships.

BACKGROUND/CONTEXT: There is growing recognition within the field of medicine that healing and healing relationships are important and that developing evidence-based medicine approaches to healing should be an important aspect of this emerging field, including the use of systematic reviews. Health care leaders charged with developing healing initiatives in hospitals often are frustrated in their attempts to find rigorous reviews of the literature to support their programs. OBJECTIVE: The objective of this project was to conduct a systematic review that asked, "What is the return on investment to hospitals that implement programs aimed at enhancing healing relationships?" METHODS: A comprehensive literature search using several electronic databases was conducted to locate studies that evaluated hospital-based programs involving "healing relationships." All studies found were evaluated as to their relevance to the study and screened for methodological quality. RESULTS: Research investigators found broad heterogeneity across the 80 included studies with regard to stated aims, target populations, outcomes measured, measurement tools employed, and evaluation methods used. Only 10 articles were categorized as being methodologically strong. CONCLUSIONS: Results of the systematic review highlighted challenges in synthesizing knowledge about healing that included absence of widely accepted definitions and language around "healing", locating literature published across many different disciplines, and absence of standards for conducting rigorous program evaluations in hospitals. A less formal qualitative review of included studies also revealed themes in the literature that provide clues about the professional, social, cultural, and historical influences that have helped to shape the evidence base to date.

Operationalizing the concept of the optimal healing environment in clinical settings: the importance of "readiness".

Creation of an optimal healing environment (OHE) in a clinical setting is a multifaceted undertaking and subject to a wide variety of developmental influences. While comprehensive definitions for OHE might provide sufficient guidance for communicating philosophy and values and developing patient-practitioner processes, direction for creating a supportive administrative structure or establishing an evaluation/research strategy is less defined. Operationalizing the concept of OHE by breaking it down into components such as values, structure, process, and measurement of outcomes, proved to be a useful framework for analyzing the evolution of our integrated care program. Future OHE initiatives may benefit from using this type of framework to assess readiness among cocreators prior to development and implementation, as a guide for ongoing evaluation of an OHE postimplementation and as a basis for comparing OHEs across a variety of clinical settings.

Evaluation of the Tzu Chi Institute for Complementary and Alternative Medicine's Integrative Care Program.

OBJECTIVE: There are an increasing number of clinics providing integrative health care using new and innovative delivery models. The purpose of this study was to quantitatively and qualitatively evaluate the Integrative Care Program offered at the Tzu Chi Institute for Complementary and Alternative Medicine, Vancouver, British Columbia, Canada. DESIGN: At enrollment, data are collected on demographics, health history, current health concerns and diagnoses, quality of life/health status (SF-36) and patient satisfaction. The measures are repeated 6 months into the program. Descriptive analysis was used to summarize the data. Focus groups were also included as part of the study design. RESULTS: Patients seeking integrative care are a highly complex population living with numerous comorbid chronic conditions. Although their baseline scores on the SF-36 are lower than Canadian population norms across all subscales, significant improvement occurred from baseline to 6 months. Qualitative data support that patients were pleased with the clinical care they received and aligned with the philosophical underpinnings of the program. DISCUSSION: This is one of the first studies to evaluate integrative health care. Studies like this are needed to develop appropriate methods to assess models of integrative health care delivery.

Maturation of complementary and alternative healthcare in Canada.

Complementary and alternative medicine (CAM) use is increasing rapidly in Canada. This use is mostly driven by consumer demand. While this field of research is relatively new, it is maturing rapidly. This commentary highlights three areas of increasing maturation: the emergence of integrative healthcare; the development and application of new approaches to investigating CAM and integrative healthcare; and the development of a research infrastructure to support these developments. It is encouraging, the authors note, that organizations, networks and federal agencies such as the Canadian Institutes of Health Research and Health Canada are collectively and collaboratively identifying barriers to these developments and are developing strategies to overcome them.