Feasibility and Usability of EnergyPoints: A Mobile Health App to Guide Acupressure Use for Cancer Symptom Management.

OBJECTIVE: To examine the feasibility and usability of EnergyPoints™, an innovative mobile health app that teaches and guides people with cancer to implement daily acupressure to self-manage their fatigue and sleep disturbances. METHODS AND INTERVENTION: The study used an integrated agile, human-centered approach. Adults (age 18 years and over) with cancer experiencing at least moderate fatigue, and living in the Greater New York City community, were recruited from social media, patient advocacy groups, and referrals. Twenty participants (in 3 sprints of 3, 5, and 12) were video-recorded thinking aloud while using the app for the first time. They then used the app at home to self-administer acupressure (twice daily for 1 week) while continuously wearing a fitness tracker. Each participant completed an exit interview and modified Computer System Usability Questionnaire post-participation. RESULTS: Participants were ages 40 to 76 years and 65% female; 65% were non-Hispanic white. Mean pass rates per ritual exceeded 80%. Users completed (totally or partially) greater than 90% of stimulating acupressure and 70% of relaxing acupressure rituals. Sprint 3 SPs totally completed at least 1 ritual 87% of the time. The majority agreed or strongly agreed the app was easy to use (90%), easy to learn (85%), easy to understand (75%), and effective in helping perform self-acupressure (85%). In an analysis of ease of completing 5 key tasks, all successfully completed the tasks; 3 users required some assistance. Of 654 usability statements, those coded as personal experience/context (197), content related to acupressure learning (105), and content related to the onboarding/profile (71) were most frequent. The design team integrated recommendations into the app before the next sprint. CONCLUSIONS: Findings supported feasibility and usability, as well as acceptability, and led to significant alterations and improvements. EnergyPoints™ offers an opportunity to mainstream acupressure and help cancer survivors self-manage their symptoms.

Characteristics and Challenges of Providing Acupuncture and Chinese Herbal Medicine in Oncology Treatment: Report of Survey Data and Experience of Five Unique Clinical Settings.

Acupuncture is an integrative therapy with strong evidence to support its use in the oncology setting, yet barriers exist for implementation into conventional medical clinics. Though acupuncture is recommended in clinical practice guidelines for oncology, there is little data in the literature showing how acupuncture and other related therapies, including herbal medicine are successfully implemented in some oncology clinics, while others experience barriers to care. To characterize the current use of acupuncture (ACU) and herbal medicine (HM) in oncology clinics, we collected general demographic and usage data from 5 example clinics. In addition, to better understand the barriers faced by ACU and HM clinics in implementing acupuncture as a treatment modality, a survey was deployed to 2320 members of the Society for Integrative Oncology. This article examines the characteristics of oncology settings around the world, and shares data from the survey on the use of these therapies in the field of oncology. The primary barrier to acupuncture care, as reported by providers, was cost. With just under 70% of the oncologists reporting it as the most important obstacle. Additional barriers to implementation included concerns about competency and training, accessibility and safety of herbal medicine during treatment. Though acupuncture is being incorporated into more conventional oncology settings, organized strategies for implementation involving payers and policymakers is needed.

Incorporating Acupuncture Into American Healthcare: Initiating a Discussion on Implementation Science, the Status of the Field, and Stakeholder Considerations.

INTRODUCTION: The field of implementation science is the study of methods that promote the uptake of evidence-based interventions into healthcare policy and practice. While acupuncture has gained significant traction in the American healthcare landscape, its journey has been somewhat haphazard and non-linear. METHODS: In June 2019, a group of thirty diverse stakeholders was convened by the Society for Acupuncture Research with the support of a Patient Centered Outcomes Research Institute, Eugene Washington Engagement Award. This group of stakeholders represented a diverse mix of patients, providers, academicians, researchers, funders, allied health professionals, insurers, association leaders, certification experts, and military program developers. The collective engaged in discussion that explored acupuncture's status in healthcare, including reflections on its safety, effectiveness, best practices, and the actual implementation of acupuncture as seen from diverse stakeholder viewpoints. OBJECTIVES: A primary goal was to consider how to utilize knowledge from the field of implementation science more systematically and intentionally to disseminate information about acupuncture and its research base, through application of methods known to implementation science. The group also considered novel challenges that acupuncture may present to known implementation processes. FINDINGS: This article summarizes the initial findings of this in-person meeting of stakeholders and the ongoing discussion among the subject matter experts who authored this report. The goal of this report is to catalyze greater conversation about how the field of implementation science might intersect with practice, access, research, and policymaking pertaining to acupuncture. Core concepts of implementation science and its relationship to acupuncture are introduced, and the case for acupuncture as an Evidence Based Practice (EBP) is established. The status of the field and current environment of acupuncture is examined, and the perspectives of four stakeholder groups--patients, two types of professional practitioners, and researchers--are explored in more detail.

Acupuncture's Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management-White Paper 2017.

The United States (U.S.) is facing a national opioid epidemic, and medical systems are in need of non-pharmacologic strategies that can be employed to decrease the public's opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture's cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, and neonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.

Why does treatment fidelity matter?

Treatment fidelity is a relatively new concept in intervention research and has been discussed in scientific literature only in the last 25 y. Intervention fidelity improves power by reducing unintended variability in treatment effect, and it supports external validity by allowing for replication. As more self-administered complementary and alternative medicine (CAM) treatments are being studied, the issue of fidelity concerns is becoming more of a burden to researchers. Despite the critical role of fidelity, no comprehensive, structured guide exists.

The status of acupuncture and oriental medicine in the United States.

Since its first mention in U.S. media in the early 1970s, the practice of acupuncture and Oriental medicine (AOM) has grown in stature from a fringe, counter-culture movement to a valid, evidenced-based treatment option for patients. In the last 40 years, AOM schools and colleges have been accredited by the U.S. Department of Education, offering both masters and doctoral degree programs. To date, forty-seven states and the District of Columbia license or certify acupuncturists based on competency proven through state examination or professional certification by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). As acceptance of AOM in the U.S. has increased through both the assurance of psychometrically sound certification and the education of the American public on this topic, many challenges have emerged. Problems such as the underemployment of AOM clinicians, methodological hurdles for the investigation of mechanisms, and efficacy of acupuncture and other AOM treatment techniques have been observed. Investigative challenges also include gaps in research training as well as a dearth of the basic resources needed to conduct randomized controlled trials (RCTs). As AOM research has sought integration into the Western research model, problems have been identified in the design of AOMRCTs, and strategies for their resolution through methods such as translational research have been examined. Incorporating these strategies as well as efficacy, effectiveness, and qualitative measures will strengthen the evidence base and thus provide clinical decision makers with more tools that can be used to design patient treatment regimens.

Mechanisms of action for acupuncture in the oncology setting.

A growing body of literature supports the use of acupuncture in the oncology clinic for the relief of symptoms caused by cancer treatments. Several clinical trials are currently supported by the National Institutes of Health to assess the efficacy of such treatments, as evidenced by the listings in the National Institutes of Health Computer Retrieval of Information on Scientific Projects (CRISP) database. However, little is known about the mechanisms of action behind the effects of acupuncture. A biomedical database search for articles in the English-language literature revealed studies examining the effect of acupuncture on fibroblast cells, a decrease of inflammatory cytokines, an increase of T-lymphocytes, and increasing adenosine, neuropeptides, opioid peptides, peptide hormones, and stem cells. This limited review attempts to reveal some possible mechanisms of action for the effects of acupuncture for symptom relief in the oncology setting.

Delivery of a full-term pregnancy after TCM treatment in a previously infertile patient diagnosed with polycystic ovary syndrome.

There is a growing body of literature supporting the use of traditional Chinese medicine (TCM) for increasing the likelihood of conception and carrying a pregnancy to term. The use of TCM in fertility treatment is becoming more widely recognized, and several clinical trials are being supported by the National Center for Complementary and Alternative Medicine to assess the efficacy of such treatments, as evidenced by the listings in the National Institutes of Health's Computer Retrieval of Information on Scientific Projects (CRISP) database. In addition to subjecting TCM to the rigors of Western scientific standards, it is important that TCM and other CAM practitioners share their expertise and practical experiences through case reports in the same spirit that their Western medical counterparts do. This dissemination of knowledge is critical in increasing awareness about TCM within the broader scientific community. The clinical case report presented here describes the course of TCM treatment that resulted in a successful pregnancy in a previously infertile woman who had been diagnosed with polycystic ovary syndrome (PCOS). It also illustrates the importance of the need for collaborative efforts between TCM and Western medical practitioners.