An IM decision matrix to guide the integration of traditional and complementary medicines when there is insufficient scientific evidence

Purpose: The ongoing use of traditional and complementary medicine (T&CM), coupled with a paucity of scientific evidence, poses ongoing challenges for health policy makers, health services seeking to provide integrative medicine (IM) and those developing IM clinical guidelines. Often the only recommendations are to discuss T&CM use with patients or to undertake more research. Given that many T&CM are already in use, clearer more specific recommendations are needed even when there is insufficient scientific evidence to make a strong recommendation. Methods: National and international guidelines on the development and evaluation of healthcare guidelines were identified and appraised. The aim was to build on these to develop a framework that would enable a comprehensive, systematic assessment of a T&CM intervention and determine whether and under what circumstances it may be integrated into pre-existing health services. Results: The level and quality of evidence about safety, efficacy, effectiveness and economic value are not the only types of information needed to determine whether a T&CM intervention should be integrated with conventional healthcare. Other factors such as burden of disease, magnitude of effect, current use, demand, equity and ease of integration must also be considered. Although less information was available about how to make explicit recommendations when there is insufficient evidence, the existing guidelines were adequate to develop a decision matrix for use in the IM setting. Conclusion: The proposed IM decision matrix facilitates the direct comparison of otherwise diverse therapies, often using different research methods of variable quality to support their use. It offers pragmatic solutions for making specific recommendations about how best to integrate a T&CM intervention even when there is insufficient scientific evidence.