A collaborative design of a case report guideline for Chinese herbal medicine (CHM-CARE)

Abstract

Chinese herbal medicine (CHM) is a popular complementary medicine (CM) intervention with a long history of producing case reports and using them both for continuing medical education and improving clinical skills. Even though in modern evidence-based medicine, case reports are lower on the research pyramid; they provide detailed exchanges of a healthcare service with the patient taking centre stage. Previous research has found that trying to accommodate the complexity inherent in CM interventions like Chinese herbal medicine (CHM) in randomised controlled trials (RCTs) is a significant challenge. Clinicians also report significant barriers in trying to translate the results of controlled trials into clinical practice, preferring to rely on case reports to help shape their clinical decision-making. However, at present, there is no widely accepted case report guideline and checklist for CHM case reports, with current reporting guidelines either lacking guidance on reporting vital CHM items such as differential diagnosis and theoretical framework or being focussed on hospital-based practitioners working more within a biomedical framework. The aim of this project was to co-design a relevant CHM guideline for TEAM practitioners (Traditional East Asian Medicine) who practice in private practice or clinical outpatient settings. This project applied a two-phase mixed method approach using an exploratory sequential design. Focus group discussions with 18 participants from Australia, New Zealand, the UK, and the US were held to investigate basic components and attitudes towards the compilation and publishing of case reports. Following the content analysis of the focus group data and the consideration of other sources, phase two - a Delphi survey was conducted. There were 18 participants in the focus groups, with a median age of 50.7 years (45% female and 55% male), representing Australia (33%), New Zealand (11%), the US (28%) and the UK (28%). The content analysis of the focus group data generated 349 codes and produced a draft checklist with 98 items used in the first round of the Delphi survey. Consensus was achieved on key elements of a CHM case report guideline. Due to the lack of suitable CHM guidelines for Western-trained TEAM practitioners, the recommendations provide guidance for the compilation of CHM case reports. Future research can explore areas such as the attitude towards using Patient Reported Outcome Measures (PROMs), the transition and role of the clinician-researcher, and the capture of characteristic effects.

Date of Award	2023
Original language	English