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Building complementary and alternative health care research capacity: workshop report
Building complementary and alternative health care research capacity: workshop report H. Boon,1 M. Verhoef 2 1 2
Faculty of Pharmacy, University of Toronto, Ontario, Canada Faculty of Medicine, University of Calgary, Alberta, Canada
SUMMARY. Lack of research into the safety and efficacy of CAM has been identified as a barrier to collaboration between conventional and CAM practitioners. As an initial step to address this issue, Health Canada held an invitational roundtable discussion with researchers, practitioners and policy makers to explore specific issues related to CAM research capacity and literacy. The objectives of this workshop were to identify and prioritize CAM research infrastructure and training needs; and to identify strategies for meeting high priority needs. Eleven individuals representing three CAM groups, university-based researchers with experience in CAM research, and policy makers attended. Discussion focussed around research literacy, capacity, funding and leadership. Several recommendations were made including an advisory group, a needs assessment, support for research networks, development of learning modules, a review of existing research programmes, support for centres of excellence in CAM research, C 2002 Elsevier Science Ltd. All rights reserved. and funding for research meetings. °
needs. It should be noted that throughout the workshop process and in the workshop proceedings the term ‘complementary and alternative health care’ was used to refer to all complementary and alternative services, products and activities used by individuals for promoting, maintaining, monitoring, or restoring health.2 The term CAM, used throughout this report, is similarly meant to include this broad scope of health-related activities.
INTRODUCTION
Heather Boon PhD, Faculty of Pharmacy, University of Toronto, 19 Russell Street, Toronto, Ontario, M5S 2S2, Canada. E-mail: heather.boon@ utoronto.ca
Lack of research into the safety and efficacy of complementary and alternative medicine (CAM) including natural health products (NHP) has been identified as a barrier to collaboration between conventional and CAM practitioners.1 The relative lack of CAM research is partly due to limited research capacity (the ability to conduct research) and literacy (the ability to understand the language and concepts of research) among CAM practitioners and limited understanding of CAM research issues among university-based researchers. To facilitate evidence-based practice, research questions need to arise from CAM practice and research findings need to inform practice. As an initial step to address this issue, Health Canada planned an invitational roundtable discussion with researchers, practitioners and policy makers (held August 13–14, 2001) to explore specific issues related to CAM research capacity and literacy. The primary objectives of this workshop were:
PARTICIPANTS AND PROCESS Eleven individuals representing three CAM groups - chiropractic, naturopathic medicine and massage therapy; university-based researchers with experience in CAM research; and policy makers (from Health Canada) were invited to attend this one and one-half day interactive meeting. Consultation at this stage was limited to the CAM practitioner groups with the most developed professional structure in Canada. Individuals participated in full-group discussions and small working groups.
1. to identify and prioritize CAM research infrastructure and training needs 2. to identify strategies for meeting high priority
C 2002 Elsevier Science Ltd. All rights reserved. Complementary Therapies in Medicine (2002) 10, 49–51 °
doi:10.1054/ctim.2002.0512, available online http://www.idealibrary.com on
49
50
Complementary Therapies in Medicine
DISCUSSION RESULTS CAM research needs were identified during a large group brainstorming session. These were discussed further and four key CAM research needs emerged as priorities: • Research Literacy: More awareness and better understanding of the value of research Research literacy is relevant at institutional, practitioner, and undergraduate levels. It encompasses the need to demystify research and make it relevant for practitioners (i.e. enhance the application of research). The need to understand the concept of evidence-based health care and the need to develop methods for knowledge transfer/translation with respect to research results are also included in this category. • Research Capacity: More CAM research training Research capacity encompasses the need for research training for undergraduates, graduate students, fellows, clinicians and CAM faculty members. • Funding: More funding for CAM research, training and infrastructure A key funding issue is the difficulty that CAM practitioners and researchers face in accessing funding for research projects. Other funding issues include the need for infrastructure funding, funding for training and funding for networking. • Leadership: Mentors, role models and champions for CAM research In order to facilitate the development of research literacy and research capacity, the group identified a need for leadership from researchers and practitioners representing a variety of disciplines who could be instrumental in building the required research structure. The need for peer-support and a sustainable critical mass of CAM researchers (within the CAM disciplines) was also identified.
RECOMMENDATIONS Small working group discussions followed by reporting back to and discussion with the full participant group resulted in the following recommendations to Health Canada: 1. An advisory group should be established to follow-up on the strategies and recommendations outlined during this workshop and to advise Health Canada about future needs with respect to CAM research literacy and capacity.
2. A needs assessment or environmental scan is necessary to ensure that future CAM research literacy and capacity strategies meet the needs of a broad range of stakeholders. 3. Support for a network (or networks) of CAM researchers and clinician investigators should be forthcoming to facilitate the development of CAM research capacity. 4. Development of research learning modules and training support programmes that can be accessed by a variety of CAM institutions is recommended as a way to address the CAM research literacy and capacity needs identified during this workshop. These programmes should be designed and implemented following a broader needs assessment (see recommendation 2). 5. Health Canada should encourage the Canadian Institutes of Health Research (CIHR) to review current funding and training programs to ensure that CAM clinician investigators, faculty members and researchers are not unnecessarily excluded from applying for programs that clinician investigators, faculty members and researchers from conventional health care programs can currently access. 6. Support for one or more Centres of Excellence in CAM research are recommended as a long-term strategy to enhance CAM research capacity. 7. Funding for CAM research knowledge transfer is recommended as a long-term strategy to enhance CAM research literacy and capacity.
CONCLUSIONS The planning committee from this workshop continues to work closely with representatives from Health Canada to ensure that the recommendations presented here will be enacted upon. Progress is being made. For example, the recommended training capacity needs assessment is currently underway and a summary report should be available in the summer of 2002. In addition, Health Canada and the CIHR have begun discussions toward a collaborative relationship with respect to CAM research funding. One example of this is a workshop to establish CAM research priorities (planned for February 2002) that has been jointly funded by Health Canada and the CIHR. The recommendations presented here are very similar to those identified by expert panels and working groups in other countries. For example, The House of Lords Report from the United Kingdom highlighted the need to generate evidence of the effectiveness of CAM therapies (recommendation 3) and to include the principles of evidence-based medicine and research
Building complementary and alternative health care research capacity
methods in the curriculum of CAM practitioners (recommendation 20). In addition, recommendations 30–36 address the infrastructure needs of CAM researchers and the need for funding of CAM research.3 They echo recommendations from the Prince of Wales’ report several years earlier.4 The need for a critical mass of skilled CAM researchers (from both the CAM and conventional communities) was also identified in the National Center for Complementary and Alternative Medicine’s five-year strategic plan for the United States.5 Clearly, there is a need to share experiences and strategies (both success stories and failures) in order to facilitate growth in CAM research capacity internationally.
51
REFERENCES 1. Ernst E. Integrating complementary medicine? J Roy Soc Health 1997; 117(5): 285–286. 2. Last JM, editor. A Dictionary of Epidemiology. New York: University Press; 1983. 3. Select Committee on Science and Technology. Complementary and Alternative Medicine. London: House of Lords; 2000 21 November. Report No. 6: Session 1999–2000. 4. Coates JR, Jobst KA. Integrated healthcare: A way forward for the next five years? A discussion document from the Prince of Wales’ initiative on integrative medicine. The Journal of Alternative and Complementary Medicine 1998; 4(2): 209–247. 5. National Center for Complementary and Alternative Medicine. Expanding Horizons of Healthcare. Five-Year Strategic Plan. Washington, DC: NIH; 2000 28 August.
Faculty of Pharmacy, University of Toronto, Ontario, Canada Faculty of Medicine, University of Calgary, Alberta, Canada
SUMMARY. Lack of research into the safety and efficacy of CAM has been identified as a barrier to collaboration between conventional and CAM practitioners. As an initial step to address this issue, Health Canada held an invitational roundtable discussion with researchers, practitioners and policy makers to explore specific issues related to CAM research capacity and literacy. The objectives of this workshop were to identify and prioritize CAM research infrastructure and training needs; and to identify strategies for meeting high priority needs. Eleven individuals representing three CAM groups, university-based researchers with experience in CAM research, and policy makers attended. Discussion focussed around research literacy, capacity, funding and leadership. Several recommendations were made including an advisory group, a needs assessment, support for research networks, development of learning modules, a review of existing research programmes, support for centres of excellence in CAM research, C 2002 Elsevier Science Ltd. All rights reserved. and funding for research meetings. °
needs. It should be noted that throughout the workshop process and in the workshop proceedings the term ‘complementary and alternative health care’ was used to refer to all complementary and alternative services, products and activities used by individuals for promoting, maintaining, monitoring, or restoring health.2 The term CAM, used throughout this report, is similarly meant to include this broad scope of health-related activities.
INTRODUCTION
Heather Boon PhD, Faculty of Pharmacy, University of Toronto, 19 Russell Street, Toronto, Ontario, M5S 2S2, Canada. E-mail: heather.boon@ utoronto.ca
Lack of research into the safety and efficacy of complementary and alternative medicine (CAM) including natural health products (NHP) has been identified as a barrier to collaboration between conventional and CAM practitioners.1 The relative lack of CAM research is partly due to limited research capacity (the ability to conduct research) and literacy (the ability to understand the language and concepts of research) among CAM practitioners and limited understanding of CAM research issues among university-based researchers. To facilitate evidence-based practice, research questions need to arise from CAM practice and research findings need to inform practice. As an initial step to address this issue, Health Canada planned an invitational roundtable discussion with researchers, practitioners and policy makers (held August 13–14, 2001) to explore specific issues related to CAM research capacity and literacy. The primary objectives of this workshop were:
PARTICIPANTS AND PROCESS Eleven individuals representing three CAM groups - chiropractic, naturopathic medicine and massage therapy; university-based researchers with experience in CAM research; and policy makers (from Health Canada) were invited to attend this one and one-half day interactive meeting. Consultation at this stage was limited to the CAM practitioner groups with the most developed professional structure in Canada. Individuals participated in full-group discussions and small working groups.
1. to identify and prioritize CAM research infrastructure and training needs 2. to identify strategies for meeting high priority
C 2002 Elsevier Science Ltd. All rights reserved. Complementary Therapies in Medicine (2002) 10, 49–51 °
doi:10.1054/ctim.2002.0512, available online http://www.idealibrary.com on
49
50
Complementary Therapies in Medicine
DISCUSSION RESULTS CAM research needs were identified during a large group brainstorming session. These were discussed further and four key CAM research needs emerged as priorities: • Research Literacy: More awareness and better understanding of the value of research Research literacy is relevant at institutional, practitioner, and undergraduate levels. It encompasses the need to demystify research and make it relevant for practitioners (i.e. enhance the application of research). The need to understand the concept of evidence-based health care and the need to develop methods for knowledge transfer/translation with respect to research results are also included in this category. • Research Capacity: More CAM research training Research capacity encompasses the need for research training for undergraduates, graduate students, fellows, clinicians and CAM faculty members. • Funding: More funding for CAM research, training and infrastructure A key funding issue is the difficulty that CAM practitioners and researchers face in accessing funding for research projects. Other funding issues include the need for infrastructure funding, funding for training and funding for networking. • Leadership: Mentors, role models and champions for CAM research In order to facilitate the development of research literacy and research capacity, the group identified a need for leadership from researchers and practitioners representing a variety of disciplines who could be instrumental in building the required research structure. The need for peer-support and a sustainable critical mass of CAM researchers (within the CAM disciplines) was also identified.
RECOMMENDATIONS Small working group discussions followed by reporting back to and discussion with the full participant group resulted in the following recommendations to Health Canada: 1. An advisory group should be established to follow-up on the strategies and recommendations outlined during this workshop and to advise Health Canada about future needs with respect to CAM research literacy and capacity.
2. A needs assessment or environmental scan is necessary to ensure that future CAM research literacy and capacity strategies meet the needs of a broad range of stakeholders. 3. Support for a network (or networks) of CAM researchers and clinician investigators should be forthcoming to facilitate the development of CAM research capacity. 4. Development of research learning modules and training support programmes that can be accessed by a variety of CAM institutions is recommended as a way to address the CAM research literacy and capacity needs identified during this workshop. These programmes should be designed and implemented following a broader needs assessment (see recommendation 2). 5. Health Canada should encourage the Canadian Institutes of Health Research (CIHR) to review current funding and training programs to ensure that CAM clinician investigators, faculty members and researchers are not unnecessarily excluded from applying for programs that clinician investigators, faculty members and researchers from conventional health care programs can currently access. 6. Support for one or more Centres of Excellence in CAM research are recommended as a long-term strategy to enhance CAM research capacity. 7. Funding for CAM research knowledge transfer is recommended as a long-term strategy to enhance CAM research literacy and capacity.
CONCLUSIONS The planning committee from this workshop continues to work closely with representatives from Health Canada to ensure that the recommendations presented here will be enacted upon. Progress is being made. For example, the recommended training capacity needs assessment is currently underway and a summary report should be available in the summer of 2002. In addition, Health Canada and the CIHR have begun discussions toward a collaborative relationship with respect to CAM research funding. One example of this is a workshop to establish CAM research priorities (planned for February 2002) that has been jointly funded by Health Canada and the CIHR. The recommendations presented here are very similar to those identified by expert panels and working groups in other countries. For example, The House of Lords Report from the United Kingdom highlighted the need to generate evidence of the effectiveness of CAM therapies (recommendation 3) and to include the principles of evidence-based medicine and research
Building complementary and alternative health care research capacity
methods in the curriculum of CAM practitioners (recommendation 20). In addition, recommendations 30–36 address the infrastructure needs of CAM researchers and the need for funding of CAM research.3 They echo recommendations from the Prince of Wales’ report several years earlier.4 The need for a critical mass of skilled CAM researchers (from both the CAM and conventional communities) was also identified in the National Center for Complementary and Alternative Medicine’s five-year strategic plan for the United States.5 Clearly, there is a need to share experiences and strategies (both success stories and failures) in order to facilitate growth in CAM research capacity internationally.
51
REFERENCES 1. Ernst E. Integrating complementary medicine? J Roy Soc Health 1997; 117(5): 285–286. 2. Last JM, editor. A Dictionary of Epidemiology. New York: University Press; 1983. 3. Select Committee on Science and Technology. Complementary and Alternative Medicine. London: House of Lords; 2000 21 November. Report No. 6: Session 1999–2000. 4. Coates JR, Jobst KA. Integrated healthcare: A way forward for the next five years? A discussion document from the Prince of Wales’ initiative on integrative medicine. The Journal of Alternative and Complementary Medicine 1998; 4(2): 209–247. 5. National Center for Complementary and Alternative Medicine. Expanding Horizons of Healthcare. Five-Year Strategic Plan. Washington, DC: NIH; 2000 28 August.