TY - JOUR

T1 - Views of Conventional Medicine and Integrative Medicine among Informal Dementia Caregivers and Healthcare Professionals in NW England

AU - Chalfont, Garuth

AU - Simpson, Jane

AU - Eccles, Fiona

AU - Milligan, Christine

PY - 2020/1/21

Y1 - 2020/1/21

N2 - The urgent need for innovative approaches to dementia treatment that are acceptable, effective and affordable underlies this research. Growing evidence supports ‘integrative medicine’ as a potential treatment approach aligned with and including conventional medicine. However, success will depend on addressing barriers, recognising needs of diverse communities and involving people in co-creating desired interventions. The three aims of this study were to, 1) describe conventional allopathic medicine and integrative or functional medicine (I/FM) approaches for dementia treatment in NW England; 2) to explore the views of informal dementia caregivers and service users, compared to healthcare professionals on the benefits and barriers to providing and receiving these two approaches. Thirdly, we engaged caregivers and service users in co-creating a vision for dementia treatment based on their needs and expectations. We conducted semi-structured interviews, focus groups and a deliberative workshop. Data were analysed using framework analysis. A total of 49 participants reported benefits and barriers to providing and receiving treatments. Themes related to inequalities of socioeconomics and access, cultural influences, disempowerment, demotivation and physician pressures. For instance, the NHS conventional medicine approach provided free nearby access, highly rated post-diagnostic support and good quality web-based information. Barriers included limited discussion of non-pharmaceutical treatment options, low-morale and high rates of stress and burnout among GPs who felt de-motivated as they could not slow or stop the progression. I/FM benefits included time for in-depth investigations to determine the underlying causes of a patient’s dementia, and practitioners trained in addressing them. Barriers included limited access to I/FM practitioners, need to pay for services, difficulties of making lifestyle changes such as diet, need for strong support from caregivers (or payment for a health coach) and poor compliance. Participants co-created a vision for dementia treatment including the wider environmental, social and cultural context. Neither conventional NHS medicine nor I/FM provided consistently beneficial treatment outcomes for dementia. Findings support the development of a model of dementia treatment that includes the benefits provided by both existing approaches, but further informed by patient, caregiver and practitioner experience and co-design. Such an approach must consider a complexity of cultural and generational needs, ensuring empowerment, making available current evidence, resources and support.

AB - The urgent need for innovative approaches to dementia treatment that are acceptable, effective and affordable underlies this research. Growing evidence supports ‘integrative medicine’ as a potential treatment approach aligned with and including conventional medicine. However, success will depend on addressing barriers, recognising needs of diverse communities and involving people in co-creating desired interventions. The three aims of this study were to, 1) describe conventional allopathic medicine and integrative or functional medicine (I/FM) approaches for dementia treatment in NW England; 2) to explore the views of informal dementia caregivers and service users, compared to healthcare professionals on the benefits and barriers to providing and receiving these two approaches. Thirdly, we engaged caregivers and service users in co-creating a vision for dementia treatment based on their needs and expectations. We conducted semi-structured interviews, focus groups and a deliberative workshop. Data were analysed using framework analysis. A total of 49 participants reported benefits and barriers to providing and receiving treatments. Themes related to inequalities of socioeconomics and access, cultural influences, disempowerment, demotivation and physician pressures. For instance, the NHS conventional medicine approach provided free nearby access, highly rated post-diagnostic support and good quality web-based information. Barriers included limited discussion of non-pharmaceutical treatment options, low-morale and high rates of stress and burnout among GPs who felt de-motivated as they could not slow or stop the progression. I/FM benefits included time for in-depth investigations to determine the underlying causes of a patient’s dementia, and practitioners trained in addressing them. Barriers included limited access to I/FM practitioners, need to pay for services, difficulties of making lifestyle changes such as diet, need for strong support from caregivers (or payment for a health coach) and poor compliance. Participants co-created a vision for dementia treatment including the wider environmental, social and cultural context. Neither conventional NHS medicine nor I/FM provided consistently beneficial treatment outcomes for dementia. Findings support the development of a model of dementia treatment that includes the benefits provided by both existing approaches, but further informed by patient, caregiver and practitioner experience and co-design. Such an approach must consider a complexity of cultural and generational needs, ensuring empowerment, making available current evidence, resources and support.

KW - dementia

KW - integrative medicine

KW - functional medicine

KW - Gujarati

KW - co-design

KW - treatment

U2 - 10.21926/obm.geriatr.2001102

DO - 10.21926/obm.geriatr.2001102

M3 - Journal article

VL - 4

JO - OBM Geriatrics

JF - OBM Geriatrics

IS - 1

M1 - 17

ER -