Appropriateness of care is about ensuring that individuals receive care that is (a) clinically effective, (b) cost-effective, and is consistent with (c) ethical principles and (d) preferences relevant to individuals, communities and society. Given the prevalence of patient self-referral in complementary and alternative medicine (CAM) and the health system-wide focus on patient-centered care, it seems reasonable to consider individual preferences when assessing the appropriateness of CAM procedures. Unfortunately, we know very little about CAM users'preferences and decision-making since most CAM studies are conducted at the individual level rather than for specific illness episodes. Using chiropractic manipulation and mobilization (M/M) for chronic cervical pain as an example, this study will explore the role that patients'preferences, expectations and experiences may play in assessing the appropriateness of treatments and procedures. The study will occur in three stages. In the first stage, we will recruit patients suffering from chronic neck pain from chiropractic practices and conduct in-depth, semi-structured interviews about their past and current experiences in treating their neck pain. We will use these interviews, as well as a comprehensive review of the literature;to develop a series of interview protocols for assessing patient decision making, expectations, experiences and satisfaction with their chiropractic care. Next we will pilot test the protocols on 50 chronic cervical pain patients who are currently seeing a chiropractor and make appropriate changes as required. The finalized protocols will then be the basis for collecting data from a national sample of 800 patients with chronic cervical pain from 80 chiropractic practices located in four national sites. These data will provide unprecedented insights into patient preferences, expectations, healthcare experiences and satisfaction with those experiences, reported short- and long-term results and satisfaction with those results and treatment appropriateness. We will also describe how these vary across sociodemographic characteristics, time, initial pain severity and previous experiences with chiropractic, other CAM and other non-CAM treatments. The resulting patient-centered findings will be incorporated into the discussion concerning the appropriateness of utilizing M/M for chronic cervical pain.
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