Approaches to clinical decision-making: A qualitative study of naturopaths

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Abstract

The type of information used and its application in clinical practice has generated interest due to its relationship to evidence-based medicine (EBM). However, it is also acknowledged that the principles of EBM place less value on practitioners’ experience and intuitive insights when making clinical decisions. Research in this area has been conducted with conventional health professionals, meanwhile complementary and alternative medicine practitioners such as naturopaths have received little attention. In response interviews were undertaken with naturopaths to explore their approach to information-seeking and application in clinical settings. Thematic analysis identified how naturopaths incorporate deductive reasoning alongside intuition and clinical experience to overcome difficulties in applying information to relevant clinical situations. This research provides an understanding of the approach taken by naturopaths to improve the relevance of available data when making clinical decisions and is of significance for health policy and health service delivery in this area.

Introduction

It has been asserted that health professionals are service-focussed and task-oriented, and due to the performance of multiple roles, require efficient completion of their tasks. With this in mind, the type of information used, and as such the manner through which it is applied depends upon the professional focus of the clinician and may also be affected by the location of practice, specialty and the professional’s age.1 This perspective has been supported through research investigating the information seeking behaviour of a variety of health care professionals including general practitioners,2, 3 nurses,4, 5 pharmacists5, 6 and naturopaths.7 Furthermore, the information needs of a given health professional will inevitably impact upon their information-seeking behaviour, and ultimately the information sources used.

With this in mind, interest in the paradigmatic approach of evidence-based medicine has primarily focused upon the validity of information sources, and the process of critiquing their value and relevance.8 However, it is acknowledged that EBM also encompasses the practice of applying this information within different clinical circumstances.9 As a result, health professionals are encouraged to place less value on their clinical experience and intuitive insights when making clinical decisions.8 The tension between the practice of EBM and clinical practice, particularly in the context of intuition, has been reported by general practitioners (GPs).10 These same GPs also emphasise the importance of intuitive aspects of their clinical practice in achieving more patient-centred and holistic care. Furthermore, the rhetoric of intuition was drawn upon by these GPs to explain and justify the use of complementary and alternative medicines within their practice.

Within the range of health professions that have been explored, the information-seeking behaviour of naturopaths has had little attention, and it has been asserted that evidence-based medicine and naturopathy are paradigmatically conflicted.11, 12 This is of interest, as naturopathy is the most predominant complementary and alternative medicine (CAM) modality in Australia, and, after chiropractors, naturopaths are the most visited CAM therapists.13 For this reason, there is a need to explore the approach taken by naturopaths to locate useful information and apply it in a clinical setting.

Section snippets

Methodology

Ethics approval was gained through the University Of Queensland School Of Population Health Ethics committee and naturopaths currently practicing in south-east Queensland were recruited. The research design employed semi-structured interviews lasting 30–45 min each.

Intuition, clinical experience and deductive reasoning: bridging the gap

Analysis identified a relationship between practitioner intuition, clinical experience, and other more conventional information sources, all of which intersected to inform clinical decision-making (see Fig. 1). In particular, it was identified that the practice of applying information derived from a variety of sources within a clinical setting was an abstract and integrated process drawing upon deductive reasoning, clinical practice and intuition.

Discussion

This research suggests that in situations involving unstructured clinical questions, such as determining the most appropriate treatment protocol for a patient, naturopaths apply deductive reasoning, and in doing so integrate modern research, traditional knowledge, clinical experience, intuition and interpersonal interactions to solve problems. The incorporation of interpersonal interactions and clinical experience in answering unstructured clinical questions is comparative in some ways to

Conclusion

The outcomes of this research provide some insight to the approach taken by naturopaths to utilising and translating available data into relevant information when making clinical decisions. Furthermore, it identifies some similarities between naturopaths and other health professionals within their approach to information for clinical decision-making. This may provide an opportunity for increased inter-professional awareness of shared values and barriers particularly when considering the role

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