T. Bongiovanni1,3, R. Menza3, A. Stey1,3, K. Slown2, C. Bloom2, C. Wybourn1,2,3 1University of California, San Francisco,Department Of Surgery,San Francisco, CA, USA 2Zuckerberg San Francisco General Hospital,Department Of Critical Care,San Francisco, CA, USA 3Zuckerberg San Francisco General Hospital,Department Of Surgery,San Francisco, CA, USA
Introduction:
There is increased interest in the integration of complementary alternative medicine (CAM), such as music therapy or aromatherapy, as an adjunct to pharmaceutical management for pain, anxiety and nausea in post-operative and critically ill patients. However, it is unclear whether healthcare providers are adequately prepared to use CAM in their inpatient practice, and provider attitudes, beliefs and knowledge about CAM is unknown. Therefore, we aimed to investigate these attitudes, beliefs and knowledge, of a multi-disciplinary group of healthcare providers to both prescribe and provide CAM for critically ill and injured patients in the Surgical Intensive Care Unit (SICU) of a level one academic urban trauma center.
Methods:
A 41 item survey, designed to measure providers’ attitudes, beliefs and knowledge with CAM, was developed by a multidisciplinary research team which included MDs, NPs and RNs. The survey was informed by prior literature and was reviewed for content and face validity prior to administration. The trauma team, including critical care physicians, trauma surgeons, SICU nurses, pharmacists and nurse practitioners, were surveyed through an email solicitation using Qualtrics software. This convenience sample was conducted prior to the introduction of any formal or informal CAM.
Results:
Our survey of a critical care trauma team at a level one trauma center yielded a response rate of 48% (n=53/110). Of those, 48% were advanced practitioners (12 MDs and 13 NPs) with a mean range of 11-15 years of practice. The majority of respondents (89%) agreed or strongly agreed that they would be interested in implementing CAM clinically. However, one third of our respondents believed that there was insufficient evidence to use it in the hospital, and one third of respondents rated their knowledge of CAM for symptom management as “none”. There was no statistically significant difference between type of provider and willingness to implement CAM in clinical practice. Among those unwilling to implement CAM in their practice, they were worried that patients might not take them seriously (p<0.05), reported poor knowledge of CAM (p=0.05) or did not believe that the use of CAM would reduce medication use (p<0.05).
Conclusion:
Our study found that healthcare providers on a surgical trauma team are overwhelmingly interested in implementing CAM for symptom management for critically ill patients. Despite this, many reported a lack of sufficient evidence, a lack of personal knowledge and lack of comfort with its use for the in their own practice. This work highlights the need for development of evidence surrounding the usefulness of CAM for critically ill trauma patients, as well as the inclusion of educational modules for CAM therapies in acute care.Further work should be done to explore barriers to implementation and programs to increase provider comfort and confidence with CAM.