Assessment Tools for Contextual Factors in Interactions in CAM

描述（由申请人提供）：该提案解决了一个与补充和替代医学（CAM）治疗相关的基本主题：我们如何衡量一次会面的背景？遭遇被定义为患者到达辅助医学诊所和离开诊所之间的经历。这种遭遇可以分为两部分：(a)主要治疗干预的经历（干预）和(b)在干预之前、期间和之后的所有其他经历（背景）。背景效应在评估辅助医疗干预的功效和效果方面起着两个关键作用。首先，情境效应可能会影响治疗的效果（情境作为中介）。其次，情境效应实际上可能直接影响结果（情境即干预）。在经典的随机对照试验中，研究人员通常希望控制情境作为中介的效应，并测量情境作为干预的效应，以弄清结果的哪一部分是由于干预，哪一部分是由于情境。在CER中，研究人员不太关心控制情境作为中介效应，但他们想要了解相遇的哪一部分可以解释任何积极的结果。在任何一种情况下，调查人员都必须知道如何衡量上下文。没有这些措施，就不可能评估任何一种环境效应。该提案有三个具体目标：1。了解患者在CAM接触过程中暴露于哪些环境因素？2. 确定如何通过观察和/或患者和提供者回忆可靠地测量这些背景因素；和3。评估背景因素在CAM模式（即脊椎指压疗法与整骨疗法）内部和之间的差异程度；(b)实践地点，(c)提供者，和(d)个体患者遭遇本研究将使用脊椎指压治疗遭遇作为CAM的范例，并开发一种快速人种学观察方法来研究遭遇的背景。该项目的目标是开发一种可靠、有效和严格的方法来收集有关上下文的数据。拟议的研究解决了所有健康结果研究的一个基本问题：如何衡量环境对健康结果的影响。

DESCRIPTION (provided by applicant): This proposal addresses a fundamental topic relative to Complementary and Alternative Medicine (CAM) treatments: How do we measure the context of an encounter? Encounters are defined as what patients experience between when they arrive at a CAM practice site and when they leave. The encounter can be divided into two parts: (a) the experience of the main treatment intervention (the intervention) and (b) all other experiences before, during, and after the intervention itself (the context). Contextual effects play two critical roles in assessing the efficacy and effectiveness of CAM interventions. First, contextual effects may mediate how well a treatment works (context as mediator). Second, context effects may actually contribute to outcomes directly (context-as-intervention). In a classic RCT, investigators typically want to control for context-as-mediator effects and measure context-as-intervention effects to disentangle what portion of the results are due to the intervention and what are due to the context. In CER, investigators are less concerned about controlling for context-as-mediator effects, but they would like to understand what part of the encounter accounts for any positive results. In either case, investigators MUST know how to measure the context. Without such measures, it is impossible to assess either type of context effect. This proposal has 3 specific aims: 1. to understand what kinds of contextual factors patients are exposed to during CAM encounters? 2. To determine how to measure such contextual factors reliably via observation and/or patient and provider recall; and 3. To assess the degree to which contextual factors might vary within and across (a) CAM modalities (i.e., chiropractic versus osteopath); (b) practice sites, (c) providers, and (d) individual patient encounters This study will use the chiropractic encounter as an exemplar for CAM and develop a rapid ethnographic observation method to study the context of the encounter. The objective of this project is to develop a reliable, valid, and rigorous methodology for collecting data about the context. The proposed study addresses a fundamental issue of all outcome studies in health: how to measure the effect of the context on the health outcomes.