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A pre- and post-test intervention design to develop a communication training model for practitioners of traditional Chinese medicine (TCM): a pilot study



 

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In Hong Kong, the increasing availability of TCM in the healthcare system makes more patients choose it on top of or in additional to Western Medical (WM) treatment. In the light of this expanding trend, it calls for a need to investigate the role of effective clinical communication in TCM context, particularly for communicating with patients who seek both TCM and WM care. In a TCM consultation, the comprehensive account of multiple body sensors and organs in TCM is different from WM because TCM practitioners tend to pay more attention to the patient’s personal experience, taking a holistic view of the patient’s physical body, the organs’ conditions and relationship with their environment. In contrast, WM doctors may perhaps only focus on identifying the primary clinical concerns of a patient that have caused the illness, using scientific evidence. Illnesses are mainly diagnosed through the use of empirical data obtained from a range of physical examinations with the help of high-end medical apparatuses and instruments. In Hong Kong healthcare context, the risk analysis reports from the Hospital Authority, along the recent media coverage on medical incidents and hospital crises, revealed that an effective health communication is pivotal to the current health care system in Hong Kong, and that there is a need to build a well-informed framework for education and professional development for health care professionals.

Background

About

This project is funded by Health and Medical Research Fund, under the Hong Kong Government, Food and Health Bureau, and the aim is to develop an intervention to train TCM practitioners to communicate effectively with patients who can understand and incorporate patient’s Western-based medical history during diagnosis and treatment, with the ultimate goals of improving TCM practitioners’ communication skills in the provision of their patient-centered care. 

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Mission

Supported by Health and Medical Research Fund (HMRF), Dr. Jack Pun, an Assistant Professor from the Department of English at CityU, and his team designed a communication intervention based on the Calgary-Cambridge guides for teaching effective doctor-patient communication skills and modified it for TCM context, in collaboration with TCM professors/researchers from School of TCM at HKBU and CUHK. The aim of the intervention is to enhance the communication skills of TCM practitioners by offering them a structural communication framework to elicit their patients’ Western-based medical history and allowing space for discussions about treatments and diagnosis, taking account of the patients’ western medical encounters.

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Vision

The finding of this projet aims to significantly improve the providers' patient-centred communication and the TCM practitioners' communication proficiency post-training. Based on the results, the team develops and validates an effective communication model that will integrate TCM and WM in HK. The framework helps the trained TCM practitioners better integrate their patients' Western medical history when delivering patient care.

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Details of the pilot study

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There were eight TCM practitioners participating in the project, four were in the control group and another four in the experimental group. They are registered Cantonese-speaking practitioners in Hong Kong randomly recruited in HA tripartite clinics (with TCM training qualifications in mainland China, and in three HK universities: HKU, CUHK and HKBU). Using pre-test, post-test and delayed-post test, communication skills of the participated TCM practitioners were evaluated in terms of their quality of interaction, coverages of topics under Calgary-Cambridge guides on effective doctor-patient communication. 

For control group, TCM practitioners delivered consultation according to their usual practice without much of consideration of patients’ western medical history.  On the other hand, the experimental group was given in training focused on patient-centred communication, with an international recognized and validated in global consultation settings communication framework (e.g. Calgary-Cambridge guide) on how to take a patient's Western medical history and communicate diagnosis and treatment plans. Consultations before and after training were recorded and rated by using trained raters to measure the quality of the interactions. The efficacy of the training was evaluated by comparing the two groups before training (baseline) and immediately after training, and at 3-month intervals.

Measure Methods

Using validated scales, the primary outcomes were measured for the practitioners' clinical communication skills and the quality of interactions. Other secondary outcomes were measured in terms of patient compliments and understanding of their treatment, plus patient satisfaction. After controlling for baseline scores, TCM practitioners’ age, qualification, working experience and their prior knowledge of western medicine using a structured questionnaire, the mean scores of TCM consultations in both the experimental and control groups were calculated using independent t-test, in order to determine whether there are any group differences between TCM practitioners with and without training in terms of their clinical communication skills, quality of interactions, patient activation levels and satisfaction.

Expected Outcomes

The result should show that the intervention is successful in promoting better communication amongst those TCM pracitioners in the experiment groups where they elicit patients about their wester-medical history. For control group, TCM practitioners delivered consultation according to their usual practice without much of consideration of patients’ western medical history. In contrast, patients in the experimental group were invited actively to discuss their medical history from past Western-based medical treatments.

Related Publication

  1. Pun, J. & Wong, W. (2022). Navigating communication between conventional medicine and traditional Chinese medicine: A case study of patients with cancer in Hong Kong. Supportive Care in Cancer. https://doi.org/10.1007/s00520-022-06986-8.

  2. Pun, J. and Chor, W. (2020). Use of Questioning between Traditional Chinese Medicine Practitioners and Patients to Realize TCM Philosophy: Holism, Five Elements and Yin-Yang in the Context of Doctor–Patient Communication, Health Communication.https://doi.org/10.1080/10410236.2020.1828533

  3. Pun, J. (2020). Moments of 'touch' as a way for mental support in Traditional Chinese Medicine consultations: Analysis of the interactional process of co-constructing understanding of the patient's body conditions in Hong Kong. Complementary Therapies in Medicine. https://doi.org/10.1016/j.ctim.2020.102516 

  4. Pun, J., Chor, W. & Zhong, L. (2019). Delivery of patient-centered care in complementary medicine: Insights and evidence from the Chinese medical practitioners and patients in primary care consultations in Hong Kong. Complementary Therapies in Medicine. https://doi.org/10.1016/j.ctim.2019.06.013

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