Healthcare professionals’ attitudes towards

acupuncture: an analysis of barriers and

enablers to its integration

Zhang, M, N1,2; Zheng, Z1; Vesty, G1

1. School of Health and Biomedical Sciences, RMIT University,

Bundoora, Victoria, Australia

2. School of Nursing, Midwifery and Paramedicine, ACU,

Melbourne, Australia

My Research / Thesis

Australian doctors and nurses or midwives’

attitudes and perceptions of acupuncture and

acupressure practice in Perioperative Care-

National Survey

RMIT University 2

http://i.dailymail.co.uk/i/pix/2017/03/02/12/3DDFF69100000578-0-image-a-

17_1488456787923.jpg

Figure 1. Matthews (2017),

http://www.dailymail.co.uk/health/article-4274898/Ditch-

paracetamol-try-ACUPUNCTURE.html.

Figure 2. “Acupressure”. n.d.

https://fullbodybalancing.com/acupressure-5-benefits-

health/

Definition of terms

•Acupuncture: needles

•Acupressure: pressure

•Complementary and Alternative Medicine (CAM)

–broad set of health care practices ≠

conventional medicine

RMIT University 3

Side Effects after operations/GA

PONV Pain (Post Operative Nausea and Vomiting)

RMIT University 4

Figure 3. Gayer (2014), http://www.outpatientsurgery.net/guides/ambulatory-

anesthesia/2014/images/9_prevention.jpg

Figure 4. “Boy in hospital bed” (2016),

http://www.med.uio.no/helsam/english/research/projects/pediatric-pain-

management-practices-postoperative/

Aims and Study Design

Study 1

Literature Review

Aim 1

Purposive literature review to identify key themes associated with barriers,

enablers and acceptance of acupuncture use in perioperative care

Study 2

National Survey

Aim 2

Examine the beliefs, attitudes, perceptions, clinical use, knowledges and perceptions of Australian

doctors and nurses toward the use of acupuncture and acupressure in perioperative care

Further analysis of Study 2

Aim 3

Identify any potential barriers that may impact on the implementation of the use of acupuncture /

acupressure in perioperative care

RMIT University 5

Why examine attitudes?

Proven Effectiveness

Cochrane review: compared PC 6 stimulation with

sham treatment →PC6 acupoint stimulation

significantly ↓ the incidence of nausea, vomiting and

the need for rescue antiemetics (Lee, Chan & Fan, 2015).

Acupuncture (Level I), specifically auricular

acupuncture (Level I [PRISMA] ↓ postoperative pain,

opioid requirements as well as opioid-related adverse

effects compare to a variety of controls (Schug et al., 2015).

RMIT University 6

Why examine attitudes? (Continued)

Attitudes of physicians – 80% considered it is effective & safe

Current literature focuses on CAM in general

High referral rate of acupuncture

Australia: 70-80% (Easthope et al., 2000; Wardle et al., 2013)

International: 50-94% (Chen et al., 2010)

RMIT University 7

Literature Search Strategies

To explore the attitudes and perceptions of

acupuncture use in peri-operative care

Integrative Review

Broadest type of research review method inclusion of

experimental and non-experimental research

Study selection-Purposive sampling

PRISMA flowchart of study selection process followed

- 12 studies selected

RMIT University 8

PRISMA Flowchart

RMIT University 9

Literature Review Findings

Perceptions and attitudes

• Overall positive attitudes and perception among

surveyed health care professionals despite low

knowledge of and exposure to acupuncture.

• GPs took a favourable view towards both the efficacy

and cost effectiveness of acupuncture among other

physicians (Wardle, Sibbrit & Adams, 2013; Norheim & Fonnebo, 1998; Lipman,

Dale & MacPherson, 2003; Czarnawska-Illiev & Robinson, 2016).

Who referred patients and to whom

GPs, Age groups, Sex

RMIT University 10

Literature Review: Findings (Continued)

Barriers and enablers of integrating acupuncture

into conventional medicine (Manias et al, 2015)

Three themes identified

–Intrapersonal

–Interpersonal

–Environmental & External

RMIT University 11

Findings (Continued)

1. Intrapersonal barriers +/- enablers

- Knowledge of and exposure to acupuncture

- Personal use

- Prior positive experiences

- Prescribed CAM previously and comfortable with referral to

acupuncture

- Belief in the efficacy of acupuncture

- Perceived lack of evidence

- Scepticism and Prejudice

RMIT University 12

Findings (Continued)

2. Interpersonal barriers +/- enablers

-Patients’ own request

-Number of patients asking about acupuncture

-Using CAM practitioners for source of information

-Direct interactions with the acupuncturists to build trust

-Patient feedback and refusal

-Different medical paradigms of Western Medicine and Traditional

Chinese Medicine

RMIT University 13

Findings (Continued)

3. Environmental/External barriers +/- enablers

-Lack of options

-Side effects from conventional therapies

-Availability of credentialed providers

-Difficulty in finding a practitioner

-Lack of reimbursement & insurance coverage

-Lack of regulation

-Logistical (facility, issues with administration such as frequency, timing,

length of time, hospital setting, body parts, number of needles)

RMIT University 14

Limitations of prior research: areas to

further explore

• Low response rate associated with large online

studies

• Bias with regional/small number of participants/single

site study

–limits the generalisability of results

• Cultural diversity and geographical differences

• Missing data from nurses!!!

RMIT University 15

Implications for future clinical practice

•Change in patient and societal interest in CAM.

•Healthcare professionals must be well informed about

acupuncture and the potential benefits and limitation.

•Attitudes are important to this integration. Knowledge shapes

attitudes.

•Education is the key!!!

RMIT University 16

Overcoming Barriers Figure 2: A conceptual framework for translating evidence into

practice adapted from Gonales et al (2012)

RMIT University 17

Key Points

• The national survey (Study 2) focuses on the GAP

between translating evidence into practice

• Participants including nurses/midwives (whom spend

most of our time with our patients during their

hospitalization!!!)

• First nationwide survey in Australia

• Willingness of receiving further education has been

included in the survey questionnaire.

• Provide the foundation for further studies

RMIT University 18

Quote

“Innovation is taking two things that already

exist and putting them together in a new way.”

Tom Freston

RMIT University 19

References

• Chen, L., Houghton, M., Seefeld, L., Malarick, C., & Mao, J. (2010). A survey of selected physician views on

acupuncture in pain management. Pain Medicine, 11, 530-534.

• Czarnawska-Iliev, I., & Robinson, N. (2016). General Practitioners’ use of and attitudes to acupuncture in

relation to the UK’s National Institute for Health and Care Excellence (NICE) clinical guidelines – a pilot

study. European Journal of Integrative Medicine, 8, 342-354. Retrieved from:

http://dx.doi.org/10.1016/j.eujim.2016.07.004.

• Donald, G.K., Mackeret, P., & Tobin, I. (2010). Medical students and acupuncture: a short sharp placement

experience. Acupuncture Medicine, 28(1),12-15. doi: 10.1136/aim.2009.001602. PubMed PMID: 20351370.

• Easthope, G., Tranter, B., & Gill, G. (2000). Normal medical practice of referring patients for complementary

therapies among Australian general practitioners. Complementary Therapies in Medicine, 8, 226–233. Retrieved

from: http://dx.doi.org/10.1054/ctim.2000.0398

• Faircloth, A. (2014). Perceptions of acupuncture and acupressure by Anaesthesia provider (VCU Theses and

dissertation). Paper 3586

• Fries, C. J. (2008). Classification of complementary and alternative medical practices. Canadian Family

Physicians, 54, 1570-71. PubMed PMID: 19005130.

• Giordano, J., Boatwright, D., Stapleton, S., & Huff, L. (2002). Blending the boundaries: steps toward an

integration of Complementary and Alternative Medicine into mainstream practice. Journal of Alternatively and

Complementary Medicine, 8, 897-906. doi: 10.1089/10755530260511892. PubMed PMID: 12614540.

• Gonzales, R., Handley, M.A., Ackerman, S., & O’Sullivan P.S. (2012). Increasing the translation of evidence

into practice, policy, and public health improvements: a framework for training health professionals in

implementation and dissemination science. Academic Medicine, 87, 271-8. doi:

10.1097/ACM.0b013e3182449d33. PMCID: PMC3307591.

RMIT University 20

References (Continued)

• Johnston, M.F, Hui, K. K., & Bastani, R. (2005). Incorporating acupuncture into oncologic practice: how

clinical need shapes physicians acceptance. Journal of Cancer, 3, 11-12. Scopus ISSN: 15446301.

• Lee, A., Chan, S,K,C., Fan, L, T, Y. (2015). Stimulation of the wrist acupuncture point PC6 for preventing

postoperative nausea and vomiting. Cochrane. Retrieved from:

http://www.cochrane.org/CD003281/ANAESTH_wrist-pc6-acupuncture-point-stimulation-prevent-nausea-

and-vomiting-after-surgery

• Lipman, L., Dale, J., & MacPherson, H. (2003). Attitudes of GPs towards the provision of acupuncture on the

NHS. Complementary Therapies in Medicine, 11, 110-114. doi: 10.1016/S0965-2299903)00042-6

• Manias, E., Rixon, S., Williams, A., Liew, D., & Braaf, S. (2015). Barriers and enablers affecting patient

engagement in managing medications with specialty hospital settings. Health Expectations, 18(6), 2787-2798.

doi: 10.1111/hex.12255

• Moher,D., Liberati, A,, Tetzlaff, J., & Altman, D.G, (2009). The PRISMA Group. Preferred Reporting Items

for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Medicine, 6(7):e1000097. Retrieved

from: http://dx.doi.org/10.1371/journal.pmed.1000097

• Norheim, A. J., & Fonnebo, V. (1998). Doctors’ attitudes to acupuncture-a Norwegian study. Social Science &

Medicine, 47(4), 519-523. Retrieved from PubMed.

• Schug, S.A., Palmer, G. M., Scott, D. A., Halliwell, R., & Trinca, J. (2015). Acute Pain Management: Scientific

Evidence (4th ed.). Melbourne: Australian and New Zealand College of Anaesthetists and Faculty of Pain

Medicine.

• Shao, J, Y, J., Borthwick, A, M., Lewith, G, T., & Hopwood, V. (2005). Attitudes towards traditional

acupuncture in the UK. Evidence Based Integrative Medicine, 2(1), 37-45. Retrieved from AMED.

RMIT University 21

References (Continued)

• Wardle, J.L., Sibbrit, D., & Adams, J. (2013). Acupuncture referrals in rural primary healthcare: a survey of

general practitioners in rural and regional New South Wales Australia. Acupuncture in Medicine, 31, 375-382.

doi: 10.1136/acupmed-2013-010393

• Whittemore, R., & Knafl, K. (2005). The integrative review: updated methodology. Journal of Advanced

Nursing, 52, 546-553.

• World Health Organization (WHO). (n.d). Acupuncture: review and analysis of reports on controlled

clinical trials. Retrieved from apps.who.int/medicinedocs/pdf/s4926e/s4926e.pdf

• Ytrehus, I. A., Norheim, A J., Emaus, N., & Fonnebo, V. (2010). Physicians become acupuncture patients-not

acupuncturists. The Journal of Alternative and Complementary Medicine, 16(4), 449-455. doi:

10.1089/acm.2008.06434

RMIT University 22

Thank you

RMIT University 23