S03: Tools for Measuring and Enhancing Contextual Factors in Healing

Carol Greco1,Ronald Glick1, Wayne Jonas2

1UPMC Center for Integrative Medicine, USA; 2Samueli Institute, USA


Trials of integrative medicine interventions frequently fail to show significant effects beyond “sham” or “placebo” controls. Although such results may be due to lack of efficacy of the treatment, they may also reflect a lack of attention to unmeasured capacities for healing such as patients” health beliefs and expectations, and supportive patient-provider interactions that may be at work in both “placebo” and active treatments.  These unmeasured capacities can be termed “non-specific contextual factors.”  Concise tools to assess these contextual factors are needed. For researchers, such tools could lead to improved clinical trial methodology.  In clinical settings, the tools could be used to assess organizational needs, and to guide improvements to the physical and social environment of healing.  This symposium describes tools for measuring contextual factors involved in healing, and practical approaches for enhancing these healing factors. We will present our instrument development work, in which item response theory (IRT) will be applied to develop item banks. The item banks can be used to create brief but accurate computerized adaptive tests that assess the patient’s perception of contributors to healing.  This NCCAM project, The Healing Context in CAM: Instrument Development and Initial Validation, uses the instrument development methods of the NIH Roadmap Initiative, Patient Reported Outcomes Measurement Information System (PROMIS) to develop and validate a family of self-report measures to assess contextual factors such as attitudes towards health, the clinical environment, and patient views of the patient-provider relationship. The overall methodology includes qualitative methods such as interviews with experts, patient focus groups, and “think-aloud” interviews on individual items, as well as quantitative methods such as factor analyses, IRT calibrations on local patients and internet samples, differential item functioning, and validation in integrative and conventional medicine settings.  This symposium will also address approaches for enhancing contextual healing factors in the clinical setting.  As understanding of the important contextual factors involved in healing has grown, there is growing interest in applying this knowledge in the clinical setting and in health care organizations.  We will provide practical information on how to augment healing features of the physical environment, simple methods for fostering therapeutic, collaborative patient-provider relationships, and guidelines for creating an organizational culture that can enhance the patient’s healing process.