Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong; Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
Xiang-Ya School of Public Health, Central South University, Changsha, China.
J Pain Symptom Manage. 2019 Dec;58(6):1002-1014.e7. doi: 10.1016/j.jpainsymman.2019.08.002. Epub 2019 Aug 9.
Chinese medicine modalities, including acupuncture and Chinese herbal medicine (CHM), have been used as palliative interventions among cancer patients. More research should be conducted to confirm their effectiveness.
The objective of this study was to prioritize Chinese medicine clinical research questions for cancer palliative care.
Twelve international experts, including physicians, Chinese medicine practitioners, nurses, and clinical research methodologists (n = 3 from each category), from Asia, North America, Australia, and Europe participated in a two-round Delphi survey for prioritizing 29 research questions identified from existing systematic reviews. The experts were asked to 1) rate clinical importance of answering the questions on a nine-point Likert scale; 2) provide qualitative comments on their ratings; and 3) suggest outcome measurement approaches.
Eight research priorities reached positive consensus after the two-round Delphi survey. Six of the priorities focused on acupuncture and related therapies, of which median ratings on importance ranged from 7.0 to 8.0 (interquartile range: 1.00 to 2.50), and the percentage agreement ranged from 75.0% to 91.7%. The remaining two priorities related to CHM, with median ratings ranged from 7.0 to 8.0 (interquartile range: 1.00 to 1.50) and percentage agreement ranged from 75.0% to 83.3%. Neither positive nor negative consensus was established among the remaining 21 questions.
The findings will inform rational allocation of scarce research funding for evaluating the effectiveness of Chinese medicine for cancer palliative care, especially on acupuncture and related therapies. Further research on herb safety and herb-drug interaction should be performed before conducting international trials on CHM.
包括针灸和中药（CHM）在内的中医模式已被用作癌症患者的姑息治疗干预措施。应开展更多研究以确认其疗效。
本研究旨在为癌症姑息治疗中医临床研究问题确定优先次序。
来自亚洲、北美、澳大利亚和欧洲的 12 名国际专家（每类 3 名，包括医生、中医师、护士和临床研究方法学家）参与了两轮 Delphi 调查，对从现有系统评价中确定的 29 个研究问题进行优先排序。专家们被要求：1）对回答这些问题的临床重要性进行九点 Likert 量表评分；2）对他们的评分进行定性评论；3）提出结果测量方法。
两轮 Delphi 调查后，有 8 项研究重点达成了积极共识。其中 6 项重点关注针灸及相关疗法，其重要性评分中位数范围为 7.0 至 8.0（四分位距：1.00 至 2.50），一致性百分比范围为 75.0%至 91.7%。其余 2 项重点与中药有关，评分中位数范围为 7.0 至 8.0（四分位距：1.00 至 1.50），一致性百分比范围为 75.0%至 83.3%。其余 21 个问题既未达成积极共识，也未达成消极共识。
这些发现将为合理分配评估中医治疗癌症姑息治疗有效性的稀缺研究资金提供信息，特别是在针灸及相关疗法方面。在开展中药的国际试验之前，应进一步开展草药安全性和草药-药物相互作用的研究。
