BMJ Open BMJ Open: first published as 10.1136/bmjopen-2014-006178 on 8 September 2015. Downloaded from A qualitative research on the use of traditional Korean medicine (TKM) in patients with chronic fatigue ForJournal: peerBMJ Open review only Manuscript ID: bmjopen-2014-006178 Article Type: Research Date Submitted by the Author: 13-Mar-2015 Complete List of Authors: Son, Haeng-Mi; Department of Nursing, University of Ulsan Park, Eun Young; College of Nursing, Gachon University Kim, Duck Hee; Department of Nursing, Woosuk University Kim, Eunjeong; Department of Nursing, Daedong College Shin, Mi-Suk; Department of nursing, Daejeon University Kim, Tae-Hun; Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University <b>Primary Subject Complementary medicine Heading</b>: Secondary Subject Heading: Qualitative research COMPLEMENTARY MEDICINE, QUALITATIVE RESEARCH, Adult palliative Keywords: care < PALLIATIVE CARE http://bmjopen.bmj.com/ on October 2, 2021 by guest. Protected copyright. For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 24 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2014-006178 on 8 September 2015. Downloaded from 1 2 3 4 Standards for Reporting Qualitative Research (SRQR) checklist 5 6 7 No Topic Item 8 S1 Title P1 9 10 S2 Abstract P2 11 S3 Problem formulation P5 12 S4 Purpose or research question P5 13 14 S5 Qualitative approach and P6 15 For peerresearch paradigmreview only 16 17 S6 Researcher characteristics and P7 18 reflexivity 19 20 S7 Context P6 21 S8 Sampling strategy P6 22 S9 Ethical issues pertaining to P6-7 23 24 human subjects 25 S10 Data collection methods P6 26 27 S11 Data collection instruments P6 28 and technologies 29 S12 Units of study P8, P23 30 31 S13 Data processing P6 32 S14 Data analysis P6 33 34 S15 Techniques to enhance P7 35 trustworthiness http://bmjopen.bmj.com/ 36 37 S16 Synthesis and interpretation P8-P17 38 S17 Links to empirical data P8-P17 39 S18 Integration with prior work, P18 40 41 implications, transferability, 42 and contribution(s) to the field 43 on October 2, 2021 by guest. Protected copyright. 44 S19 Limitations P19 45 S20 Conflicts of interest P20 46 47 S21 Funding P20 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 24 BMJ Open: first published as 10.1136/bmjopen-2014-006178 on 8 September 2015. Downloaded from 1 2 3 4 5 MS to BMJ Open 6 7 8 9 10 A qualitative research on the use of traditional Korean medicine (TKM) in patients with chronic 11 12 fatigue 13 14 15 For peer review only 16 Haeng-Mi Son1, Park, Eun Young2, Kim, Duck Hee3, Kim, Eunjeong4, Mi-Suk Shin5, Tae-Hun Kim6,* 17 18 19 20 1 21 Department of Nursing, University of Ulsan, Ulsan, Korea 22 23 2 College of Nursing, Gachon University, Incheon, Korea 24 25 3 Department of Nursing, Woosuk University, Wanju, Korea 26 27 4 Department of Nursing, Daedong College, Busan, Korea 28 29 5 30 Department of nursing, Daejeon University, Daejeon, Korea 31 6 32 Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, 33 34 South Korea 35 http://bmjopen.bmj.com/ 36 37 38 *Corresponding author 39 40 41 42 43 on October 2, 2021 by guest. Protected copyright. 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 24 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2014-006178 on 8 September 2015. Downloaded from 1 2 3 4 5 Abstract 6 7 Objectives 8 9 10 To explore the chronic fatigue patient’s perception and experience of traditional Korean 11 12 medicine (TKM) and their motivation for choosing TKM 13 14 Design 15 For peer review only 16 Qualitative one-on-one, in-depth interview study 17 18 19 Setting 20 21 Primary TKM hospitals in Seoul, Inchon and Daejeon, South Korea 22 23 Results 24 25 Fifteen chronic fatigue patents were interviewed in this study. Patients with chronic 26 27 fatigue experienced physical and psychological symptoms that resulted in severe 28 29 30 difficulties associated with routine daily activities. The motivation for choosing TKM 31 32 practice was mainly dissatisfaction with conventional medicine and previous positive 33 34 experiences with TKM. After TKM treatments, patients found that TKM practitioners 35 http://bmjopen.bmj.com/ 36 considered fatigue to be a treatable illness and patients felt comfortable with the 37 38 doctor-patient relationship in TKM practice. 39 40 41 Conclusion 42 43 Health care providers need to be concerned with the symptoms of chronic fatigue to a on October 2, 2021 by guest. Protected copyright. 44 45 degree that is in line with the patient’s own perceptions; TKM might present a possible 46 47 solution that can redeem conventional medicine and is an approach that has 48 49 50 considerable influence on Korean patients. 51 52 Keywords 53 54 Chronic fatigue, traditional Korean medicine, TKM, qualitative research 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 24 BMJ Open: first published as 10.1136/bmjopen-2014-006178 on 8 September 2015. Downloaded from 1 2 3 4 5 Article summary 6 7 Strengths and limitations of this study 8 9 10 Traditional Korean medicine (TKM) is a unique medical system which shares identical origin, 11 12 interventions and medical theory with traditional Chinese medicine but has been developed and 13 14 practiced in a specific context of Korea. 15 For peer review only 16 This is the first qualitative research on the perception and experience of patients with chronic fatigue 17 18 about TKM. This study results suggest detailed insight into the patient's attitude to usage of TKM 19 20 21 treatment. Practitioners are able to use the findings for understanding behaviour of the patients with 22 23 chronic fatigue for seeking complementary and alternative treatments including TKM for health 24 25 promotion. 26 27 For our one-on-one, in-depth interview, we recruited interviewees through the referral from TKM 28 29 30 physicians and snowball sampling method which potentially affected the characteristics of the 31 32 interviewees who might be positively biased toward TKM treatments. 33 34 From this study, we found that chronic fatigue patients believed that their symptoms were related to 35 http://bmjopen.bmj.com/ 36 normal aging and personal characteristics as well as physical illness. Dissatisfaction with conventional 37 38 medicinal treatment was the key motivation for choosing TKM clinics. Patients had tendency to 39 40 41 participate in the TKM treatment willingly even though it demands endurance of long-term and 42 43 sometimes intolerable treatment process. on October 2, 2021 by guest. Protected copyright. 44 45 The limitation is that study findings can be only applied to Korean population who uses or at least 46 47 familiar with TKM. 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 5 of 24 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2014-006178 on 8 September 2015. Downloaded from 1 2 3 4 5 Introduction 6 7 8 9 10 Fatigue is generally accepted to be a combination of symptoms that are an acute 11 12 response to physical or mental exertion and is characterised by recovery after rest. 13 14 When fatigue symptoms continue for more than six months, it is defined as a chronic 15 For peer review only 16 condition1. Various types of illnesses are associated with fatigue2, however, many 17 18 patients who complain of severe disability in daily life have fatigue symptoms that 19 20 3 21 cannot be explained by pathological causes . Chronic fatigue syndrome, a condition that 22 23 is defined by a period of more than six months of continuous fatigue without a specific 24 25 underlying disease, is prevalent among the general population in Korea: the prevalence 26 27 is estimated to be 0.6 to 2.0 %, which is quite similar to that found in Western societies 28 29 4 30 (0.5 to 2.5 %) . 31 32 33 34 Traditional Korean medicine (TKM) is a medical practice system included within the 35 http://bmjopen.bmj.com/ 36 orthodox medicine category in Korea. TKM interventions consist of herbal medicine, 37 38 acupuncture, moxibustion, and cupping therapies, similar to those of traditional Chinese 39 40 41 medicine; however, TKM has developed unique medical theories and practice 42 43 manoeuvres that have been influenced by medical practices in other East Asian on October 2, 2021 by guest. Protected copyright. 44 45 countries5. Recent survey results suggest that many Korean patients have had 46 47 experience with the use of TKM for chronic fatigue6. However, the previous study 48 49 50 failed to give any clues as to the motivation for choosing TKM over conventional 51 52 medicine. 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 6 of 24 BMJ Open: first published as 10.1136/bmjopen-2014-006178 on 8 September 2015. Downloaded from 1 2 3 4 5 Systematic reviews (SRs) on the effectiveness of complementary and alternative 6 7 medicine (CAM) interventions including acupuncture, moxibustion and herbal 8 9 10 medicines suggest that these alternative therapies may be effective in improving 11 7-9 12 symptoms related to chronic fatigue .