Identifying Therapeutic Relationship Themes in Long-Term Complementary and Alternative - PowerPoint Presentation

1. Identifying Therapeutic Relationship Themes in Long-Term Complementary and Alternative Medicine Breast Cancer Survivorship: Implications for Integrative Patient-Centered Care Vinita Agarwal, PhDSalisbury University USAVirtual Poster Presentation (PowerPoint) to the Global Approaches of Integrative Oncology session at the National Cancer Institute, Trans NCI-NIH Conference on International Perspectives on Integrative Medicine for Cancer Prevention and Cancer Patient Management, Natcher Conference Center, NIH Main Campus, Bethesda, MD USA Author note:*The study was supported by an institutional Building Research Excellence grant. *Part of the study data (yoga therapy providers) was presented at the Symposium for Yoga Research at Kripalu. [Agarwal, V. (2019). Accepted abstracts. Integrating yoga therapy principles in breast cancer survivorship follow-up care: Tailoring Patanjali’s sutras to empower, restore, and heal. International Journal of Yoga Therapy, 29, Supplement 2, 22—46. doi:https://doi.org/10.17761/1531-2054.29.s2.1]

2. Aims/ObjectivesAim: To identify CAM therapeutic relationship themes specific to breast cancer survivors to inform patient-centered care (PCC) in integrative breast cancer settings. Background:Intersubjective engagement with others aids our learning about the external world and our relationship with the world. Human interactions are pre-reflective as we do not consciously reflect before engaging (Merleau-Ponty’s, 1962 phenomenological view). In PCC, providers seek to make sense of the patients’ perceptions (e.g., chronic pain, CP) in their lived context by employing narrative communicative styles mirroring their patients’ mental state through self-awareness and self-reflexivity (Davidsen, 2009). Such practices help bridge the gap between the patient’s perspective and the provider’s understanding of the patient’s health in immediate and direct ways (Agarwal, 2018; Baarts et al., 2000). In PCC, rather than positioning the patient as an objective, static entity, the provider adopts an open-ended understanding of their own self, situating their communication on an understanding that is closely intertwined in a relational matrix comprising the patient and the care context.

3. MethodsParticipants: CAM providers, based in N. America, who were active practitioners for the past 1-year and have had in the past year or currently have breast cancer survivors as clients were recruited using purposive-and snowball-sampling (N=15; Table 1, in part). Project Goals and Desired Outcomes: Based on prior research (Agarwal, 2011; 2017a, 2017b, 2018), a semi-structured qualitative interview protocol was constructed to assess patient-provider relationship, provider characteristics, and survivorship treatment challenges. Semi-structured interviews were audio-recorded, professionally transcribed verbatim (253 single-spaced pages), and analyzed using grounded theory. Ensuring visibility and including participant voice and awareness of limitations helped address reliability and validity. Data Analytic Methods: Inductive case study approach using qualitative grounded theory methods (Table 2, preliminary barriers)

4. Results & ConclusionsResults: Emergent themes included whole-person support through provider employment of self-reflexivity in facilitating: (a) embodiment, (b) mind-body-process connection, and (c) metacognitive dialogue supporting movement through fear, body acceptance, and shared decision making. Analysis: Breast cancer survivorship therapeutic relationship dimensions of embodiment, self-reflexivity, intuitive listening, and meta-cognitive dialogue were identified. Ongoing challenges: Scale construction for embodiment, self-reflexivity, intuitive listening, and meta-cognitive dialogue. Potential opportunities: The therapeutic relationship can bridge patient-survivor transition in long-term breast cancer chronic care continuum. Conclusions: Integrate provider self-reflexivity to facilitate embodiment, intuitive listening, and metacognitive dialogue Framework for constructing a supportive therapeutic relationship as defined by connection, movement through fear, body sensation acceptance, self-observation, and shared decision-making in the primary care domain to bridge integrative care in breast cancer survivorship. Contact Information: Vinita Agarwal, Ph.D., Department of Communication, 1101 Camden Ave., FH 272, Fulton School of Liberal Arts, Salisbury University, Salisbury MD USA 21801Email: vxagarwal@salisbury.edu | Telephone (Office): 410-677-0083 | URL: https://www.salisbury.edu/faculty-and-staff/vxagarwal