The Dutch healthcare system is under pressure and faces many challenges with the rising number of elderly and people with chronic conditions [1], increasing workload for healthcare professionals[2] and rising healthcare costs. This has enforced a paradigm shift towards patient-centred care where lifestyle, prevention and patient’s ownership regarding their health (self-management) are becoming increasingly important [3], [4]. These newly demanding changes in healthcare could be partly met by the use of the various types of complementary care which are commonly based on whole person health, a holistic view of the human being, patient-centred care and on promoting the self-healing capacity of the body [5].
Data on the use of complementary care in the Netherlands is scarce. Kemppainen et al. reported that 14.1% of the Dutch population had used at least one complementary therapy over the last 12 months in 2016[6]. In various patient populations this number is higher, for instance the use of complementary care in people with chronic joint pain is estimated to be as high as 86% [7], one third of children visiting a paediatrician use complementary care [8] and 42.4% of children visiting a paediatric oncologist use complementary care [9].
Although complementary care is generally being applied on a small scale in hospital settings, often unstructured and without any policy and procedures, there has been an increase in the interest and use of complementary therapies over the past decades, especially in oncology, in psychiatry and in palliative care settings for symptoms such as anxiety, stress, pain and fatigue [10]. This is also reflected in the growing number of initiatives regarding non-pharmacological interventions in hospitals and nursing homes and integrative outpatient clinics [11], [10]. Therefore, there is need for guidance and implementation of complementary care, since the infrastructure of the Dutch healthcare system does not facilitate this [11].
Guidelines on complementary therapies for general practitioners (GPs) were developed in 2008 (revisioned in 2022) by the Royal Dutch Medical Association [12]. However, these guidelines only describe conditions under which a GP is allowed to practice complementary care himself, but does not give any guidance about communication, referral or collaboration.
In 2016, a first model was developed for the integration of complementary therapies into primary healthcare in the Netherlands, with patients’ needs as starting point [13]. An important step is to build an integrative collaborative network of GPs and complementary care practitioners [14]. Moreover, shared decision making was introduced to facilitate discussions on complementary care between patients and GPs. Shared decision making includes discussion of the patients’ health problems and history, complementary therapy options which enables the patient to make safe and well-informed decisions consistent with her values and preferences.
However, patients mostly do not discuss their complementary therapy use during a consultation with their GP. They expressed the need that they would rather want their GP to listen, to inform them about complementary care options and if necessary, to refer them to or collaborate with complementary healthcare practitioners (HCPs) [7]. Patients would benefit from an active involvement of GPs concerning communication and shared-decision making on possible referral to complementary therapies. On the other hand, the main barriers in primary care to communicate, collaborate with and refer to complementary care are the lack of knowledge about complementary therapies, their effectivity and safety, lack of concrete information to provide to patients and lack of knowledge about the reliability and professional standards of complementary care practitioners [13].
In a previous project in the Netherlands, needs and wishes were assessed of complementary HCPs of five modalities (acupuncture, chiropractic, osteopathy, homeopathy and naturopathy) and GPs regarding communication and collaboration in complementary care in a series of focus group discussions [15]. The result was a first evidence-based communication toolkit aimed to be used by complementary HCPs to contact and communicate with GPs about their treatment of mutual patients. It was concluded that communication between conventional and complementary HCPs should be further strengthened and the tools should be further expanded, optimized and implemented. Since this toolkit was targeted solely towards GPs, it was desired to extend towards other conventional HCPs, such as medical specialists, nurse practitioners and physiotherapists.
This paper describes the process and outcome of a co-creation research project that aimed to strengthen communication and collaboration between complementary and conventional HCPs and improve mutual collaboration between complementary HCPs in the Netherlands. In three field labs the existing communication toolkit was assessed and updated, new communication tools were developed, and implementation strategies were discussed. Additionally, researchers aimed to develop an evidence based decision aid for complementary care for 13 complementary therapies and 6 indications.