Internationale Koordination
Anthroposophische Medizin
Freie Hochschule für Geisteswissenschaft
Medizinische Sektion am Goetheanum

Patient Perspective in Anthroposophic Medicine Research

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Anthroposophic Medicine/AM aims to enhance health and transformation in human beings. How can we be sure that AM has realised what AM is aiming for? There are two main perspectives to be used: On one side, research may ask, how patients perceive anthroposophic interventions and on the other side, research may ask, what patients need. For each perspective different research methods are available to realise this aim. This overview is limited to methods and aspects of the patient perspective in medical research already to be found in the AM literature. Other methods are available and can be added. Currently the following methods and approaches have been used:

1. Evaluation of patient’s perception of anthroposophic medicine
  • using qualitative methods, for example to evaluate stress reduction and eurythmy therapy (Berger et al., 2015a
  • using reviews of qualitative studies of patient perception, for example of Viscum album (mistletoe) therapies (Evans et al., 2016)
  • collecting data regarding satisfaction with the anthroposophic service compared with conventional medicine (Esch et al., 2008)
  • using existing patient relevant outcome measures (like self efficacy) to evaluate patient perception of treatment (Büssing, 2010; Büssing et al., 2017)
  • developing specific measuresments to evaluate patient-relevant outcomes (Büssing, 2010; Kröz et al., 2013; Koster et al., 2016; Baars et al., 2017; Kröz et al., 2017)
2. asking patients what they need
  • using reviews of existing studies (Franzel et al., 2013)
  • using different qualitative methods even including methods to support patients in recognition and reflection on treatment effects from an anthroposophic perspectiv, including Drawings (Cramer et al., 2013; Lauche et al., 2012; Böning, 2016)
  • using methods to include patients in clinical decision making (Berger et al., 2015b; Schwarz et al., 2016)
  • empowering and improving patients’ competencies in dealing with the health care system (Berger et al., 2010; Berger, 2013; Berger et al., 2013; Stock et al., 2015)
3. supporting patients in self management and self efficacy and health literacy when preventing or dealing with their (chronic) diseases

  • development of structured self - management programs (Berger et al., 2017a)
  • assessing aspects of Anthroposophic Medicine in this field (Baars et al., 2017)
  • individual support in self - efficacy through introspection and biographic reflection (Michaelis et al., 2012; Michaelis et al., 2014; Michaelis et al., 2017)
  • regarding the development of patient information, decision aids material and patient education as a complex intervention using existing tools and scientific methods (Muhlhauser and Berger, 2002; Steckelberg et al., 2005; Berger et al., 2008)
4. using patient perception to develop theoretical concepts or study designs
  • developing study designs from patient perspective and supporting patients in realising their own study designs (Musial, 2015; Berger et al., 2017b)
  • developing theoretical concepts based on patient perception (Berger et al., 2015a)

June 2018

For further details contact:
Dr. Bettina Berger,
Chair of Medical Theory, Integrative and Anthroposophic Medicine,
Research Associate,
bettina.berger@uni-wh.LÖSCHEN.de,
Tel.: 0049-2330- 624763

Exemplary literature

Büssing A, Bertram M (2010). Questionnaire to measure reactions of the ‘Sentiment Body’ during anthroposophically based therapies. Focus on Alternative and Complementary Therapies 11, 8-9.
DOI: https://doi.org/10.1111/j.2042-7166.2006.tb04727.x.

Baars E, Koster E, Verhoef J (2017). The contribution of anthroposophic medicine to self-management: an exploration of concepts, evidence and patient perspectives. Complementary Medical Research 34(4), 225-231. DOI:
https://doi.org/10.1159/000478981.

Berger B, Bertram M, Kanitz J, Pretzer K, Seifert G (2015a). "Like walking into an empty room": effects of eurythmy therapy on stress perception in comparison with a sports intervention from the subjects' perspective-a qualitative study. Evidence-Based Complementary and Alternative Medicine 2015, Article ID 856107, 11 pages. DOI:
https://doi.org/10.1155/2015/856107.

Berger B, Gerlach A, Groth S, Sladek U, Ebner K, Muhlhauser I et al. (2013).Competence trainingin evidence-based medicine for patients, patient counsellors, consumer representatives and healthcare professionals in Austria: a feasibility study. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 107(1), 44-52. DOI:
https://doi.org/10.1016/j.zefq.2012.11.013

Berger B, Lenz M, Muhlhauser I (2008).[A satisfied patient--a good doc? To what extent is patient satisfaction an indicator of quality in general practice? A systematic review]. Zeitschrift für Evidenz,Fortbildung und Qualität im Gesundheitswesen 102(5), 299-306. DOI:
https://doi.org/10.1016/j.zgesun.2008.01.004.

Berger B, Schwarz C, Heusser P (2015b). Watchful waiting or induction of labour--a matter of informed choice: identification, analysis and critical appraisal of decision aids and patient information regarding care options for women with uncomplicated singleton late and post term pregnancies: a review. BMC Complementary and Alternative Medicine 15, 143. DOI:
https://doi.org/10.1186/s12906-015-0663-y.

Berger B, Sethe D, Hilgard D, Heusser P (2017a). Design of a self–management program for children aged 6-12 with Type 1 Diabetes mellitus at the Community Hospital Herdecke, Germany. Complemantary Medical Research 24(4), 255-263. DOI:
https://doi.org/10.1159/000479532.

Berger B, Stange R, Michalsen A, Martin DD (2017b). "Prolonged Fasting in T1DM – case study from patient perspective", European Conference of Integrative Medicine (Berlin).

Berger B , Steckelberg A, Meyer G, Kasper J, Muhlhauser I (2010). Training of patient and consumer representatives in the basic competencies of evidence-based medicine: a feasibility study. BMC Medical Education 10, 16. DOI:
https://doi.org/10.1186/1472-6920-10-16.

Büssing A, Jung S, Lötzke D, Recchia D, Robens S, Ostermann T et al. (2017). Randomized clinical trial to treat patients with chronic back pain: a comparison of the efficacy of Yoga, Eurythmytherapy and standard physiotherapy. World Conference of Integrative Medicine and Health. DOI:
https://doi.org/10.1186/s12906-017-1782-4.

Cramer H, Lauche R, Haller H, Langhorst J, Dobos, G, Berger B (2013). "I'm more in balance": a qualitative study of yoga for patients with chronic neck pain. Journal of Alternative and Complementary Medicine 19(6), 536-542. DOI:
https://doi.org/10.1089/acm.2011.0885.

Esch, B.M., Marian, F., Busato, A., and Heusser, P. (2008).Patient satisfaction with primary care: an observational study comparing anthroposophic and conventional care. Health and Quality of Life Outcomes 6, 74.
DOI:
https://doi.org/1477-7525-6-74.

Evans M, Bryant S, Huntley AL, Feder G (2016).Cancer Patients' Experiences of Using Mistletoe (Viscum album): A Qualitative Systematic Review and Synthesis. Journal of Alternative and Complementary Medicine 22(2), 134-144. DOI:
https://doi.org/10.1089/acm.2015.0194.

Franzel B, Schwiegershausen M, Heusser P, Berger B (2013).Individualised medicine from the perspectives of patients using complementary therapies: a meta-ethnography approach. BMC Complementary and Alternative Medicine 13, 124. DOI: https://doi.org/10.1186/1472-6882-13-124.

Koster EB, Baars EW, Delnoij DM (2016). Patient-centered outcomes on quality of life and anthroposophic healthcare: a qualitative triangulation study. Quality of Life Research 25(9), 2257-2267. DOI:
https://doi.org/10.1007/s11136-016-1276-8.

Kröz M, Fink M, Reif M, Grobbecker S, Zerm R, Quetz M et al. (2013). Multimodal therapy conceptand aerobic training in breast cancer patients with chronic cancer-related fatigue. Integrative Cancer Therapies 12, 301-311. DOI:
https://doi.org/10.1177/1534735412464552

Kröz M, Reif M, Glinz A, Berger B, Nikolaou A, Zerm R et al. (2017). Impact of a combined multimodal-aerobic and multimodal intervention compared to standard aerobic treatment in breast cancer survivors with chronic cancer-related fatigue - results of a three-armed pragmatic trial in a comprehensive cohort design. BMC Cancer 17(1), 166. DOI:
https://doi.org/10.1186/s12885-017-3142-7.

Lauche R, Cramer H, Haller H, Musial F, Langhorst J, Dobos GJ et al. (2012). My back has shrunk: the influence of traditional cupping on body image in patients with chronic non-specific neck pain. Forschende Komplementmedizin 19(2), 68-74. DOI:
https://doi.org/10.1159/000337688

Michaelis R, Andrews DJ, Reiter JM, von Schoen-Angerer T (2014). Resolving cognitive dissonance by acquisition of self-organizational skills may decrease drug-resistant seizures - A case report. Epilepsy and Behavior Case Reports 2, 64-66. DOI:
https://doi.org/10.1016/j.ebcr.2014.03.003.

Michaelis R, Niedermann C, Berger B (2017). How can we enhance the sense of self-efficacy in epilepsy? Individual answers from two qualitative case reports. Forschende Komplementärmedizin 3, 215-224. DOI:
https://doi.org/10.1159/000468986

Michaelis R, Schonfeld W, Elsas SM (2012). Trigger self-control and seizure arrest in the Andrews/Reiter behavioral approach to epilepsy: a retrospective analysis of seizure frequency. Epilepsy and Behavior Case Reports 23(3), 266-271. DOI:
https://doi.org/10.1016/j.yebeh.2011.11.023.

Muhlhauser I, Berger M (2002). Patient education - evaluation of a complex intervention.Diabetologia 45(12), 1723-1733. DOI:
https://doi.org/10.1007/s00125-002-0987-2.

Musial F (2015). Patients as Active Partners in Research - a Fashionable Phrase or a Fundamental Paradigm Shift? Forschende Komplementmedizin 22(4), 224-225. DOI:
https://doi.org/10.1159/000439318.

Schwarz C, Gross MM, Heusser P, Berger B (2016). Women's perceptions of induction of labour outcomes: Results of an online-survey in Germany. Midwifery 35, 3-10. DOI:
https://doi.org/10.1016/j.midw.2016.02.002.

Steckelberg A, Berger B, Kopke S, Heesen C, Muhlhauser I (2005). Kriterien für evidenzbasierte Patienteninformationen. [Criteria for evidence-based patient information]. Zeitschrift für ärztliche Fortbildung und Qualität im Gesundheitswesen 99, 343-351.

Stock S, Altin S, Palmowski S, Berger B, Passon A (2015). Patients' advocates and counselors: Perceived needs in education and training. Patient Education and Counseling 98(11), 1431-1438. DOI:
https://doi.org/10.1016/j.pec.2015.06.014