Table 1.

Barriers to Integrative Medicine Approaches for Patients With Sickle Cell Disease

Barriers	Descriptive Quote
Lack of process	Well, in short, unfortunately there isn't a great process for these things, and it's very dependent on what and who is available at the time. —Nurse practitioner (NP)
Lack of resources (providers to do the treatments)	And then also having enough people that are certified and trained to do these things like Reiki and acupuncture. It'd be nice if we had access to them, but I don't know how many people are truly certified to do these things. —Physician
Buy-in	I think the big thing for me is if you can get the patients/families to buy in to it. So I think part of that is in sort of the presentation of how you talk about these strategies as being helpful. I'm very careful never to say that this is going to take all your pain away, because that is unrealistic and sets up a bad expectation. —Psychologist
Cost	I mean some of our patients can't afford to park here! The last thing that they are thinking about is going and having a massage! —Nurse
Lack of provider comfort/training	I'm not so familiar with it [Reiki] so I don't discuss it that often. I don't like talking about things I don't know anything about. —NP
Lack of time	I think that… um, we have a limited about of time per patient, and so we hit them with the things that are tried and true, and mainstream, and you know, if you have an extra 5 min, you may bring it up, or if the family brings it up, you may talk about it. But otherwise, you usually don't have enough time to talk about these therapies. That's another barrier, in terms of one of our barriers, a physician barrier. —Physician
Lack of evidence	There are many things which we think may be beneficial, but they have not been clearly tested in a clinical trial or some other setting. —Physician
Difficulty of teaching a skill or a new modalities during an acute pain episode	I think when you are in the midst of a crisis, we can teach the strategies, but at least anecdotally, it's not necessarily going to be as effective as if they had been practicing all along and had trained their body to be able to respond to the cues. —Psychologist