Table 3.

Creative Solutions to Promote Integrative Medicine for Patients With Sickle Cell Disease

Creative Solution	Barrier Addressed/Facilitator Utilized	Descriptive Quotes
Develop protocols	Lack of process Lack of provider comfort/training Lack of time Difficulty in teaching a skill or a new modalities during an acute pain episode Buy-in Starting early and reinforcing often	I think we almost need to create like a clinic for it. Almost like the infant clinic. And I think if we were to do something like a CAM clinic, that it would probably be someplace that providers would send their patients as part of their routine sickle cell care. —Nurse So I think some kind of organizational structure would be helpful, you know if we say that, even if it's just like one visit every time a kid turns 6, then they see a psychologist [to learn relaxation strategies]. —Psychologist
Parent/patient education sessions and handouts	Buy-in Lack of time Starting early and reinforcing often	I think they [SCD patients/families] would be [receptive to IM], I think when we raise it, most of them, I find, are receptive. But, it's just kind of a culture of how we teach them about fevers, and penicillin, and managing pain, and how we talk about motrin, oxycodone and all those medicines, we should just frame it in the same way, so it could become part of the treatment plan. Not forcing it, but just making sure they know it's there, because I find that most of the time, they are receptive to it. —NP
List of community CAM providers	Lack of time Lack of provider comfort/training	I think if we had kind of a go to of resources that were in the hospital, and in the community, it would be a lot easier to talk to families, and to be able to give them something. It's very hard to say, well you should try this, but I don't know where you can go, or how much it will cost. —NP
Yoga for inpatients	Buy-in Starting early and reinforcing often	I think it would be really neat if our hospital could have like a yoga program or something for our patients, especially the inpatients. —NP
Grant funding to support IM	Culture of collaboration Cost Lack of time Lack of evidence	A grant funded study that will provide a person that can come in and train, and do 1 or 2 therapies with an endpoint of effectiveness… because of the time commitment and lack of reimbursement, you would need it to be on a grant funded study that someone is being paid for their time to do the training and do actually do whatever intervention. —Physician
Increase training	Lack of provider comfort/training Lack of evidence	I would love to be able to know how to teach guided imagery, I would love to be able to sit in on a session by one of our psychologists when they do that. —Physician

Abbreviations: CAM, complementary and alternative medicine; IM, integrative medicine; NP, nurse practitioner; SCD, sickle cell disease.