Traditional acupuncture: exploring the rationale and theory of change in the specific context of early breast cancer and chemotherapy in research and practice

Acupuncture is an increasingly popular complementary therapy. Acupuncture research, however, leaves uncertainty as to its effectiveness and raises question about what traditional acupuncture (TA) is. This thesis aims to examine what acupuncture is, by using the Theory of Change (ToC) as a novel approach to elucidate the pathways for change. Early breast cancer (EBC) is used as a complex exemplar providing the TA practitioner with the opportunity to utilise TA in all of its complexity. A ToC framework was developed from the professional accrediting body of TA. This ToC framework was applied to two sets of literature: firstly acupuncture research where validated outcome measures were used; secondly research on the exploration of practitioner and patients’ perceptions of TA. A longitudinal study was constructed to examine change over time during the EBC experience. This study entailed interviewing 14 women before, during and after chemotherapy while they received up to ten sessions of TA. The two practitioners were also interviewed; they kept diaries and treatment logs of the process creating additional data. Grounded theory methods were used to analyse the data. The ToC was refined after analysis of all the data to provide a comprehensive insight into the components of TA providing further weight to the idea that it is a complex intervention. Treatment entails a continuous process with multiple pathways to change. TA offers great flexibility in addressing chronic illness with acute features or daily fluctuations of a range of problems. The concept of outcome patterns arose from this which is ripe for further exploration. The therapeutic relationship is part of the intervention, used to engage the individual with new insights into health and changing behaviour as well as to enable disclosure leading to person-centred goals of treatment. Therapeutic befriending emerged as a notion suitable for further exploration within CAM.