I am an acupuncturist working for Dimbleby Cancer Care, an integrative oncology department in Guy’s and St Thomas’ NHS Foundation Trust. As part of my MSc from the Northern College of Acupuncture, I recently conducted a service evaluation, where I navigated the dual role of being a researcher-practitioner.
As a novice researcher, I was expecting to be challenged throughout the process. Yet I had not anticipated the influence that being a researcher-practitioner would have at every stage of the project.
When designing the research project, I made decisions that took into account my role as a researcher-practitioner, such as how informed consent was taken, or choosing to use questionnaires over interviews. These decisions were made in order to reduce participation bias (the desire of the participant to please the researcher). I was aware that a researcher’s beneficence is to society whereas a practitioner’s is to their patients, creating potential conflict where the practitioner’s duty of care to patients should prevail over the researcher’s (Aita and Richer, 2005). With this in mind, I was attempting to separate my role as researcher from my role as practitioner, ensuring both ethical research and practice. At the design stage, I thought these decisions were well thought out, and other than a brief mention in the limitations, no more consideration would be required.
Before giving informed consent, I advised potential participants to take time to fully read the Participation Information Sheet and ask any questions they may have. Despite such precautions, I still held the dual role of the researcher requesting consent and the practitioner delivering treatments. It was noteworthy that almost all patients gave consent whilst the remaining few did not return for treatments. When reflecting on this, I was aware there had to be some participation bias in these decisions, despite my attempts to mitigate for such eventualities. Did the patients truly have a free choice? Does this impact the ethics of the research? I used my research journal to reflect on these, and other pertinent questions as they arose. In doing so, my understanding of this dual role evolved over the course of the project, which I will further illustrate using examples from my journal.
At times, I grappled with the internal tension between prioritising the best care for the patient as their practitioner and my interest in the research. For example, when a patient told me of their worsening symptoms, I was immediately curious as to how they would subsequently report their experience of acupuncture. As their practitioner I would usually only be concerned with their symptomatic change. This curiosity felt immediately inappropriate. When reflecting on the experience, I was able to identify the conflict, allowing me to ensure that the patient’s best interests were not compromised. Furthermore, this reflective process allowed me to identify similar events and respond reflexively going forward.
I decided to utilise questionnaires rather than interviews because I thought their use would reduce participation bias. However, there were occasions when their use challenged my role as a researcher-practitioner. For example, discrepancies occasionally arose between the written responses in the completed questionnaire and the verbal information conveyed to me as the practitioner. I was uncertain whether the cause of these discrepancies was a result of misreading or misunderstanding the questions, or if it was a conscious decision made by the participant. Consequently, I was concerned about the impact of potentially incorrect data on my results. It was only through reflecting on each example in my research journal that I was able to conclude that all data needed to be included as provided. I needed to ensure that any additional insights I may hold as the practitioner had to be disregarded.
A similar example occurred when I possessed more detailed information concerning the circumstances of a participant’s experience of acupuncture than was reported in the questionnaire. This was frustrating because of the stark contrast between the richness of the data I possessed and the sparsity of the data provided. This occurred towards the end of the data collection period, and by this time, I had reflected on numerous other examples. I was able to respond reflexively, knowing that I was only able to include the written data.
Neither of these examples would have occurred had I used interviews instead of questionnaires, yet I had dismissed interviews because of the higher risk of participation bias. Would interviews have been the preferable option? I would have already established rapport and trust as the practitioner, allowing for richer data collection. However, participants with negative experiences would be more likely to omit information (Jack, 2008). Both options require a self-awareness of my own bias and power in the relationship alongside reflexivity. In hindsight, I might have included a purposeful sample of interviews nested within a questionnaire study.
There are interesting lessons to learn from these experiences. A researcher-practitioner has a moral obligation to prevent exploitation by being a reflective practitioner (Costley and Gibbs, 2006). Equally, reflexivity is required to be aware of the complexity and contradictions inherent throughout the research project (Appleby, 2013). Reflecting on the challenges as they occurred was a learning experience and allowed for greater reflexivity as the project progressed.
At the start of this project, I would have chosen to work in a team and not have to encounter these issues. However, this process has had a positive impact on me. As an experienced practitioner, I am very comfortable with contradictions during the treatment process and respond reflexively where necessary. I have learnt to harness this reflexivity during the research process and accept the inherent challenges; I have grown as both a researcher and practitioner, and this can only have a positive impact on future research endeavours.
It is often the practitioner that becomes researcher in the world of complementary and integrative medicine and understanding the value of this role is important. As the recent recipient of the George Lewith Memorial Prize, it is fitting to conclude with his thoughts that the “…tension inherent in the identity of being a practitioner-researcher is frequently uncomfortable but it is a vital contribution to deepening our understanding of what constitutes CAM and how we can properly evaluate it” (Lewith et al., 2009 p344).
Aita, M. and Richer, M.-C., 2005. Essentials of research ethics for healthcare professionals. Nursing and Health Sciences, 7, pp.119–125.
Appleby, M.M., 2013. The Nature of Practitioner Research: Critical distance, power and ethics. Practitioner Research in Higher Education, 7, pp.11–21.
Costley, C. and Gibbs, P., 2006. Researching others: Care as an ethic for practitioner researchers. Studies in Higher Education, 31(1), pp.89–98.
Jack, S., 2008. Guidelines to Support Nurse-Researchers Reflect on Role Conflict in Qualitative Interviewing. The Open Nursing Journal, 2, pp.58–62.
Lewith, G., Brien, S., Barlow, F., Eyles, C., Flower, A., Hall, S., Hill, C. and Hopwood, V., 2009. The meaning of evidence: Can practitioners be researchers? Forschende Komplementarmedizin, 16(5), pp.343–347.