Standardised Chinese herbal medicine for oligomenorrhoea and amenorrhoea in polycystic ovary syndrome: Nominal group technique study

Problem

Polycystic ovary syndrome (PCOS) affects an estimated 6-18% of women of reproductive age and oligo- and amenorrhoea are cardinal symptoms. First-line treatment with oral contraceptives or insulin-sensitising agents is not always effective or suitable for all women. Preliminary research conducted by this team concluded that Chinese herbal medicine (CHM) prescribed by herbal practitioners may be a promising therapeutic option. In order that CHM can be prescribed in primary care however, it is necessary to evaluate a standardised CHM prescription that could be offered directly to patients. This research aims to develop a standardised 4-herb prescription for PCOS-related oligomenorrhoea and amenorrhoea and to explore the feasibility of using nominal group technique (NGT) to seek consensus amongst herbal medicine experts.

Approach

This NGT study involves two rounds of contact with a purposive sample of 7 herbal experts. The first NGT round is a questionnaire survey where participants will provide their clinical opinions on effective herbal combinations and treatment strategies. Qualitative questionnaire data will be analysed using content analysis whilst descriptive analysis will be used for quantitative data. This data will inform the topic guide for the second NGT round and facilitate the composition of three herbal prescriptions – each containing 4 herbs – informed by these responses.In the second NGT round, the same participants will attend a focus group discussion which will be audio-recorded and transcribed. Two facilitators will present the three herbal treatments derived from participant responses. Each participant will be invited for individual comment and a group discussion will follow. We will amend the contents of one or more of the herbal prescriptions in real-time as a direct result of comments from participants. At the end of the group discussion, individual voting will take place for each of the herbal prescriptions. The highest ranking prescription will be considered the most appropriate to evaluate in a subsequent observational study. The transcription of the focus group discussion will be thematically analysed to examine the feasibility of using this approach for seeking consensus and to explore areas where opinions were more divided. This will enable us to highlight areas of conflict as well as agreement when reporting our findings.

Findings

We have recruited 4 practitioners to date with the focus group discussion scheduled for April 2017. Our results will be available for presentation in July 2017.

Consequences

By the end of this study, we will have a practitioner-informed CHM prescription suitable for evaluation in an observational study which will explore the safety and clinical effectiveness of this prescription for oligomenorrhoea and amenorrhoea in PCOS. We will have evaluated the feasibility of using NGT to seek consensus amongst herbal medicine experts and will provide recommendations regarding future research using NGT as a way of maximising model validity for clinical trials in herbal medicine.