Naturopathic Medicine for Endometriosis (NatME) Program: a pilot feasibility trial

The proposed study will investigate a novel approach to delivering naturopathy to people with endometriosis using a group visit model based on the shared medical appointment model. The study will involve 6 x 2-hour group sessions over 12 weeks (one session per fortnight) with 5-10 participants per group. The study intervention will reflect real-world naturopathic practice, so each participant will receive a naturopathic treatment plan which may consist of any of the following or a combination of the following: dietary recommendations, lifestyle and self-care recommendations, natural medicines or nutritional supplements. A program manual has been developed which the naturopathic practitioner will follow which outlines a curriculum for each session within which they will apply their naturopathic treatments to each patient. The curriculum covers patient education about endometriosis, links between digestive system, immune, food and endometriosis, and lifestyle and self-care strategies for managing endometriosis. The program manual was developed based on the available literature, and in consultation with Naturopath practitioner experts in endometriosis and patients living with endometriosis (through focus groups), and in consultation with experts in the field of group medical visits - predominantly Associate Professor John Stevens from Australasian Society of Lifestyle Medicine (who trains clinicians in shared medical appointments across Australia and New Zealand); and Dr Paula Gardiner from the University of Massachusetts (who is the researcher who developed the Our Whole Lives program which uses integrative medicine group visits for chronic pain, has been tested in trials and is now used by clinicians in the US). The program structure is based on that of the Our Whole Lives program and adapted to endometriosis with feedback and guidance from Dr Paula Gardiner. Treatments will include dietary guidance for each patient in the group according to their needs, self-care, and the possibility of herbal or nutritional medicines depending on the needs of the patient and their preference and budget (there is no cost for the intervention but prescribed natural medicines will be paid by the participant should they wish to, and the naturopaths will give them recommendations and low or no-cost options depending on their preference. Examples of self care or lifestyle recommendations will be at the discretion of the naturopath and what they use in their clinical practice and what the needs of the individual patient are (as naturopathy is whole-systems and individualised system of medicine) but the program was designed in consultation with naturopath experts in endometriosis and recommendations may include mindfulness activities, application of castor oil packs (external), dietary adjustments (e.g. increased anti-inflammatory foods minimisation of alcohol and/or caffeine as examples only), herbal medicine or nutritional supplementation ( diet/symptom diaries will be completed by participants which will guide the naturopaths on dietary and nutritional needs of each patient as in real-world practice). The intervention will be delivered by a naturopath who is registered with an Australian professional association, has over 5 years experience in clinical practice and identifies as specialising in or experienced with endometriosis management. There will be 4 naturopaths in the study who will run one cohort each. The naturopaths have also undertaken training in shared medical appointments through the Australasian Society of Lifestyle Medicine, and will be supported by a co-facilitator will play an administrative role by keeping notes, keeping discussion on topic and to time and ensuring the naturopath has had an opportunity to attend to each participant in the group each session. Session attendance checklists will be kept and notes will be kept each session about challenges and successes of the participants with implementing the recommendations of the naturopath.