Complementary medicine use by Australian women with gynaecological cancer

Barriers to Applying Integrative Oncology from the Perspective of the Care Providers in Iran: A Mixed-Methods Study

OBJECTIVE

The present study aims to explain and determine the use of integrative oncology from the perspective of the care providers in Iran.

DATA SOURCES

This mixed-methods study is a convergent type of study with quantitative and qualitative phases that have been performed simultaneously. The quantitative phase was a descriptive study that was conducted through convenience sampling. With the use of a psychometrically evaluated questionnaire with 10 items, 202 nurses and physicians were included in the study to assess their views on the integration of traditional and complementary medicine (TCM) within supportive cancer care. The qualitative part of the study was conducted through semistructured interviews with 11 care providers. The interviews were analyzed through conventional content analysis and the method proposed by Graneheim and Lundman with the use of MaxQDA software.

CONCLUSION

After the quantitative and the qualitative data were combined, we identified four main categories as the important dimensions of using TCM: patients' main expectations of TCM services, reasons for using these services, existing challenges and barriers, and recommendations and strategies to improve the interaction between physicians and patients to facilitate the use of integrative oncology .

IMPLICATION FOR NURSING PRACTICE

Although cancer patients use TCM due to a wide range of expectations, there are many barriers to integrative oncology in Iran. Therefore, it is necessary to pay attention to the benefits of conventional medical and TCM treatments, conceptualize integrative oncology, and try to meet the existing challenges.

Exploring traditional and complementary medicine use by Indigenous Australian women undergoing gynaecological cancer investigations

BACKGROUND

Indigenous Australian women experience worse gynaecological cancer outcomes than non-Indigenous women. While traditional and complementary medicine (T&CM) is increasingly used by cancer patients alongside conventional treatments, little is known about T&CM use by Indigenous women. This study aimed to explore the beliefs, attitudes and experiences related to T&CM use and disclosure among Indigenous women undergoing gynaecological cancer investigations.

METHODS

A mixed-methods design explored T&CM use among Indigenous women who presented for gynaecological cancer investigation at an urban Queensland hospital (September 2016 and January 2018).

RESULTS

Fourteen women participated. The reported use (86%) and perceived value of T&CM was high among the participants, however, women reported major challenges in communicating with healthcare providers about T&CM, commonly associated with trust and rapport.

CONCLUSIONS

These findings highlight the need for strategies to facilitate culturally-appropriate doctor-patient communication around T&CM to foster trust and transparency in gynaecological cancer care for Indigenous women.

Complementary medicine use by the Australian population: a critical mixed studies systematic review of utilisation, perceptions and factors associated with use

BACKGROUND

There is increasing evidence that complementary medicine (CM) services are being used by a substantial proportion of the Australian population and this topic has attracted keen interest from primary health care providers and policy makers. This article outlines the first summative critical review of the predictors of CM use in Australia as well as the characteristics and perceptions of Australian CM users over the last 14 years.

METHODS

A literature search was conducted to ascertain original research from 2000 to 2014 in the AMED; CINAHL; and PubMed databases. Selected articles were subject to a critical appraisal analysis to identify the quality of the article. The search was confined to peer reviewed original articles published in English which identified the nature of CM services use in Australia.

RESULTS

The findings indicate a correlation between CM users and gender, with reports of a higher rate of use from females compared to males. Female CM users are more likely to be middle-aged with a higher education and higher annual income in comparison to female non-CM users. An association between resident location and use of CM disciplines was also identified with reports of rural residents utilising manual therapies more frequently compared to urban residents. CM users are more likely to seek CM services for a range of chronic conditions including diseases identified as National Health Priority Areas by the Australian Government.

CONCLUSIONS

This article provides the first comprehensive review examining the nature of CM use in Australia. The review findings offer important insights into the characteristics and features of CM use in Australia and provide insights for national and regional primary health care initiatives and of interest to medical doctors, allied health professionals, CM practitioners, researchers and policy makers.

Understanding the Attitudes of Patients with Cancer Toward Complementary and Alternative Therapies

BACKGROUND

The high prevalence of complementary and alternative medicine (CAM) use among patients with cancer can be explained by reasons such as growing scientific evidence and improved regulation. However, subjective considerations are also relevant for practicing CAM and perceiving its effectiveness. The current study aimed at qualitatively estimating patients' prior beliefs and expectations, as well as their level of satisfaction after the treatment.

PATIENTS AND METHODS

Patients with cancer who received six weekly sessions of CAM during their oncologic treatments participated in the study. They detailed their prior expectations and their level of posttreatment satisfaction. The open-ended answers were analyzed using interpretative phenomenological analysis. In addition, the contents before and after the intervention were compared.

RESULTS

Over a 2-year period, 163 patients entered the study, 135 of whom completed all six CAM sessions. The content analysis of the pretreatment expectations revealed four main categories: emotional, physical, external, and aspects related to the practice of CAM. After the intervention, patients referred to the therapeutic encounter as a significant aspect, in addition to the emotional and physical ones.

CONCLUSION

CAM sessions encouraged emotional and relational aspects in patients' perspectives, which may be highly relevant for their coping process. Encouraging personal motives may increase treatment efficacy and ensure optimal use of health care resources.

Quality of life, perceptions of health and illness, and complementary therapy use among people with type 2 diabetes and cardiovascular disease

OBJECTIVES

To explore perceptions of health and illness, and the use of complementary and alternative medicine (CAM), among people with type 2 diabetes and/or cardiovascular disease (CVD), and relate these to quality of life.

DESIGN

A self-administered survey was delivered by mail and internet. The questionnaire was designed from data generated from qualitative research and other sources, to collect information on health-status, CAM use, and health and illness perceptions. Quality of life was compared among participants using Assessment of Quality of Life (AQoL-4D).

SUBJECTS

Adults with type 2 diabetes and/or CVD residing in Victoria, Australia, whether or not they used CAM therapies as well as conventional medical treatment.

OUTCOME MEASURES

Comparisons were made of AQoL-4D utility scores, demographic, health and wellbeing status, care-seeking and health management behaviors, and behavioral and illness perception variables. A range of descriptive statistical and predictive modeling techniques were used to assess significant associations (p<0.01) between CAM-user and non-user populations.

RESULTS

From a sample of 2766 people, 45.1% had used CAM in the past 12 months and the remainder had never used CAM; ages ranged from 20-96 years. CAM-users tended to report lower (worse) quality of life measures than non-users, and a greater number of chronic conditions in addition to diabetes and CVD. Despite this, CAM-users reported their illness perception and behavioral change more positively than non-users. There was little difference between CAM and non-users in use of prescription medications despite CAM-users greater disease burden.

CONCLUSION

Higher CAM use and low quality of life appear to reflect comorbidity and poor general health. Greater evidence is needed of how CAM use might support chronic illness prevention and complement chronic disease management, with important policy implications concerning the integration of CAM therapies with mainstream health services.

Attitudes of patients with gynecological and breast cancer toward integration of complementary medicine in cancer care

OBJECTIVE

The purpose of this study was to explore prospectively the perspectives of patients with breast and gynecological cancers regarding integration of complementary and alternative medicine (CAM) in conventional oncology settings.

METHODS

We developed a 27-item questionnaire that was administered to convenient sample of patients with breast cancer and another with gynecological cancer who were attending a community-based oncology service in northern Israel.

RESULTS

Of the 275 respondents, 109 (39.6%) had gynecological cancers and 166 (60.4%) had breast cancer. Current and/or previous year CAM use for oncology treatment was significantly higher among the patients with gynecological cancer (73/166 [44%] vs 67/106 [63%], P = 0.03). A logistic regression model indicated that CAM use was associated with gynecological cancer (EXP [B], 2.51; 95% confidence interval for EXP [B], 1.29-4.88; P = 0.007], younger age, Jewish religion, and lesser degree of religiosity. The patients highly expected their gynecologist-oncologist and family doctor to refer them to CAM counseling. Moreover, they expected their gynecologist-oncologist to participate in building a CAM treatment plan if CAM were to be integrated into the oncology service. The patients expected the CAM consultant to inform them of the safety and efficacy of CAM treatments, emphasizing expectations to strengthen their general ability to cope with the disease, reduce chemotherapy side effects, and provide emotional and spiritual support.

CONCLUSION

Although patients with gynecological malignancies use CAM significantly more than patients with breast cancer, both groups share similar conceptions regarding the active role of their gynecologist oncologists in the process of CAM integration within supportive care and expect CAM consultation to focus on improving their well-being.

Defining research priorities in complementary medicine in oncology

OBJECTIVES

The high usage of complementary and alternative medicines (CAM) by cancer patients is increasing, despite limited research available to support their use. Therefore identifying research priorities that can inform the evidence base for CAM treatment is relevant for many stakeholders, including funders, researchers and consumers.

DESIGN AND SETTING

Integrative medicine experts, oncologists with interest in CAM research, consumer representatives and CAM practitioners and researchers took part in a modified Delphi process conducted online over three rounds. In round 1 each participant recommended up to five CAM research priorities, which were collated and ranked in round 2 by their potential usefulness in cancer care, using a Likert scale. In round 3, participants ranked the remaining propositions by their ability to impact cancer care in Australia. The lowest ranking priorities were eliminated at the completion of each round.

RESULTS

From the 122 propositions originally submitted by the 27 participants, the highest scoring ones included: studying interactions between biologically based CAM and conventional cancer treatments, examining CAM effects on quality of life, identifying effective communication strategies around CAM, studying the role of physical activity in symptom relief and cancer prevention and exploring the role of acupuncture in cancer care.

CONCLUSION

This method of research prioritisation achieved consensus of opinion among a very diverse group of stakeholders, invited to collaborate around a highly polarising topic. Through a structured interaction, the group agreed on a priority research list acceptable to all stakeholders, which can serve as a blueprint for CAM research in oncology in Australia.

The experience of using complementary therapies after a diagnosis of cancer: a qualitative synthesis

This article describes a qualitative synthesis of published research on cancer patients' experiences of complementary therapies. We conducted a systematic search for qualitative studies on this subject published between 1998 and 2007. Twenty-six refereed journal articles met the inclusion criteria. These 26 articles were repeatedly read by the research team and key concepts emerging from them were identified. Differences and variations were examined in association with treatment, therapy type and by stage of cancer (early stage, mid-treatment, advanced cancer, palliative care and long term 'survivors'). Six overarching concepts were located, which describe the key aspects of patients' experiences of the use of complementary and alternative medicine after a diagnosis of cancer: Connection; Control; Well-being; Transformation; Integration; and Polarization. These are described in a 'line of argument' synthesis, and differences associated with treatment type and stage of disease are noted. The findings are presented in a table showing the six concepts according to treatment type and stage; as a composite story; and in a diagrammatic model showing the individual, practitioner and organizational levels. The synthesis identified various specific ways in which complementary therapies supported cancer patients, as well as occasional negative effects. The most notable barrier was the perceived polarization of complementary therapies and biomedicine; patients reported better experiences in integrated settings.

The use and perceived benefits resulting from the use of complementary and alternative medicine by cancer patients in Australia

AIM

The use of complementary and alternative medicine (CAM) by cancer patients is growing. However, few studies have examined the perceived benefits and adverse effects resulting from the use of CAM by cancer patients. The aim of this study was to evaluate CAM use by cancer patients and to explore their perceptions of the benefit, safety and efficacy of CAM in general.

METHODS

Oncologists from three university teaching hospitals screened patients for eligibility. Eligible patients (N = 1323) were mailed a letter of invitation with a questionnaire between January and May 2008.

RESULTS

Overall 381 questionnaires were returned, showing that 65% of cancer patients used at least one form of CAM. Patients considered taking biological CAM before, during and after chemotherapy. Up to 90% of CAM users believed that CAM provided potential health benefits and less than 3% reported adverse effects experienced from the use of CAM. Most respondents (80%) believed CAM can provide health benefits even when efficacy has not been proven. Most patients (90%) believed that doctors should consider learning about CAM to provide appropriate advice to their cancer patients, and most (83%) indicated they would be happier to accept CAM if it was offered by the hospital.

CONCLUSION

A substantial portion of Australian cancer patients use CAM. Given the limited data on efficacy and safety for most CAM, it may be reasonable to offer CAM within the hospital environment so its use can be monitored and patients can receive more evidence-based care.

Cancer Patients' Experiences of Using Complementary Therapies: Polarization and Integration

Objective

The use of complementary therapies by people with cancer is commonplace. In a recent synthesis of 26 qualitative studies of patients' experiences of complementary therapy use after a diagnosis of cancer, the emergent theme of ‘polarization’ was the most notable barrier to a positive experience of complementary therapies. In this paper, we explore the two synthesis concepts of ‘polarization’ and ‘integration’, and their relationship to health service policies and guidelines on integrated services.

Methods

A systematic literature search and a meta-ethnography to synthesize key concepts.

Results

The majority of patients who used complementary therapies after a diagnosis of cancer wanted to be certain that the therapies were not interfering with their conventional cancer treatment. They valued the therapies in wider terms including: taking ‘a niche of control’, relieving symptoms, improving wellbeing, and promoting reconnection and social interaction. The emergent theme of ‘polarization’ suggested that conventional physicians who are perceived to be poorly informed or negative about complementary approaches induce patient anxiety, safety concerns, and difficulties in access. They may compromise their therapeutic relationship and, rarely, they may trigger patients to abandon conventional medicine altogether. In contrast, integrated advice and/or services were highly valued by patients, although some patients preferred their complementary health care to be provided in a non-medicalized environment.

Conclusions

Our findings suggest that the current polarized situation is unhelpful to patients, detrimental to therapeutic relationships and may occasionally be dangerous. They indicate that complementary therapies, in a supportive role, should be integrated into mainstream cancer care.

Cancer survivorship, mor(t)ality and lifestyle discourses on cancer prevention

Despite ongoing controversies regarding the impact of lifestyle factors such as body weight, diet and exercise on health, this framework has become increasingly prominent in understandings of cancer aetiology. To date, little consideration has been given to the impacts of such discourses on people with a history of cancer. Drawing on an ethnographic study of cancer survivors, I explore the constitutive dimensions of these discourses and the ways that they shape the subjectivities of women and men with a history of the disease. Overall, the study participants evidenced a complex and ambivalent engagement with such discourses. While they were generally unwilling to accept that their lifestyle had an impact on the development of their cancer, to varying degrees they endorsed the idea that weight, diet and exercise affected cancer progression. However, this acceptance was generally borne of an active desire to gain control over the uncertainty of living with the disease and was mediated by other aspects of the experience of surviving cancer.

"Researcher saturation": the impact of data triangulation and intensive-research practices on the researcher and qualitative research process

Theoretically and methodologically sound qualitative research demands an extended period of fieldwork and the use of multiple methods to achieve data saturation and develop the grounded theory. Little is known about the experiences of researchers who conduct such studies. The authors explore these matters by drawing on their experiences of conducting a 3-year qualitative study with women about their gynecological cancer journey. Their fieldwork consisted of participant observation and in-depth interviews with women and health professionals. They demonstrate that researchers who are involved in all phases of emotionally demanding research; that is, data collection (recruiting, observing, expanding field notes, and interviewing), transcription, and data analysis repeatedly relive difficult events, which might potentially compromise the researchers' well-being and, in turn, the research process and data validity. The authors discuss how researchers can deal effectively with these matters during fieldwork and propose a more formal approach to debriefing.