Patterns of complementary therapy use by homebound cancer patients in Taiwan

Use of decision aid to improve informed decision-making and communication with physicians on the use of oral complementary and alternative medicine (CAM) among cancer patients on chemotherapy treatment: a randomised controlled trial

PURPOSE

Complementary and alternative medicine (CAM) is often used by cancer patients and is concerning as concomitant oral CAM and chemotherapy use may result in adverse interactions and toxicities. We hypothesise that a decision aid (DA) may promote informed and rational use of oral CAM during chemotherapy, and increase patients' discussion with their oncologists on CAM use.

METHODS

We randomised 240 patients initiating chemotherapy to receive DA or none. Questionnaires were administered at randomisation (visit 1), 1 month (visit 2) and 3 months (visit 3). The primary endpoint was the decisional conflict score (DCS) for decision made on CAM use during chemotherapy. Secondary endpoints include patients' decision regret score (DRS) on CAM use, CAM uptake, discussion with oncologists on CAM usage, and difference in quality of life (QoL) score between CAM and non-CAM users at visit 3.

RESULTS

There was no difference in the mean DCS (mean difference 2.7 [95 CI - 2.9 to 8.3, p = 0.345]) and DRS (mean difference - 0.3 [95% CI - 6.3 to 5.8, p = 0.926]) between the two arms. There was a reduction in odds of CAM usage in the intervention arm compared to control arm (OR = 0.36, 95% CI 0.17 to 0.78, p = 0.009), but there was no difference in discussion with oncologists on CAM usage (OR = 0.46, 95% CI 0.07 to 3.01, p = 0.419), or in the QoL between CAM and non-CAM users.

CONCLUSION

Our DA did not reduce DCS among cancer patients on chemotherapy. DA that provides more evidence-based information on CAM, and non-judgemental discussion initiated by oncologists to discuss CAM, may improve its effectiveness.

Decision-making related to complementary and alternative medicine use by people with Type 2 diabetes: a qualitative study

AIMS AND OBJECTIVES

To explore how complementary and alternative medicine (CAM) users make decisions about CAM use. Specifically, an exploration of the processes used by people with Type 2 diabetes, related to the assessment of information sources, factors influencing decision-making and the role of other key individuals, was undertaken.

BACKGROUND

Patients with chronic illnesses increasingly seek to use CAM to improve their well-being. Currently, however, the decision-making processes related to CAM use among people with Type 2 diabetes are poorly understood.

METHODS

An exploratory study using a naturalistic design, with in-depth semi-structured interviews, was undertaken. Purposive sampling was used to recruit participants with Type 2 diabetes who used CAM alongside conventional medicine. The data were analysed in a three-step coding process. Ethical approval was gained from a human research ethics committee.

RESULTS

Evidence about CAM use from interview data was consistent with a multi-dimensional decision-making processes used by participants. Four major categories emerged: recognising the need for using CAM; assessing the potential CAM before use; matching CAM use to personal philosophy; and ongoing evaluation of CAM.

CONCLUSION

As diabetes affects the entirety of a person's being self-management, incorporating CAMs has become a way of controlling the condition and improving well-being. It is important for health professionals to consider clients' CAM use and to incorporate this information, where appropriate, into management plans.

RELEVANCE TO CLINICAL PRACTICE

Health care professionals should be aware of patients who use CAM while under conventional medical care and should discuss CAM use at various points in the client journey to facilitate better communication.

Cancer patients' experience of combined treatment with conventional and traditional Chinese medicine: a biopsychosocial phenomenon

BACKGROUND

Traditional Chinese medicine (TCM) is used worldwide as a complementary and alternative medicine, but little is known about cancer patients' experience when using combination therapy of TCM and conventional medicine.

OBJECTIVES

The goal of this study was to understand the experiences of Taiwanese cancer patients undergoing conventional chemotherapy and using TCM at the same time.

METHODS

For this qualitative descriptive study, 9 cancer patients (42-63 years old) were interviewed individually and in depth using a semistructured guide. All interviews were audiotaped and transcribed verbatim. Data were concurrently collected and analyzed using a constant comparative method to develop major themes and categories.

RESULTS

Data analysis revealed 3 themes: (1) biomedical aspect: TCM as a supplementary force to conventional medicine, (2) psychological aspect: different beliefs about TCM create different TCM uses, and (3) social aspect: interactions among patients, physicians, and economic issues.

CONCLUSIONS

Our study reveals that the phenomenon of using TCM is captured in a biopsychosocial model.

IMPLICATIONS FOR PRACTICE

When assessing the issue of TCM use among cancer patients, healthcare providers must take into consideration its biological, psychological, and social aspects.

Association of distress symptoms and use of complementary medicine among patients with cancer

AIMS AND OBJECTIVES

The aim of this study was to investigate the association between distress symptoms and the types of complementary and alternative medicine use in patients with cancer.

BACKGROUND

Patients diagnosed with cancer have increasingly turned to the use of complementary and alternative medicine to manage its symptoms and cope with the side effects of conventional treatment.

DESIGN

A descriptive cross-sectional study.

METHODS

A face-to-face interview using a structured questionnaire was conducted with 208 outpatients at a medical centre in central Taiwan. The questionnaire included questions on socio-demographic information, disease specifics, distress symptoms and complementary and alternative medicine usage in the past 12 months. Logistic regression analysis was used to assess the association between distress symptoms and the use of different complementary and alternative medicine modalities.

RESULTS

A total of 165 (79·3%) patients reported use of at least one complementary and alternative medicine modality during the past 12 months. Complementary and alternative medicine users and non-users were not significantly different in age, sex, marital status, education level, religious affiliation and disease-related variables. Fatigue (66·8%) was the most frequently reported symptoms and was significantly associated with complementary and alternative medicine use (OR = 14·11, p = 0·001). Regarding specific complementary and alternative medicine modalities, chanting and enzyme therapy were found to be associated with 13 (68·4%) of the 19 distress symptoms.

CONCLUSIONS

There was no association between complementary and alternative medicine use and demographic or disease-related variables. Complementary and alternative medicine was widely used by patients with cancer, and symptom of fatigue was most strongly associated with complementary and alternative medicine use. Chanting and enzyme therapy were the two most frequently used complementary and alternative medicine modalities that were significantly associated with the 19 distress symptoms.

RELEVANCE TO CLINICAL PRACTICE

Health care providers should ask their patients about their complementary and alternative medicine use to avoid possible adverse interactions between conventional treatment and complementary and alternative medicine interventions, in particular, those remedies that are likely to interact with cancer medications.

Use of Chinese medicine by cancer patients: a review of surveys

Chinese medicine has been used to treat a variety of cancer-related conditions. This study aims to examine the prevalence and patterns of Chinese medicine usage by cancer patients. We reviewed articles written in English and found only the Chinese medicine usage from the studies on complementary and alternative medicine (CAM). Seventy four (74) out of 81 articles reported rates of CAM usage ranging from 2.6 to 100%. Acupuncture was reported in 71 out of 81 studies. Other less commonly reported modalities included Qigong (n = 17), Chinese herbal medicine (n = 11), Taichi (n = 10), acupressure (n = 6), moxibustion (n = 2), Chinese dietary therapy (n = 1), Chinese massage (n = 1), cupping (n = 1) and other Chinese medicine modalities (n = 19). This review also found important limitations of the English language articles on CAM usage in cancer patients. Our results show that Chinese medicine, in particular Chinese herbal medicine, is commonly used by cancer patients. Further research is warranted to include studies not written in English.

Taiwanese nurses’ attitudes towards and use of complementary and alternative medicine in nursing practice: A cross-sectional survey

BACKGROUND

Increasingly, nurses in Western countries express positive attitudes to complementary and alternative medicine (CAM) but lack knowledge, access to education and organisational policy to guide practice. It is unclear whether nurses in developed Asian countries mirror or differ from this profile.

OBJECTIVES

To determine the attitudes towards and use of CAM by registered nurses in Taiwan.

DESIGN

Cross sectional survey.

SETTING

A Nursing College in eastern Taiwan.

PARTICIPANTS

Registered nurses (N=170) working in various clinical settings who were studying a post registration Bachelor of Nursing conversion course.

METHODS

Questionnaire distributed to nurses during class time.

RESULTS

Most nurses had positive attitudes to CAM and most used therapies, like massage, occasionally in practice. However, none had formal qualifications in CAM and most perceived that there were insufficient resources or organisational policy to facilitate practice.

CONCLUSIONS

Taiwanese nurses need more formal education about CAM and require access to clear policies regarding the safe use of CAM in nursing practice.

The impact of acculturation on the use of traditional Chinese medicine in newly diagnosed Chinese cancer patients

GOALS OF WORK

This study assessed the impact of acculturation on the prevalence of traditional Chinese medicine and other complementary and alternative medicine (TCM/CAM) use in newly diagnosed Chinese cancer patients. The individual determinants of TCM/CAM use among patients were also investigated.

MATERIALS AND METHODS

A consecutive sample of Chinese cancer patients treated at the British Columbia Cancer Agency was surveyed at admission using a 15-item questionnaire. Items included TCM/CAM use, sociodemographics, as well as medical and cultural factors. Data were analyzed using bivariate methods including Pearson's X (2) test and Student's t test. As well, multiple logistic regression was used to obtain the final causal model.

MAIN RESULTS

Of the 230 respondents, 57% completed the survey in Chinese and 94% were immigrants. The average age was 59. Participants had a mean disease duration of approximately 2 months and 79% had already received at least one conventional treatment. Overall, TCM/CAM was used by 47% of respondents. Herbal remedies, vitamins/minerals, and prayer were the most commonly used therapies. Multivariable analysis showed that prior TCM/CAM use (p < 0.001), having received conventional treatment(s) (p = 0.029), and being less acculturated (p = 0.028) were associated with TCM/CAM use.

CONCLUSIONS

Prevalence and type of use were found to vary as a function of the degree of acculturation. Health care practitioners would be well advised to discuss TCM/CAM use with their patients, especially those who are less acculturated to Western society, since they are the most likely users of TCM/CAM.