Oncologists’ and specialist cancer nurses’ approaches to complementary and alternative medicine and their impact on patient action

Beyond standard treatment: A qualitative descriptive study of cancer patients' perceptions of hypnotherapy in cancer care

BACKGROUND AND PURPOSE

Cancer remains a leading cause of death in Australia. The number of new cancer cases diagnosed each year is expected to surpass 200,000 by 2033. This marks a significant increase from about 88,000 cases in 2000 to an estimated 165,000 cases in 2023. Despite advancements in treatment, emotional and psychological challenges in cancer care are often overlooked. This study focuses on hypnotherapy, a complementary therapy recognized for its efficacy for physical and emotional symptoms, yet underutilized in Australian cancer care. The research aims to explore patients' perceptions of hypnotherapy and identify barriers to its integration, contributing to the development of holistic, patient-centered cancer care models.

MATERIALS AND METHODS

A qualitative study employing semi-structured interviews was conducted with 14 adult cancer patients (breast, lung, and colorectal) undergoing active treatment, selected through convenience sampling. The interviews were carried out from May 2022 to August 2023, focusing on participants' experiences and attitudes toward hypnotherapy among other complementary and alternative medicine (CAM) therapies. Thematic analysis using Braun and Clarke's six-step framework was applied to the data.

RESULTS

Five themes were developed following analysis: 1) emotional roller coaster of cancer diagnosis, 2) participants' perspectives on hypnotherapy among other CAM modalities, 3) hypnotherapy as a psychological vs physiological support, 4) fringe benefits of hypnosis, and 5) the main hurdles: cost and lack of information. Participants expressed a diverse range of experiences and attitudes towards hypnotherapy and CAM, with a strong emphasis on the need for emotional support in cancer care. Although hypnotherapy was recognized for its potential to address both emotional and physical symptoms, its predominant use was for emotional well-being. Participants also highlighted the importance of attitudes and endorsements from healthcare providers in their decision-making process about CAM therapies.

CONCLUSION

The study findings emphasize the need for a more integrative and patient-centered approach in cancer care that includes hypnotherapy as a non-pharmacological intervention for physical and particularly emotional support. Healthcare providers should be aware of the potential value of hypnotherapy and consider patient preferences in their recommendations. In addition, addressing the identified barriers could improve the accessibility and integration of hypnotherapy into cancer care protocols in Australia.

Use of Complementary and Alternative Medicine in the context of cancer; prevalence, reasons for use, disclosure, information received, risks and benefits reported by people with cancer in Norway

BACKGROUND

Research exploring the use of specific Complementary and Alternative Medicine (CAM) modalities by Norwegian cancer patients is sparse. The aims of this study were therefor to map the different CAM modalities cancer patients use and further investigate their rationale for use, communication about use, self-reported benefits and harms, and their sources of information about the different modalities.

METHODS

In cooperation with the Norwegian Cancer Society (NCS), we conducted an online cross-sectional study among members of their user panel with present or previously cancer (n = 706). The study was carried out in September/October 2021 using a modified cancer-specific version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q). In total, 468 members, 315 women and 153 men, agreed to participate resulting in a response rate of 67.2%. The study was reported in accordance with the National Research Center in Complementary and Alternative Medicine's (NAFKAM) model of reporting CAM use.

RESULTS

A large proportion of the participants (79%, n = 346) had used some form of CAM with a mean of 3.8 modalities each (range 1-17); 33% (n = 143) had seen a CAM provider, 52% (n = 230) had used natural remedies, while 58% (n = 253) had used self-help practices. Most of the participants used CAM to increase their quality of life, cope with the cancer disease or for relaxation/well-being (64%-94%), mostly with high satisfaction and low rates of adverse effects. Few used CAM to treat cancer or prevent it from spreading (16%, n = 55). The main information sources were health care providers (47%), the internet (47%), and family and friends (39%). More than half (59%) of the cancer patients discussed their use of at least one CAM modality with a physician.

CONCLUSIONS

The results of this survey will provide health professionals with more in-depth insight into the patterns of CAM use by cancer patients and facilitate better-informed discussions with their patients. Considering the high use of CAM, reliable information provision supporting cancer care providers' knowledge and health literacy among patients as well as good communication are crucial. The cooperation between the NCS and NAFKAM provides an example of how to address these issues.

A pre-post evaluation of oncology healthcare providers' knowledge, attitudes, and practices following the implementation of a complementary medicine practice guideline

PURPOSE

Complementary medicine (CM) use is prevalent among cancer patients, yet it is often not assessed by oncology healthcare providers (HCPs). The purpose of this study was to evaluate oncology HCPs' knowledge, attitudes, and practices surrounding CM use before and after the implementation of a practice guideline focusing on standardizing assessment and documentation of CM.

METHODS

Oncology HCPs across a provincial cancer agency were invited to participate in the study. The implementation strategy included an initial education session for HCPs and standardized CM assessment forms. Pre-post surveys assessing knowledge, attitudes, and practices related to CM were completed by HCPs prior to attending the education session and following the 4-month implementation period. Paired t-tests were conducted to determine differences between baseline and follow-up surveys.

RESULTS

A total of 31 oncology HCPs completed both baseline and follow-up surveys, with over 3700 patient CM assessment forms being completed during the 4-month study period. At the end of the study, HCPs reported greater CM knowledge (p < 0.001), readiness to support cancer patients' CM decisions (p = 0.002), and willingness to consult with another HCP about CM (p = 0.004). No significant change in HCPs' reported attitudes towards CM, or other clinical practices related to CM were observed.

CONCLUSION

Implementing a practice guideline, including a CM education session and a standardized assessment form, was found to improve oncology HCPs' self-reported CM knowledge and readiness to answer cancer patients' questions about CM. The findings provide support for future knowledge translation research aimed at standardizing how CM is addressed within cancer care settings.

Addressing Complementary and Alternative Medicine Use Among Individuals With Cancer: an Integrative Review and Clinical Practice Guideline

Complementary and alternative medicine (CAM) use is common among individuals with cancer, but many choose not to discuss CAM with healthcare providers (HCPs). Moreover, there is variability in the provision of evidence-informed decision making about CAM use. A clinical practice guideline was developed to standardize how oncology HCPs address CAM use as well as to inform how individuals with cancer can be supported in making evidence-informed decisions about CAM. An integrative review of the literature, from inception to December 31st, 2018, was conducted in MEDLINE, EMBASE, PsychINFO, CINAHL, and AMED databases. Eligible articles included oncology HCPs' practice related to discussing, assessing, documenting, providing decision support, or offering information about CAM. Two authors independently searched the literature and selected articles were summarised. Recommendations for clinical practice were formulated from the appraised evidence and clinical experiences of the research team. An expert panel reviewed the guideline for usability and appropriateness and recommendations were finalised. The majority of the 30 studies eligible for inclusion were either observational or qualitative, with only three being reviews and three being experimental. From the literature, seven practice recommendations were formulated for oncology HCPs regarding how to address CAM use by individuals with cancer, including communicating, assessing, educating, decision-coaching, documenting, active monitoring, and adverse event reporting. It is imperative for safe and comprehensive care that oncology HCPs address CAM use as part of standard practice. This clinical practice guideline offers directions on how to support evidence-informed decision making about CAM among individuals with cancer.

Communication and information needs about complementary and alternative medicine: a qualitative study of parents of children with cancer

BACKGROUND

Many parents choose support such as Complementary and Alternative Medicine (CAM) for themselves and their children who have cancer. The aim of this paper is to describe, how parents who have children with cancer communicated with conventional health care providers about CAM, and what types and sources of information they would like to receive about CAM when the child was ill.

METHOD

This focused ethnography draws from in-depth, semi-structured interviews conducted with 22 families in Norway with 24 adult participants (two couples), including two individuals who had had cancer themselves. Four domains were explored in the data analysis: the use of CAM, advice from laypeople about CAM, communication with conventional health care providers about CAM, and parents' information needs about CAM.

RESULTS

Many of the participants had personal experiences with CAM before the child received the cancer diagnosis. The health care providers did not raise the question about CAM in the consultations. However, when the parents raised the question, they were mostly met in a positive way. The participants did not receive any information about CAM at the hospital, which they would have appreciated. Instead, they received recommendations about CAM from laypersons, which were mostly rejected, as the advice was not in line with their health values/philosophy.

CONCLUSION

The reason participants did not disclose CAM use is that physicians did not ask them about it. However, positive communication about conventional treatment facilitated fruitful conversations about CAM. The participants wanted information about CAM from authoritative sources, primary from health care providers at the hospital and the Children's Cancer Society. They demand information about risks and benefits when using CAM as well as whether CAM can improve the immune system, fight the cancer, and improve the quality of life of the family. An evidence-based decision aid is warranted to enable health care providers and parents of children with cancer to make well-informed decisions about CAM.

What do medical specialists think about a proposed academic, integrative health centre in Australia? A qualitative study

OBJECTIVES

This qualitative study aimed to explore medical specialists' perspectives on a proposed academic integrative healthcare (IHC) centre to be established in their local district.

METHODS

A convenience sample of medical specialists were recruited via direct email invitations that was augmented with snowball sampling until data saturation was reached. The in-depth, semi-structured interviews were conducted via telephone, audio recorded and transcribed verbatim, followed by a thematic analysis.

RESULTS

Eight participants took part in the study. Three main themes emerged: 1) the benefits of an academic setting, 2) sound clinical governance, and 3) specialists in the field of traditional, complementary and integrative medicine (TCIM). Underpinning the three themes was the belief that patients were at risk of harm due to haphazard, unsupervised use of unproven TCIM. It was anticipated that an academic centre would address these issues with appropriate risk management protocols, effective interprofessional communication, and by upholding the principles of evidence- based practice to ensure safe and coordinated patient-centred care. Opportunities from collaborations within secondary care included centre being recognized as specialists in the field of TCIM, conducting research, and bidirectional learning.

CONCLUSIONS

The findings demonstrated that medical specialists acknowledged the need for a TCIM model of care that interfaces with the local secondary care landscape through the implementation of sound safeguards, credentialed practitioners, and evidence-based practice to adequately protect patients and clinicians. The findings will be amalgamated with the input from other stakeholder groups via a community-based participatory research framework to refine the model of care.

Complementary medicine visits by palliative care patients: a cross-sectional survey

BACKGROUND

The paucity of empirical research examining complementary medicine (CM) use in palliative care in France compared with other countries results in a gap in scientific knowledge. This study aims to describe the frequency and the cause of palliative care patients consulting with a CM clinician along with the conventional physicians.

METHODS

This study is an observational cross-sectional survey conducted in three palliative care centres in Lyon, France, between July 2017 and May 2018: two tertiary hospitals and one palliative care unit in a private hospital. Inpatients and outpatients visiting the palliative care clinics with a primary diagnosis of cancer were invited to participate in the study. Using a 19-item paper-based survey instrument, we collected data on the participants' personal characteristics, health service utilisation and attitudes towards CM.

RESULTS

From the 138 participants meeting the inclusion criteria, 100 (72.4%) were included in the study. On average, they were 62.9 years old (SD 12.4) and the majority were women (60%). The primary cancer site was mostly colorectal (29.0%), breast (15.0%) and gynaecological (11.0%). The most commonly visited CM clinician was the aromatherapist (72.7%), recording more than six consultations (78.1%) for symptom management (21.9%). Visits to an osteopath were reported by 28.6% of patients, and 45.8% of osteopathy users reported visiting an osteopath more than six times for symptom management (62.5%). Participants visiting a naturopath (15.3%) reported less than four visits and indicated symptom management as the most common reason (76.9%).

CONCLUSIONS

Our findings show a substantial proportion of palliative care patients visit CM clinicians and primarily seek symptom management from CM clinical care.

Communication about Complementary and Alternative Medicine in Danish Oncological Settings: An Intervention Study

PURPOSE

Communication about complementary and alternative medicine (CAM) between cancer patients and health professionals rarely takes place. This article reports on an intervention study that aimed to support communication about the use and effects of CAM between cancer patients and care providers.

METHODS

The intervention consisted of the use of evidence-based information material (website; leaflet) about the effects of CAM for cancer. Focus groups with cancer patients, relatives, nurses and doctors (n = 50) determined the preferred content and format of materials and evaluated the intervention. The information material was informed by a related systematic metareview of literature. A survey identified patient participants' CAM use, information sources, and the extent of communication about CAM before and after the intervention.

RESULTS

No significant impact of the intervention on communication about CAM for cancer patients, patients' CAM use or sources of information was identified. Health professionals disseminated the leaflet only in response to patients raising the topic; the website was not accessed during consultations. The intervention and information materials were well received.

CONCLUSION

Cancer patients and care providers wish to improve communication about CAM. Nevertheless, patients and professionals wait for the other to broach the subject of CAM. This reflects a "culture of waiting."

Complementary and Alternative Therapy Usage Status and Attitudes of Hypertension Patients

Aim: With the increase in chronic diseases, the number of patients using complementary and alternative medicine is increasing. In this study, it was aimed to examine the opinions and practices of complementary and alternative therapy usage status and attitudes of hypertension patients. Methods: A descriptive and cross-sectional study consisting of 290 patients was performed with patients who applied to the cardiology and internal diseases outpatient clinic of a public hospital and diagnosed with hypertension. Data were collected by using the patient information form which including socio-demographic form, disease-related characteristics and opinions, and also practices of the patients about the use of complementary and alternative therapies and attitudes towards Holistic Complementary and Alternative Medicine Scale. Results: The mean age of the patients was 61.52±11.19 and 63.1% were female, 83.4% were married, and 74.8% were at primary school and lower education level. Of patients, 56.9% use complementary and alternative treatment methods in addition to hypertension therapy. 27.3% of them think that they are more effective than drugs, 63% of them do not share the method they use with health care workers. The total score of the Holistic Complementary and Alternative Medicine Scale is 23.05±5.80. The scores are taken out of the scale and the sub-dimensions differ according to the age groups, education level, monthly income status and complementary and alternative treatment methods usage status (p <0.05). Conclusion: It was found that patients use complementary and alternative methods but do not share them with health care workers, and they have a positive attitude towards holistic complementary and alternative medicine. It is considered important for health care professionals to question the use of these methods in planning the patients’ treatment.

College students' communication about complementary and alternative medicine practices

While the use of Complementary/Alternative Medicine (CAM) has increased over the last two decades, how patients communicate about their decisions to use CAM has yet to be fully explored. The purpose of this study is to examine college students’ decision-making and communication about CAM. Fourteen college students participated in semi-structured focus group interviews about their CAM use and communication about CAM with family, friends, and health care providers. Participants use CAM to improve their physical and mental health. However, they have difficulties justifying their decision to practice CAM to others. They relied on CAM not only for physical and mental stability, but also as a sounding board for larger spiritual issues. Participants use passive communication strategies to communicate about their CAM use and often do not disclose CAM use to their providers because of the stigmas related to CAM. There is potential danger for CAM users who do not disclose CAM use to providers, family, and friends. More efforts are needed to encourage open and honest communication about CAM use.

Typologies for Restructuring Relationships in Cancer Survivorship: Temporal Changes in Social Support and Engagement With Self-Management Practices

BACKGROUND

Cancer survivors with good social support are generally more motivated to undertake self-management behaviors and make lifestyle changes. However, the impact of changes in social support over time, from prediagnosis through treatment and into survivorship, on the health and recovery of cancer survivors with a range of cancer diagnoses has not been explored.

OBJECTIVE

The aim of this study was to examine how temporal changes in social support offered to cancer survivors by family and friends influence their engagement with self-management practices and adaptation to lifestyle changes.

METHODS

The interview study took place in a teaching hospital in the West Midlands, United Kingdom. Forty participants were purposively sampled. A narrative approach to data collection was chosen, and data were thematically analyzed.

RESULTS

Six typologies of restructuring relationships postcancer were identified. A greater understanding of the changes to social relationships that a cancer diagnosis can incur and the impact of this on people's outlook and ability to self-manage was developed.

CONCLUSION

The restructuring of social relationships by cancer survivors over time can impact their outlook and ability to self-manage in survivorship, shaping their engagement with health promoting activities and reconciling cancer within the wider context of their lives.

IMPLICATIONS FOR PRACTICE

Appropriate clinical nursing processes and tailored interventions are required to support cancer survivors and promote engagement with self-management practices. Nurses are a vital component of the social support that enables patients to make the best health and lifestyle choices available to them.

Referrals to integrative medicine in a tertiary hospital: findings from electronic health record data and qualitative interviews

OBJECTIVE

To examine patterns of, and decision-making processes, informing referrals for inpatient access to integrative medicine (IM) services at a large, acute care hospital.

DESIGN

Retrospective electronic health record review and structured qualitative interviews.

SETTING

A 630-bed tertiary care hospital with an IM service available to inpatients.

PARTICIPANTS

IM referrals of all inpatients aged ≥18 years between July 2012 and December 2014 were identified using the hospital's electronic health record. Fifteen physicians, 15 nurses and 7 administrators were interviewed to better understand roles and perspectives in referring patients for IM services.

RESULTS

In the study hospital, primary sources of referrals for IM services were the orthopaedic and neuroscience/spine service lines. While the largest absolute number of IM referrals was made for patients with lengths of stay of 3 days or fewer, a disproportionate number of total IM referrals was made for patients with long lengths of stay (≥10 days), compared with a smaller percentage of patients in the hospital with lengths of stay ≥10 days. Physicians and nurses were more likely to refer patients who displayed strong symptoms (eg, pain and anxiety) and/or did not respond to conventional therapies. IM referrals were predominantly nurse-initiated. A built-in delay in the time from referral initiation to service delivery discouraged referrals of some patients.

CONCLUSIONS

Conventional providers refer patients for IM services when these services are available in a tertiary hospital. Referral patterns are influenced by patient characteristics, operational features and provider perspectives. Nurses play a key role in the referral process. Overcoming cultural and knowledge differences between conventional and IM providers is likely to be a continuing challenge to providing IM in inpatient settings.

Complementary Medicine Health Literacy among a Population of Older Australians Living in Retirement Villages: A Mixed Methods Study

Background. Older Australians are consumers of high levels of complementary medicines. The aim of this study was to examine health literacy in a population of older Australians related to their use of complementary medicine. Methods. A two-phase sequential mixed method design incorporating quantitative and qualitative methods was used in this study. The first phase consisted of a cross-sectional survey using a validated health literacy questionnaire and follow-up interviews with 11 residents of retirement villages. Interviews explored low scoring domains on the health literacy questionnaire. Results. Health literacy competencies scored higher for the domains of having sufficient information to manage their health; felt understood and supported by health care providers; actively managed their health; and having social support for health. Three health literacy domains scored low including appraisal of health information; ability to find good information; and navigating the health care system. The findings suggest that participants had different experiences navigating the health care system to access information and services relating to complementary medicines. Two themes of "trust" and "try and see" provide insight into how this group of older Australians appraised health information in relation to complementary medicines. Conclusions. With a focus on self-care there is a need for improved health literacy skills.

Mapping the risk perception and communication gap between different professions of healthcare providers in cancer care: a cross-sectional protocol

INTRODUCTION

Studies show that patients with cancer who use complementary and alternative medicine (CAM) have a poorer survival prognosis than those who do not. It remains unclear whether this is due to a priori poorer prognosis that makes patients turn to CAM, or whether there is a factor associated with CAM use itself that influences the prognosis negatively. Healthcare providers should assist patients in safeguarding their treatment decision. However, the current non-communication between CAM and conventional providers leaves it up to the patients themselves to choose how to best integrate the two worlds of therapy. In this study, an interactive shared decision-making (SDM) tool will be developed to enable patients and health professionals to make safe health choices.

METHODS AND ANALYSIS

We will delineate, compare and evaluate perception and clinical experience of communication of risk situations among oncology experts, general practitioners and CAM practitioners. To accomplish this, we will develop a pilot and implement a large-scale survey among the aforementioned health professionals in Norway. Guided by the survey results, we will develop a β-version of a shared decision-making tool for healthcare providers to use in guiding patients to make safe CAM decisions.

ETHICS AND DISSEMINATION

Participants must give their informed and written consent before inclusion. They will be informed about the opportunity to drop out from the study followed by deletion of all data registered. The study needs no approval from The Regional Committee for Medical and Health Research Ethics because all participants are healthcare professionals. Results from this study will be disseminated in peer-reviewed medical journals.

Survey of Policies and Guidelines on Antioxidant Use for Cancer Prevention, Treatment, and Survivorship in North American Cancer Centers: What Do Institutions Perceive as Evidence?

BACKGROUND

Health care policies and guidelines that are clear and consistent with research evidence are important for maximizing clinical outcomes. To determine whether cancer centers in Canada and the United States had policies and/or guidelines about antioxidant use, and whether policies were aligned with the evidence base, we reviewed current research evidence in the field, and we undertook a survey of the policies and guidelines on antioxidant use at cancer institutions across North America.

METHODS

A survey of policies and guidelines on antioxidant use and the development and communication of the policies and guidelines was conducted by contacting cancer institutions in North America. We also conducted a Website search for each institution to explore any online resources.

RESULTS

Policies and guidelines on antioxidant use were collected from 78 cancer institutions. Few cancer institutions had policies (5%) but most provided guidelines (69%). Antioxidants from diet were generally encouraged at cancer institutions, consistent with the current research evidence. In contrast, specific antioxidant supplements were generally not recommended at cancer institutions. Policies and guidelines were developed using evidence-based methods (53%), by consulting another source (35%), or through discussions/conference (26%), and communicated mainly through online resources (65%) or written handouts (42%). For cancer institutions that had no policy or guideline on antioxidants, lack of information and lack of time were the most frequently cited reasons.

CONCLUSIONS

Policies and guidelines on antioxidants from diet were largely consistent with the research evidence. Policies and guidelines on antioxidant supplements during treatment were generally more restrictive than the research evidence might suggest, perhaps due to the specificity of results and the inability to generalize findings across antioxidants, adding to the complexity of their optimal and safe use. Improved communication of comprehensive research evidence to cancer institutions may aid in the development of more evidence-based policies and guidelines.

Patterns of self-management practices undertaken by cancer survivors: variations in demographic factors

The study purpose was to examine self-management (SM) use among cancer survivors; and to explore variations in uptake of SM in survivorship and whether these differed in relation to age, income, gender, ethnicity, cancer type and treatment type. This is an important area for exploration as SM utilisation has the potential to impact on the health status, health behaviours and quality of life (QoL) of cancer survivors. A postal survey was conducted among 445 cancer survivors identified from a hospital in the West Midlands, UK. Demographic data were collected and respondents were asked to identify which practices across six SM categories - diet, exercise, complementary and alternative medicine (CAM), psychological therapies, support groups and spirituality/religion - they had used (if any). The findings indicate that the large majority (91%) had used some form of SM after their cancer treatment. Exercise (84%) and diet (56%) were the most popular SM interventions for cancer survivors and socio-demographic and cancer-related factors were associated with SM uptake. These findings can form the basis for designing and implementing appropriate SM interventions aimed at improving the health, well-being and QoL of cancer survivors.

Performance care practices in complementary and alternative medicine by Thai breast cancer survivors: an ethnonursing study

The purpose of this study was to explore how Thai breast cancer survivors perform care practices in complementary and alternative medicine to promote their health and well-being. Research was conducted using an ethnonursing method. Data were collected through semi-structured interviews with 17 Thai breast cancer survivors in Thailand. The transcribed interviews were analyzed using the ethnonursing analysis method. The findings showed Thai breast cancer survivors started their care practices in complementary and alternative medicine immediately following a diagnosis of breast cancer. They sought out and gathered alternative medicine information from several sources, such as the people around them, media resources, books, magazines, or newspapers. After gathering information, Thai breast cancer survivors would try out various types of complementary medicines rather than use only one type because of information from other people and their own evaluation. The findings of this study indicate the need for a conversation about complementary medicine use between healthcare providers and Thai breast cancer survivors as an on-going process throughout the cancer trajectory to ensure that safe and holistic care is provided.

The Complementary Medicine Education and Outcomes (CAMEO) program: a foundation for patient and health professional education and decision support programs

OBJECTIVE

This paper describes the background, design and evaluation of a theory-informed education and decision support program for cancer patients considering complementary medicine (CM).

METHODS

The program was informed by the Shared Decision Making theory, the Ottawa Decision Support Framework and the Supportive Care Framework. Previous empirical evidence and baseline research were used to identify patients' and health professionals' (HPs) information and decision support needs related to CM.

RESULTS

To address the continuum of CM needs, a variety of education and decision support interventions were developed, including basic CM information and resources for patients and HPs, a group education program and one-on-one decision support coaching for patients, and an on-line education module for HPs. Evaluation of the program and individual interventions is underway.

CONCLUSIONS

This education and decision support program addresses a significant gap in care and offers an evidence-informed framework in which to translate CM evidence to conventional care settings and promote communication about CM.

PRACTICE IMPLICATIONS

Evidence-informed CM education and decision support interventions are needed to shift the culture around CM within conventional care settings and promote open communication that will lead to CM therapies being safely integrated into care.

Modes of embodiment in breast cancer patients using complementary and alternative medicine

Breast cancer patients are frequent users of complementary and alternative medicine (CAM). They often have complex reasons for, and experiences from, their use of CAM. Bodily experiences are important and almost unexplored elements in CAM use. Our aim was to explore the meaning and importance of bodily experiences among breast cancer patients who were using CAM as a supplement or an alternative to conventional treatment (CT). Our findings based on qualitative interviews with 13 women suggest that bodily experiences were particularly important when positioned outside conventional health care prior to medical diagnosis and as users of CAM as alternative to CT. We introduce three central modes of embodiment related to CAM use: the right to one's body, the body used as a gauge, and the body used as a guide. Patients' positioning between treatment systems should be further explored from a bodily perspective to safeguard and optimize their treatment choices.

The rise and fall of complementary medicine in National Health Service hospitals in England

Whilst Complementary and Alternative Medicine (CAM) has never been systematically integrated into National Health Service (NHS) provision, there has been some limited evidence of a developing presence of CAM in NHS hospital based nursing and midwifery. This paper reports on a qualitative study that sought to document the nature and extent of such integrative practice in England, and the interpersonal and organisational factors that facilitated or impeded it. The data revealed a history in which attempts to integrate CAM had some initial success underpinned by the enthusiasm of individual practitioners and a relatively permissive organisational context. However, this was followed by a decline in service provision. The fact that the services were established by individuals left them vulnerable when more restrictive funding and governance regimes emerged. Whilst the data revealed a consistent story about CAM within the NHS, it must be recognised that the use of a snowball sample limits the generalizability of the findings.

Attitudes and referral practices of maternity care professionals with regard to complementary and alternative medicine: an integrative review

AIM

This paper presents an integrative literature review examining the attitudes and referral practices of midwives and other maternity care professionals with regard to complementary and alternative treatment and its use by pregnant women.

BACKGROUND

Use of complementary and alternative medicine during pregnancy is a crucial healthcare issue. Recent discussion has identified the need to develop an integrated approach to maternity care. However, there is a lack of understanding of attitudes and behaviours of maternity care professionals towards these treatments.

DATA SOURCES

A database search was conducted in MEDLINE, CINAHL, Health Source, AMED and Maternity and Infant Care for the period 1999-2009.

REVIEW METHODS

An integrative review method was employed. Studies were selected if they reported results from primary data collection on professional practice/referral or knowledge/attitude towards complementary and alternative medicine by obstetricians, midwives and allied maternity care providers.

RESULTS

A total of 21 papers covering 19 studies were identified. Findings from these studies were extracted, grouped and examined according to three key themes: 'prevalence of practice, recommendation and referral', 'attitudes and views' and 'professionalism and professional identity'.

CONCLUSION

There is a need for greater respect and cooperation between conventional and alternative practitioners as well as communication between all maternity care practitioners and their patients about the use of complementary and alternative medicine. There is a need for in-depth studies on the social dimension of practice as well as the inter- and intra-professional dynamics that shape providers' decision to use or refer to complementary and alternative medicine in maternity care.

The reconfiguration of expertise in oncology: the practice of prediction and articulation of indeterminacy in medical consultations

Evidence-based medicine has enhanced the predictive capacity of biomedicine in population terms, but it has also introduced new challenges for patient care and biomedical expertise. In this article we examine the negotiation of prediction and indeterminacy by oncology clinicians, exploring the ways in which they report delivering prognosis and engaging with indeterminacy in conversation with their patients. We examine oncologists' strategies for delivering "news," the technological mediation of uncertainty, and reported conversational turns toward a focus on indeterminacy and individual response. Drawing from these accounts, we argue that, although predictive capacity remains central to oncological expertise, notions of individualism, subjectivity, and self-determination are being heavily drawn on by clinicians. Rather than presenting a challenge, such ideas might be becoming increasingly central to oncological expertise. Interviews with cancer nurses illustrate their precarious relationship with evidence, uncovering tensions in their approach to patients and in their attempts to traverse diverse paradigms of care. We argue for an understanding of oncological expertise as evolving within the context of potentially competing contemporary cultural shifts, and against a simplistic notion of indeterminacy as necessarily eroding expertise.

Medicinas Alternativas e Complementares: uma metassíntese

O aumento do uso de Medicinas Alternativas e Complementares (MAC) motivou o crescimento do número de estudos qualitativos sobre o tema, justificando a realização de sínteses sobre esse material. Este artigo apresenta uma revisão sistemática de pesquisas qualitativas sobre MAC publicadas em periódicos internacionais. Esta revisão se orientou pela metodologia dos metaestudos. Foi realizada busca em revistas do Portal Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior e foram selecionados 32 artigos para análise. Os estudos revisados apresentam questões que têm como foco: o paciente, suas experiências terapêuticas e seus contextos sociais e culturais; o profissional, as relações profissionais e o processo de profissionalização das MAC; a MAC e sua relação com a biomedicina. Conclui-se que as pesquisas qualitativas sobre as MAC ensejam um olhar exploratório sobre o tema, procurando identificar as experiências de pacientes e profissionais com essas terapêuticas, assim como buscam discutir as conseqüências desse uso para a Medicina Convencional ou biomedicina.

Intuition, subjectivity, and Le bricoleur: cancer patients' accounts of negotiating a plurality of therapeutic options

Cancer patients are now combining complementary and alternative medicine (CAM) with biomedical cancer treatments, reflecting an increasingly pluralistic health care environment. However, there has been little research done on the ways in which cancer patients juggle multiplicity in claims to expertise, models of disease, and therapeutic practice. Drawing on the accounts of cancer patients who use CAM, in this article I develop a conceptualization of therapeutic decision making, utilizing the notion of bricolage as a key point of departure. The patient accounts illustrate the "piecing together" (or bricolage) of therapeutic trajectories, drawing on intuitive, embodied knowledge, as well as formalized "objective" scientific expertise. Le bricoleur, as characterized here, actively mediates, rather than accepts or rejects CAM or biomedicine, and utilizes a combination of scientific expertise, embodied physicality, and social knowledge to make decisions and assess therapeutic effectiveness. Although these "border crossings" are potentially subversive of established biomedical expertise, the analysis also illustrates the structural constraints (and penalties) associated with bricolage, and furthermore, the interplay of a repositioning of responsibility with neoliberal forms of self-governance.

Oncology clinicians' accounts of discussing complementary and alternative medicine with their patients

The profile of complementary and alternative medicine (CAM) has risen dramatically over recent years, with cancer patients representing some of the highest users of any patient group. This article reports the results from a series of in-depth interviews with oncology consultants and oncology nurses in two hospitals in Australia. Analysis identifies a range of self-reported approaches with which oncology clinicians discuss CAM, highlighting the potential implications for patient care and inter-professional dynamics. The interview data suggest that, whilst there are a range of consultant approaches to CAM, ;risk' is consistently deployed rhetorically as a key regulatory strategy to frame CAM issues and potentially direct patient behaviour. Moreover, ;irrationality', ;seeking control', and ;desperation' were viewed by consultants as the main drivers of CAM use, presenting potential difficulties for effective doctor-patient dialogue about CAM. In contrast, oncology nurses appear to perceive their role as that of CAM and patient advocate - an approach disapproved of by the consultants on their respective teams, presenting implications for oncology teamwork. CAM education emerged as a contentious and crucial issue for oncology clinicians. Yet, while viewed as a key barrier to clinician-patient communication about CAM, various forms of individual and organizational resistance to CAM education were evident. A number of core issues for clinical practice and broader work in the sociology of CAM are discussed in light of these findings.

Exploring the temporal dimension in cancer patients' experiences of nonbiomedical therapeutics

To date, research on complementary and alternative medicine (CAM) use by cancer patients has tended to provide a "snapshot" of experience, with little attention given to the evolution of experience over time. Drawing on data from solicited diaries, this article examines individual cancer patients' temporal experiences of CAM. Our findings suggest that experiences of CAM are variable over time and space, and furthermore, that the everyday act of "doing CAM" is considerably more problematic than is often reported in face-to-face interview or survey studies. This is explored in relation to the tension between the perceived need for restrictive self-discipline alongside a sense of the emancipatory potential of CAM; the role of CAM therapists in reconceptualizing disease; and the complex interplay between CAM-derived notions of self-healing and acceptance of individual mortality. We argue that an emphasis on the temporality of cancer patients' CAM engagement is necessary to access a more nuanced understanding of the lived experiences of cancer patients.