Physicians and Complementary and Alternative Medicine Cancer Therapies in Greece: A Survey

Perception, attitudes, knowledge of using complementary and alternative medicine for cancer patients among healthcare professionals: A mixed-methods systematic review

BACKGROUND

With the rapid increase in the prevalence of cancer worldwide, the utilization of complementary and alternative medicine (CAM) has increased among cancer patients. This review aimed to understand the perception, attitudes, and knowledge of healthcare professionals toward using CAM for cancer patients.

METHODS

A mixed-methods systematic review was undertaken in four databases. Inclusion criteria were primary studies reporting perception, attitudes, and knowledge of healthcare professionals for using CAM for cancer patients were eligible. A mixed-methods convergent synthesis was carried out, and the findings were subjected to a GRADE-CERQual assessment of confidence.

RESULTS

Forty-two studies were chosen. The majority of the studies were quantitative and had less than 100 participants. Most publications were from European countries, and oncology was the highest among the specialties. The review found the following themes: feasibility of having negative adverse effects, low expectations of using CAM among HCPs, potential positive effects of using CAM, specific CAM training may be helpful, no concrete regulations to promote CAM practice, and poor physician-patient communication.

CONCLUSIONS

Nurses had more positive views than other professions; oncologists were concerned regarding herb-drug interactions; integration of CAM into the healthcare system was favorable; HCPs felt the need to participate in specific CAM training; and HCPs agreed that CAM education should be provided more regularly. Future studies should explore the studies views of cancer patients and details of in-depth evidence of CAM in oncology settings.

Psychosocial adaptation of families with children newly diagnosed with cancer in the Greek population amidst the socioeconomic crisis

OBJECTIVE

To present the initial assessment of psychosocial adaptation among Greek parents whose children were newly diagnosed with cancer amidst the turmoil of an ongoing financial crisis.

STUDY DESIGN

This prospective observational study used a quantitative approach.

PARTICIPANTS

Sixty-one parents of children with cancer treated at a large urban tertiary-care children's hospital were prospectively recruited to participate in our study during the first week of their child's diagnosis (2013-2016).

METHODS

The parents were asked to complete the psychosocial assessment tool (PAT 2.0), Zung Depression Scale, State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale, and World Health Organization Quality of Life-Bref Instrument; Moreover, three female healthcare providers (the physician oncologist, the head nurse and a senior nurse) completed the relevant PAT 2.0 -Staff Perceptions questionnaire the results of which were then compared to those of the child's parent.

FINDINGS

The majority of parents had PAT 2.0 scores indicative of increased psychosocial risk :54% were stratified into the "Targeted" (moderate risk) and 15% into the "Clinical" (highest risk) categories, whereas healthcare providers underestimated psychosocial risk in 57%-59% of the cases. The subscales that most contributed to the increased scores were Parental Stress Reaction, Family Structure and Resources, and Family Social Support. The PAT 2.0 had statistically significant correlations with most of the anxiety and depression scales, with Zung having the strongest correlation (r-value: +0.5, p-value <0.01). Our cohort presented more anxiety and depression compared to the general Greek population (14% for depression versus 2,9% for the general population and 46% for anxiety compared to 4,1%) in the years of financial recession in Greece.

CONCLUSIONS

The parents of children newly diagnosed with cancer in Greece are at increased risk for developing anxiety and depression in the years of financial recession in Greece compared to general population.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS

Parental stress reaction to diagnosis as well as lack of family resources and social support may contribute to this difference. Screening for psychosocial risk factors is essential for the early identification of these families and for the optimal utilization of the limited available resources in times of economic hardship.

Use of complementary and alternative medicine by children in Europe: published data and expert perspectives

INTRODUCTION

Few data document the use of complementary and alternative medicine (CAM) in Europe, with even fewer investigating use by children.

METHODS

A narrative, non-systematic review of CAM use in Europe was performed by combining data from published surveys with expert perspectives. Limitations created by a lack of representative studies, varying definitions of CAM use, and what qualifies as CAM in different countries was partially overcome by integrating local experts to summarise information available only in the national language and provide their perspectives about CAM availability, quality, use and popularity in their countries using a semi-structured questionnaire. Local and international published surveys were summarised, and the prevalence of CAM use was extrapolated.

RESULTS

Data from 20 European countries were available, representing 69% of the European population. Some data about CAM use by the general population were available for 90% of the examined countries, whereas peer-reviewed published surveys were available for only 60%. We extrapolated that 56% (range: 10-90%, adjusted for population size) of the European population in general had used CAM at least once in the past year. Surveys in CAM use by children were available for 55% of the investigated countries. The extrapolated prevalence of CAM use by children in Europe was 52% (range: 5-90%, adjusted for population size). Paediatric CAM experts reported an increasing awareness for and use of CAM in healthcare institutions.

CONCLUSION

This precursor for further surveys indicates that CAM appears to be popular not only among adults in Europe, but also for children. Development of a pan-European definition of CAM use and CAM therapies are required to achieve surveys comparable between European countries. Additionally, more research investigating the efficacy and potential adverse effects of CAM therapies is needed because of increasing CAM use by children in Europe.

Attitude of conventional and CAM physicians toward CAM in India

OBJECTIVES

The aim of the present study was to compare the attitude toward complementary and alternative medicine (CAM) of primary care physicians trained in conventional medicine with CAM physicians whose training was for a comparable duration. The CAM physicians included practitioners of Ayurveda, homeopathy, and naturopathy.

PARTICIPANTS

Two hundred and ninety five (295) physicians with aged 20-60 (group mean±standard deviation, 48.2-12.3 years, 87 females) participated. Eighty-six (86) of them were trained in Ayurveda, 90 in homeopathy, 82 in conventional medicine, and 37 in naturopathy. They were attending a 4-day residential program on Indian culture. All of them gave their signed consent to take part in the study, and the institution's ethics committee approved the study.

STUDY DESIGN

The study was a cross-sectional survey. Since the participants had self-selected to join for the program on Indian culture, the sampling could be considered as convenience sampling.

RESULTS

The number of conventionally trained and CAM physicians were similar in number and in their reasons for selecting CAM treatments.

CONCLUSIONS

Conventionally trained and CAM physicians were comparably likely to prescribe CAM treatments for their patients. Their reasons for prescribing CAM treatments appeared to be (1) the idea that CAM treatments deal with the cause, and (2) a belief in the treatments. A limiting factor of the survey is that it did not determine whether the belief was based on evidence or on faith alone.

Complementary and Alternative Medicine: Comparison of Current Knowledge, Attitudes and Interest among German Medical Students and Doctors

Although it has been agreed that complementary and alternative medicine (CAM) should be included in the German medical curriculum, there is no consensus on which methods and how it should be taught. This study aimed to assess needs for CAM education by evaluating current knowledge, attitudes and interests of medical students, general physicians and gynecologists. Two instruments based on established and validated questionnaires were developed. One was given to seventh semester medical students and the other to office-based doctors. Data were analyzed by bivariate correlation and cross-tabulation. Altogether 550 questionnaires were distributed-280 to doctors and 270 to medical students. Completed questionnaires were returned by 80.4% of students and 78.2% of doctors. Although 73.8% (160/219) of doctors and 40% (87/217) of students had already informed themselves about CAM, neither group felt that they knew much about CAM. Doctors believed that CAM was most useful in general medicine, supportive oncology, pediatrics, dermatology and gynecology, while students believed that dermatology, general medicine, psychiatry and rheumatology offered opportunities; both recommended that CAM should be taught in these areas. Both groups believed that CAM should be included in medical education; however, they believed that CAM needed more investigation and should be taught "critically". German doctors and students would like to be better informed about CAM. An approach which teaches fundamental competences to students, chooses specific content based on evidence, demographics and medical conditions and provides students with the skills they need for future learning should be adopted.

Beliefs of New Zealand doctors about integrative medicine for cancer treatment

AIMS. This study aimed to give an up-to-date description of the views and knowledge that health professionals in New Zealand (NZ) have about complementary and alternative medicine (CAM) and its use in the context of integrative medicine.

STUDY DESIGN

A self-administered questionnaire.

METHODS

Doctors in the Otago region of New Zealand (n = 235 out of 395, 59% response rate) answered questions addressing attitudes toward the principle of integrative medicine, attitudes indigenous Ma-ori holistic views of health, and attitudes about CAM. Information on physician demographics was also gathered.

RESULTS

Almost all doctors (95%) agreed that they should address all aspects of a patient's health, whereas around 60% agreed that CAM can be integrated into a treatment regime to provide the best care for a patient. Most (93%) agreed that in a NZ context, it is important to be aware of Ma-ori holistic views of health. Doctors had many concerns about CAM, and only 26% personally used any CAM therapies themselves. However, many doctors wanted to learn more about CAM (58%) and Ma-ori holistic views of health (62%). Doctors who believed that they "knew enough" about CAM were more likely to ask about it and to recommend it to patients.

CONCLUSION

Integrative medicine is increasingly being accepted in medical practice, although many doctors still do not agree with the use of CAM. There is a need for increased patient-doctor discussions of CAM use. Doctors' lack of knowledge about CAM may be a barrier to communication and should be addressed with specific medical training.

Complementary and alternative medicine: attitudes and patterns of use by German physicians in a national survey

OBJECTIVE

To generate valid data on attitudes about complementary and alternative medicine (CAM) as well as patterns of use in a large stochastic sample of general practitioner physicians and specialists.

DESIGN

Cross-sectional survey in a large random sample of 516 German outpatient care physicians with qualifications in 13 medical fields representative of a basic population of 118,085 statutory health insurance physicians.

MATERIALS AND METHODS

Telephone interviews with 36 wide-ranging questions about CAM attitudes and preferred techniques were conducted in November and December 2005 as part of a national healthcare survey.

RESULTS

In our sample, 51% were in favor of CAM use (26% were very much in favor, 25% were in favor). The methods most frequently prescribed (combining answers for "very often" and "at times") were physical therapy (71%), phytomedicine (67%), exercise (63%), nutrition and dieting (62%), massage (61%), relaxation techniques (55%), followed by more typical CAM interventions such as homeopathy (38%), acupuncture (37%), and traditional Chinese medicine (18%). Primary care physicians were significantly more inclined to use CAM than were specialists. No striking differences were observed with respect to gender or age.

CONCLUSIONS

This survey demonstrates a broader acceptance and practice of CAM by physicians than hitherto believed. Methods traditionally known as "natural medicine" were more frequently used than more typical CAM procedures. Further research should focus on physicians' differing motivations and observed results.

Consulting a Complementary and Alternative Medical Practitioner: A Systematic Inventory of Motives Among French Patients

OBJECTIVES

To classify people's motives for seeking care from complementary and alternative medicine practitioners. Participants were asked about a wide variety of motives representing all eight motivational states described in Reversal Theory (RT): telic, paratelic, conformist, negativist, mastery, sympathy, autic, and alloic.

DESIGN

Data from a convenience sample of 256 participants was examined using factorial techniques.

RESULTS

Six factors were evidenced that were easily interpretable in the RT framework. Participants perceived their motives largely in terms of goals and means, and within this domain they focused more on the goals (i.e., telic motives were more important than paratelic ones). Paratelic motives were, however, not unimportant: they ranked third. Participants also perceived their motives in terms of rules and constraints, and within this domain they focused more on rules (i.e., conformist motives were more important than negativist ones). Participants, finally, perceived their motives in terms of the combined domains of relationships and exchanges with others, namely, acting out of concern for others (alloic sympathy) as well as for themselves (autic mastery).

CONCLUSIONS

If the six-factor structure is proved applicable, the six corresponding subscales could be used for systematically comparing motives among different types of patients, regarding different types of therapies, and among patients from different cultures.