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Welz AN, Emberger-Klein A, Menrad K. What motivates new, established and long-term users of herbal medicine: is there more than push and pull? BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:170. [PMID: 31291938 PMCID: PMC6617938 DOI: 10.1186/s12906-019-2584-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 06/30/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND The use of herbal medicine (HM) has become an essential form of treatment and it is more and more common around the world. Little is known about the reasons that drive people to initially use HM or to maintain their behaviour, and whether the so-called "push and pull factors" known in the context of decision making for complementary and alternative medicine, also play a role for HM use. Here, our goal was to provide answers to these open questions and to analyse the reasons that motivate new, established and long-term HM consumers in detail. METHODS Thirteen reasons for HM usage, which were previously identified within a qualitative approach, were analysed quantitatively in a nationwide online survey in Germany. Data of 2,192 German HM users from the general population were grouped into new, established and long-term users. We performed a factor analysis in order to identify factors underlying the set of reasons. RESULTS We discovered a reliable factor associated with longstanding family traditions and cultural importance of HM in Germany. This finding shows that the reasons for HM use require a three-factor structure going beyond the well-known push and pull factors that explain the use of complementary and alternative medicine. In using the identified factors for further calculations, we were able to reveal important group differences and test how the factor scores perform as predictors for the new, established and long-term choice of HM. Our results showed that a high score on the push factor is associated more with initial HM usage, while long-term HM usage is impacted more by high scores on the pull and traditional factors. CONCLUSIONS Our exploratory survey and analysis of the reasons that underlie HM usage aimed at providing a better understanding of the decision for this treatment form. The findings of our work deliver insights for medical practitioners and health-care providers, including the role of family traditions for HM usage and the finding that new HM users are driven to use this treatment form in part because of negative aspects they associate with conventional medicine.
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Affiliation(s)
- Alexandra N. Welz
- TUM Campus Straubing for Biotechnology and Sustainability, Weihenstephan-Triesdorf University of Applied Sciences, Petersgasse 18, 94315 Straubing, Germany
| | - Agnes Emberger-Klein
- TUM Campus Straubing for Biotechnology and Sustainability, Weihenstephan-Triesdorf University of Applied Sciences, Petersgasse 18, 94315 Straubing, Germany
| | - Klaus Menrad
- TUM Campus Straubing for Biotechnology and Sustainability, Weihenstephan-Triesdorf University of Applied Sciences, Petersgasse 18, 94315 Straubing, Germany
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Herman PM, Yuan AH, Cefalu MS, Chu K, Zeng Q, Marshall N, Lorenz KA, Taylor SL. The use of complementary and integrative health approaches for chronic musculoskeletal pain in younger US Veterans: An economic evaluation. PLoS One 2019; 14:e0217831. [PMID: 31167005 PMCID: PMC6550429 DOI: 10.1371/journal.pone.0217831] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 05/21/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To estimate the cost-effectiveness to the US Veterans Health Administration (VA) of the use of complementary and integrative health (CIH) approaches by younger Veterans with chronic musculoskeletal disorder (MSD) pain. PERSPECTIVE VA healthcare system. METHODS We used a propensity score-adjusted hierarchical linear modeling (HLM), and 2010-2013 VA administrative data to estimate differences in VA healthcare costs, pain intensity (0-10 numerical rating scale), and opioid use between CIH users and nonusers. We identified CIH use in Veterans' medical records through Current Procedural Terminology, VA workload tracking, and provider-type codes. RESULTS We identified 30,634 younger Veterans with chronic MSD pain as using CIH and 195,424 with no CIH use. CIH users differed from nonusers across all baseline covariates except the Charlson comorbidity index. They also differed on annual pre-CIH-start healthcare costs ($10,729 versus $5,818), pain (4.33 versus 3.76), and opioid use (66.6% versus 54.0%). The HLM results indicated lower annual healthcare costs (-$637; 95% CI: -$1,023, -$247), lower pain (-0.34; -0.40, -0.27), and slightly higher (less than a percentage point) opioid use (0.8; 0.6, 0.9) for CIH users in the year after CIH start. Sensitivity analyses indicated similar results for three most-used CIH approaches (acupuncture, chiropractic care, and massage), but higher costs for those with eight or more CIH visits. CONCLUSIONS On average CIH use appears associated with lower healthcare costs and pain and slightly higher opioid use in this population of younger Veterans with chronic musculoskeletal pain. Given the VA's growing interest in the use of CIH, further, more detailed analyses of its impacts are warranted.
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Affiliation(s)
- Patricia M. Herman
- RAND Corporation, Santa Monica, California, United States of America
- * E-mail:
| | - Anita H. Yuan
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
| | - Matthew S. Cefalu
- RAND Corporation, Santa Monica, California, United States of America
| | - Karen Chu
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
| | - Qing Zeng
- Center for Health and Aging, VA Washington DC Healthcare System, Washington, District of Columbia, United States of America
- Biomedical Informatics Center, George Washington University, Washington, District of Columbia, United States of America
| | - Nell Marshall
- Center for the Study of Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, California, United States of America
| | - Karl A. Lorenz
- Center for the Study of Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, California, United States of America
- Stanford Medical School, Palo Alto, California, United States of America
| | - Stephanie L. Taylor
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
- Department of Health Policy and Management, UCLA School of Public Health, Los Angeles, California, United States of America
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Corp N, Jordan JL, Croft PR. Justifications for using complementary and alternative medicine reported by persons with musculoskeletal conditions: A narrative literature synthesis. PLoS One 2018; 13:e0200879. [PMID: 30024952 PMCID: PMC6053199 DOI: 10.1371/journal.pone.0200879] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 05/28/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Complementary and alternative medicine (CAM) is very popular with patients frequently combining it with orthodox health care. The high prevalence of CAM use and satisfaction with CAM reported by patients directly challenges an orthodox system that can only approve such use if it results from the application of biomedical concepts and science. Studies highlighting this as a cultural, sociological and historical phenomenon emphasise the value of choice for consumers of health care. Musculoskeletal conditions typify common problems for which the effectiveness of orthodox care is often unclear. We postulated that the reasons people give for using or not using CAM for musculoskeletal conditions, would therefore indicate the full range of expectations that people have of health care. Furthermore, these reasons would indicate how much people feel orthodox health care is or is not meeting their expectations. Therefore, this study aims to investigate people's reasons for choosing or avoiding CAM for non-traumatic musculoskeletal conditions. METHODS A systematic search and narrative synthesis was conducted of published qualitative and quantitative studies related to CAM and non-traumatic musculoskeletal conditions. RESULTS We identified 169 relevant papers detailing 152 separate studies, from which 1486 justifications were extracted concerning CAM use. Content analysis resulted in 11 distinct categories across four themes: practical aspects of care, clinical effectiveness, non-clinical outcomes of care, and a person's philosophy of illness and care. People provided similar rationales for both using and avoiding CAM, emphasising that, whilst CAM is perceived by many patients with musculoskeletal conditions to fill gaps in care (such as practitioner time or quality of the therapeutic relationship), orthodox care also seeks to deliver these aspects of care. However, people who used CAM also highlighted its alignment with their general philosophy and ideas about illness and health care, and often emphasised CAM's capacity to give them control over their condition and its treatment. CONCLUSION Currently, CAM appears to have a significant role for patients with common painful long-term conditions in providing choices to enable individual needs to be met.
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Affiliation(s)
- Nadia Corp
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
| | - Joanne L. Jordan
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
| | - Peter R. Croft
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
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Shaw Y, Metes ID, Michaud K, Donohue JM, Roberts MS, Levesque MC, Chang JC. Rheumatoid Arthritis Patients' Motivations for Accepting or Resisting Disease-Modifying Antirheumatic Drug Treatment Regimens. Arthritis Care Res (Hoboken) 2018; 70:533-541. [PMID: 28575542 DOI: 10.1002/acr.23301] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 06/01/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Patient refusal of and nonadherence to treatment with disease-modifying antirheumatic drugs (DMARDs) can adversely affect disease outcomes in rheumatoid arthritis (RA). This qualitative study describes how RA patients' feelings in response to experiences and information affected their decisions to accept (agree to adopt, initiate, and implement) or resist (refuse, avoid, and discontinue) DMARD treatment regimens. METHODS A total of 48 RA patients were interviewed about their experiences making decisions about DMARDs. The interviews were transcribed, coded, and analyzed for themes related to their internal motivations for accepting or resisting treatment regimens, using a narrative analysis approach. RESULTS In addition to feelings about the necessity and dangers of medications, patients' feelings towards their identity as an ill person, the act of taking medication, and the decision process itself were important drivers of patient's decisions. For patients' motivations to accept treatment regimens, 2 themes emerged: a desire to return to a normal life, and fear of future disability due to RA. For motivations to resist treatment regimens, 5 themes emerged: fear of medications, maintaining control over health, denial of sick identity, disappointment with treatment, and feeling overwhelmed by the cognitive burden of deciding. CONCLUSION Feelings in response to experiences and information played a major role in how patients weighed the benefits and costs of treatment options, suggesting that addressing patients' feelings may be important when rheumatologists counsel about therapeutic options. Further research is needed to learn how best to address patients' feelings throughout the treatment decision-making process.
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Affiliation(s)
- Yomei Shaw
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Ilinca D Metes
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and National Data Bank for Rheumatic Diseases, Wichita, Kansas
| | - Julie M Donohue
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Mark S Roberts
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | | | - Judy C Chang
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Botanical Complementary and Alternative Medicine for Pruritus: a Systematic Review. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0200-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Predicting adherence to acupuncture appointments for low back pain: a prospective observational study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:5. [PMID: 28049527 PMCID: PMC5209924 DOI: 10.1186/s12906-016-1499-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 12/06/2016] [Indexed: 01/03/2023]
Abstract
Background Acupuncture is a popular form of complementary and alternative medicine (CAM), but it is not clear why patients do (or do not) follow acupuncturists’ treatment recommendations. This study aimed to investigate theoretically-derived predictors of adherence to acupuncture. Methods In a prospective study, adults receiving acupuncture for low back pain completed validated questionnaires at baseline, 2 weeks, 3 months, and 6 months. Patients and acupuncturists reported attendance. Logistic regression tested whether illness perceptions, treatment beliefs, and treatment appraisals measured at 2 weeks predicted attendance at all recommended acupuncture appointments. Results Three hundred twenty-four people participated (aged 18–89 years, M = 55.9, SD = 14.4; 70% female). 165 (51%) attended all recommended acupuncture appointments. Adherence was predicted by appraising acupuncture as credible, appraising the acupuncturist positively, appraising practicalities of treatment positively, and holding pro-acupuncture treatment beliefs. A multivariable logistic regression model including demographic, clinical, and psychological predictors, fit the data well (χ2 (21) = 52.723, p < .001), explained 20% of the variance, and correctly classified 65.4% of participants as adherent/non-adherent. Conclusions The results partially support the dynamic extended common-sense model for CAM use. As hypothesised, attending all recommended acupuncture appointments was predicted by illness perceptions, treatment beliefs, and treatment appraisals. However, experiencing early changes in symptoms did not predict attendance. Acupuncturists could make small changes to consultations and service organisation to encourage attendance at recommended appointments and thus potentially improve patient outcomes.
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Leppin AL, Fernandez C, Tilburt JC. Missed Opportunities: A Mixed-Methods Analysis of CAM Discussions and Practices in the Management of Pain in Oncology. J Pain Symptom Manage 2016; 52:719-726. [PMID: 27693895 PMCID: PMC5107326 DOI: 10.1016/j.jpainsymman.2016.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/07/2016] [Accepted: 05/20/2016] [Indexed: 10/20/2022]
Abstract
CONTEXT Treatment of pain in cancer is a clinical priority. Many cancer patients seek and use complementary and alternative medicine (CAM) therapies. OBJECTIVES The aim of this study was to describe the role CAM plays in oncology, clinicians' approaches to pain management and its alignment with patient preference and self-care. METHODS We used quantitative criteria to identify patients with high, self-reported pain and reduced quality of life. For these patients, we merged quantitative and qualitative data from encounter audio recordings, patient surveys, and the medical record. RESULTS We identified 32 patients (72% women, average age 60) experiencing significantly symptomatic pain at enrollment. Merged themes were 1) Restricted and defined roles: Oncology clinicians suggested and documented cancer-specific approaches to pain management. Patients often (17, 53%) used CAM but rarely desired to discuss it in their encounters. 2) Proactive patients in setting of neutrality: Pain management strategies were considered in 22 instances. CAM was mentioned in 4 (18%) of these discussions but only after patient initiation. Clinicians took a neutral stance. 3) Missed opportunities for person-centered CAM discussions and management: Most (88%) patients were receiving conventional pain medications at enrollment or had them added or escalated during follow-up. Some patients in pain expressed preferences for avoiding opioids. One patient reported wishing CAM would have been discussed after an encounter in which it was not. CONCLUSION Bringing CAM discussions into the oncology encounter may facilitate a stronger patient-clinician partnership and a more open and safe understanding of pain-related CAM use.
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Affiliation(s)
- Aaron L Leppin
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA; Division of Health Care and Policy Research, Mayo Clinic, Rochester, Minnesota, USA.
| | - Cara Fernandez
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Jon C Tilburt
- Integrative Medicine Program, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Mulkins AL, McKenzie E, Balneaves LG, Salamonsen A, Verhoef MJ. From the conventional to the alternative: exploring patients' pathways of cancer treatment and care. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2016; 13:51-64. [PMID: 26259233 DOI: 10.1515/jcim-2014-0070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 07/23/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Complementary and alternative medicine (CAM) use is widespread and on the increase among cancer patients. Most research to date has involved a cross-sectional snapshot of CAM use rather than an exploration into the longitudinal, nonlinear treatment trajectories that cancer patients develop. Our aim is to explore and describe different treatment and decision-making pathways that individuals develop after receipt of a diagnosis of either breast, colorectal, or prostate cancer. METHODS The study was part of a larger mixed-methods pilot project to explore the feasibility of conducting a five-year international study to assess cancer patients' treatment pathways, including health care use and the perceived impact of different patterns of use on health outcomes over the course of one year. The results presented in this paper are based on the analysis of personal interviews that were conducted over the course of 12 months with 30 participants. RESULTS Five pathways emerged from the data: passive conventional, self-directed conventional, cautious integrative, aggressive integrative, and aggressive alternative. Factors that shaped each pathway included health beliefs, decision-making role, illness characteristics, and the patient-practitioner relationship. CONCLUSIONS The results of this examination of the longitudinal treatment and decision-making trajectory provide important information to support health care professionals in their quest for individualized, targeted support at each stage of the patient pathway.
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Suhami N, Muhamad MB, Krauss SE. Why Cancer Patients Seek Islamic Healing. JOURNAL OF RELIGION AND HEALTH 2016; 55:1507-1518. [PMID: 26391242 DOI: 10.1007/s10943-015-0114-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Islamic healing is frequently referred to as the treatment of choice by many Muslim cancer patients in Malaysia. Despite its widespread use, there is limited information relating to patients' healing preferences. With rising cancer rates in the country, this issue has become a concern to public health policy makers. The purpose of this study was to understand why cancer patients seek Islamic healing. This qualitative study utilized in-depth interviews with 18 cancer patients. The findings indicate three main reasons: (1) recommendations from family, friends and doctors; (2) belief in Islamic healing and (3) the perceived ineffectiveness and dissatisfaction with conventional treatments. Islamic healing will likely continue to be popular complementary cancer treatment in Malaysia as it is grounded in strong cultural and religious beliefs.
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Affiliation(s)
- Norhasmilia Suhami
- Professional Development and Continuing Education, Faculty of Educational Studies, Universiti Putra Malaysia, Serdang, Malaysia.
| | - Mazanah Bt Muhamad
- Professional Development and Continuing Education, Faculty of Educational Studies, Universiti Putra Malaysia, Serdang, Malaysia
- Cancer Resource and Education Centre, Universiti Putra Malaysia, Serdang, Malaysia
| | - Steven Eric Krauss
- Institute for Social Science Studies, Universiti Putra Malaysia, Serdang, Malaysia
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Koithan M, Bell IR, Caspi O, Ferro L, Brown V. Patients' Experiences and Perceptions of a Consultative Model Integrative Medicine Clinic: A Qualitative Study. Integr Cancer Ther 2016; 6:174-84. [PMID: 17548796 DOI: 10.1177/1534735407301992] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: A common theme in integrative medicine (IM) is patient-centered partnering in care between patients and providers. Despite the stated ideals, few studies have assessed patients' perspectives on their actual experience in the context of a specific care model. The purpose of the present study was to retrospectively explore and compare experiences of cancer and noncancer patients under care in a consultative IM outpatient teaching clinic in the south-western United States. Design: Qualitative study using inductive content analysis of focus group interview transcripts (2 groups of adult patients with cancers of various types and 1 group of chronically ill noncancer patients with mixed diagnoses). Method: Participants were recruited by random selection from a pool of eligible patients. Groups were conducted with patients who had completed their initial conventional cancer treatment and were at least 6 months postconsultation with an IM clinic physician. Transcripts of the audiotaped focus groups were analyzed. Results: Cancer patients (n = 15) and noncancer patients (n = 6) (mean age, 60 years; 77% women) expressed overall satisfaction with IM, emphasizing (1) expansion of treatment options with lower perceived toxicity than conventional therapies, (2) positive experiences of the IM physician as caring and taking time to listen, and (3) improved self-care skills and sense of empowerment. Cancer patients noted positive relationships with their conventional MDs more than did noncancer patients, although both groups appreciated the IM physicians' communication styles. Conclusion: Patients experience a consultative integrative clinic model overall as favorable. The impact on outcomes, costs, and long-term quality of life requires additional study.
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Affiliation(s)
- Mary Koithan
- Department of Medicine (Program in Integrative Medicine) at The University of Arizona Health Sciences Center, Tucson, AZ 85724-5153, USA.
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Bishop FL, Yardley L, Lewith GT. A Systematic Review of Beliefs Involved in the Use of Complementary and Alternative Medicine. J Health Psychol 2016; 12:851-67. [PMID: 17956965 DOI: 10.1177/1359105307082447] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
People might be attracted to and use complementary and alternative medicines (CAM) because they hold beliefs that are congruent with CAM. This article collates, examines and synthesizes the evidence surrounding this hypothesis. Most studies are cross-sectional and focus on a limited number of beliefs. Multivariate studies suggest that beliefs related to control and participation, perceptions of illness, holism and natural treatments, and general philosophies of life predict CAM use when controlling for demographic and clinical factors. Further research should examine the robustness of these relationships in different illness groups and the prospective relationships among beliefs and CAM use over time.
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Affiliation(s)
- Felicity L. Bishop
- University of Southampton, University of Southampton, & University of Southampton Medical School
| | - Lucy Yardley
- University of Southampton, University of Southampton, & University of Southampton Medical School
| | - George T. Lewith
- University of Southampton, University of Southampton, & University of Southampton Medical School
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Wang LH, Goopy S, Lin CC, Barnard A, Han CY, Liu HE. The emergency patient's participation in medical decision-making. J Clin Nurs 2016; 25:2550-8. [PMID: 27133134 DOI: 10.1111/jocn.13296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The purpose of this research was to explore the medical decision-making processes of patients in emergency departments. BACKGROUND Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients. DESIGN This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan. METHODS Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim. RESULTS The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage. CONCLUSIONS The findings fill a gap in knowledge about the decision-making process among emergency patients. RELEVANCE TO CLINICAL PRACTICE The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff.
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Affiliation(s)
- Li-Hsiang Wang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Suzanne Goopy
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Chun-Chih Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Alan Barnard
- Queensland University of Technology, Brisbane, Qld, Australia
| | - Chin-Yen Han
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
| | - Hsueh-Erh Liu
- School of Nursing, Chang Gung University, Taoyuan, Taiwan
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Sirois FM, Salamonsen A, Kristoffersen AE. Reasons for continuing use of Complementary and Alternative Medicine (CAM) in students: a consumer commitment model. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:75. [PMID: 26911133 PMCID: PMC4765033 DOI: 10.1186/s12906-016-1059-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/16/2016] [Indexed: 12/23/2022]
Abstract
Background Research on continued CAM use has been largely atheoretical and has not considered the broader range of psychological and behavioral factors that may be involved. The purpose of this study was to test a new conceptual model of commitment to CAM use that implicates utilitarian (trust in CAM) and symbolic (perceived fit with CAM) in psychological and behavioral dimensions of CAM commitment. Methods A student sample of CAM consumers, (N = 159) completed a survey about their CAM use, CAM-related values, intentions for future CAM use, CAM word-of-mouth behavior, and perceptions of being an ongoing CAM consumer. Results Analysis revealed that the utilitarian, symbolic, and CAM commitment variables were significantly related, with r’s ranging from .54 to .73. A series hierarchical regression analyses controlling for relevant demographic variables found that the utilitarian and symbolic values uniquely accounted for significant and substantial proportion of the variance in each of the three CAM commitment indicators (R2 from .37 to .57). Conclusions The findings provide preliminary support for the new model that posits that CAM commitment is a multi-dimensional psychological state with behavioral indicators. Further research with large-scale samples and longitudinal designs is warranted to understand the potential value of the new model.
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Sirois FM, Salamonsen A, Kristoffersen AE. Reasons for continuing use of Complementary and Alternative Medicine (CAM) in students: a consumer commitment model. Altern Ther Health Med 2016. [PMID: 26911133 DOI: 10.1186/s12906-016-1059-3.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Research on continued CAM use has been largely atheoretical and has not considered the broader range of psychological and behavioral factors that may be involved. The purpose of this study was to test a new conceptual model of commitment to CAM use that implicates utilitarian (trust in CAM) and symbolic (perceived fit with CAM) in psychological and behavioral dimensions of CAM commitment. METHODS A student sample of CAM consumers, (N = 159) completed a survey about their CAM use, CAM-related values, intentions for future CAM use, CAM word-of-mouth behavior, and perceptions of being an ongoing CAM consumer. RESULTS Analysis revealed that the utilitarian, symbolic, and CAM commitment variables were significantly related, with r's ranging from .54 to .73. A series hierarchical regression analyses controlling for relevant demographic variables found that the utilitarian and symbolic values uniquely accounted for significant and substantial proportion of the variance in each of the three CAM commitment indicators (R(2) from .37 to .57). CONCLUSIONS The findings provide preliminary support for the new model that posits that CAM commitment is a multi-dimensional psychological state with behavioral indicators. Further research with large-scale samples and longitudinal designs is warranted to understand the potential value of the new model.
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Affiliation(s)
- Fuschia M Sirois
- Department of Psychology, University of Sheffield, Sheffield, UK.,Department of Psychology, University of Windsor, Windsor, Canada
| | - Anita Salamonsen
- National Research Center in Complementary and Alternative Medicine, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Agnete E Kristoffersen
- National Research Center in Complementary and Alternative Medicine, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
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Ibrahim IR, Hassali MA, Saleem F, Al Tukmagi HF. A qualitative insight on complementary and alternative medicines used by hypertensive patients. J Pharm Bioallied Sci 2016; 8:284-288. [PMID: 28216951 PMCID: PMC5314826 DOI: 10.4103/0975-7406.199349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: The self-treatment with complementary and alternative medicines (CAMs) in chronic diseases is portraying an expanding trend worldwide. Yet, little is known concerning patients’ motives to use CAM in the control of blood pressure. Objective: This study aims to explore the self-use of CAM in the management of hypertension and explore patients’ attitudes, perceived benefits, and disclosure to the physician. Materials and Methods: A qualitative technique was adopted and face-to-face interviews, using a validated interview guide, were carried out among twenty hypertensive patients. A purposive sampling method was used to recruit patients at Al-Karama Teaching Hospital in Baghdad; the capital of Iraq; from January to April 2015. All the interviews were audio-recorded, then transcribed verbatim and examined for thematic relationships. Results: Three major themes were identified through thematic content analysis of the interviews. These encompassed patients’ understanding of CAM; experience and perceived benefits; and communication with the doctors. The use of CAM was prevalent among the majority of the respondents. The most commonly used therapies were biological-based practices (herbal remedies, special diet, vitamins, and dietary supplements); traditional therapies (Al-Hijama or cupping); and to a less extent of manipulative body-based therapies (reflexology). Factors influencing the use of CAM were traditions, social relationships, religious beliefs, low-cost therapy, and safety of natural products. Conclusion: The use of CAM was common as a practice of self-treatment among hypertensive patients in Iraq. This was underpinned by the cultural effects, social relationships, religious beliefs, and the perception that natural products are effective and safe. Understanding patients’ usage of CAM is of great importance as long as patient's safety and interaction with the standard prescribed treatment are major concerns.
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Affiliation(s)
- Inas Rifaat Ibrahim
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
| | - Fahad Saleem
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
| | - Haydar F Al Tukmagi
- Department of Clinical Pharmacy, College of Pharmacy, University of Baghdad, Baghdad, Iraq
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Lin V, Canaway R, Carter B. Interface, interaction and integration: how people with chronic disease in Australia manage CAM and conventional medical services. Health Expect 2015; 18:2651-65. [PMID: 25069626 PMCID: PMC5810634 DOI: 10.1111/hex.12239] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To understand the extent to which conventional and complementary health care are integrated for CAM users with chronic conditions. METHODS In-depth interviews and a self-administered questionnaire were used to collect data on care-seeking, self-management and CAM use among people with type 2 diabetes and/or cardiovascular disease living in Victoria, Australia. RESULTS Many participants reported regular, frequent and long-term use of CAM therapies to maintain their health or assist in the management of their chronic condition. They generally managed the interface between convention and complementary health care on their own, as the perceived or expressed negative attitudes of some doctors, or the belief that the doctor did not need to know, were barriers to the disclosure of CAM use. For a smaller group, there was interaction between conventional and CAM providers, which limited the extent of uncertainty and conflicting information being (mis)interpreted by consumers. CONCLUSIONS Greater interaction between CAM and medical providers would be beneficial to consumers. Structural barriers, related to financing and service organization, need to be addressed. Attitudinal shifts of some health-care practitioners also need to be addressed, in the context of workforce development.
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Affiliation(s)
- Vivian Lin
- CAMELOT ProjectSchool of Public Health and Human BiosciencesLa Trobe UniversityBundooraVic.Australia
| | - Rachel Canaway
- CAMELOT ProjectSchool of Social SciencesMonash UniversityClaytonVic.Australia
| | - Bronwyn Carter
- CAMELOT ProjectSchool of Public Health and Human BiosciencesLa Trobe UniversityBundooraVic.Australia
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Lin V, Canaway R, Carter B, Manderson L. Room for improvement: complementary therapy users and the Australian health system. Health Expect 2015; 18:1451-62. [PMID: 23992199 PMCID: PMC5060902 DOI: 10.1111/hex.12125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2013] [Indexed: 11/30/2022] Open
Abstract
CONTEXT People with chronic conditions who are often in contact with the health-care system are well placed to reflect on how services meet their needs. Some research characterizes people who use complementary and alternative medicines (CAMs) as a distinct group who opt out of the mainstream health system. However, many CAM users are people with chronic or terminal health conditions who concurrently use mainstream health-care services. The difference in perspectives between people with chronic conditions who do or do not use CAM has received little attention by researchers. OBJECTIVE To explore the views of CAM users with chronic conditions and identify their perspectives on the health system. DESIGN AND SETTING In-depth interviews and a self-administered questionnaire were used to collect data on care-seeking, self-management and CAM use among people with type 2 diabetes and/or cardiovascular disease living in Victoria, Australia. RESULTS One in four CAM practitioner users was partly motivated to use CAM as a result of their dissatisfaction with the mainstream health system. In general, their dissatisfaction mirrored the concerns of the general population. This included the perceived lack of a humanistic or person-centred approach, which was central to problems relating to individuals' clinical encounters as well as to health system design. DISCUSSION AND CONCLUSION Participants' concerns suggest room for improvement in the Australian health system to better reflect patients' needs. A systems approach is needed to reorient health-care practitioners to modify the organization of care because of the incentives embedded in the structure of the health-care system.
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Affiliation(s)
- Vivian Lin
- CAMELOT ProjectSchool of Public HealthLa Trobe UniversityBundooraVic.Australia
| | - Rachel Canaway
- CAMELOT ProjectSchool of Psychology and PsychiatryMonash UniversityCaulfieldVic.Australia
| | - Bronwyn Carter
- CAMELOT ProjectSchool of Public HealthLa Trobe UniversityBundooraVic.Australia
| | - Lenore Manderson
- CAMELOT ProjectSchool of Psychology and PsychiatryMonash UniversityCaulfieldVic.Australia
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Wolever RQ, Price R, Hazelton AG, Dmitrieva NO, Bechard EM, Shaffer JK, Tucci DL. Complementary Therapies for Significant Dysfunction from Tinnitus: Treatment Review and Potential for Integrative Medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:931418. [PMID: 26457113 PMCID: PMC4592735 DOI: 10.1155/2015/931418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/31/2015] [Accepted: 09/02/2015] [Indexed: 11/18/2022]
Abstract
Tinnitus is a prevalent and costly chronic condition; no universally effective treatment exists. Only 20% of patients who report tinnitus actually seek treatment, and when treated, most patients commonly receive sound-based and educational (SBE) therapy. Additional treatment options are necessary, however, for nonauditory aspects of tinnitus (e.g., anxiety, depression, and significant interference with daily life) and when SBE therapy is inefficacious or inappropriate. This paper provides a comprehensive review of (1) conventional tinnitus treatments and (2) promising complementary therapies that have demonstrated some benefit for severe dysfunction from tinnitus. While there has been no systematic study of the benefits of an Integrative Medicine approach for severe tinnitus, the current paper reviews emerging evidence suggesting that synergistic combinations of complementary therapies provided within a whole-person framework may augment SBE therapy and empower patients to exert control over their tinnitus symptoms without the use of medications, expensive devices, or extended programs.
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Affiliation(s)
- Ruth Q. Wolever
- Department of Physical Medicine & Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Schools of Medicine and Nursing, 3401 West End, Suite 380, Nashville, TN 37203, USA
- Duke Integrative Medicine and Duke Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 102904, Durham, NC 27710, USA
| | - Rebecca Price
- Department of Speech Pathology & Audiology, Duke University Health Systems, DUMC 3887, Durham, NC 27710, USA
| | - A. Garrett Hazelton
- Department of Psychiatry and Behavioral Medicine, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA
| | - Natalia O. Dmitrieva
- Department of Psychological Sciences, Northern Arizona University, P.O. Box 15106, Flagstaff, AZ 86011, USA
| | | | | | - Debara L. Tucci
- Division of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, DUMC 3085, Durham, NC 27710, USA
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Murthy V, Sibbritt D, Broom A, Kirby E, Frawley J, Refshauge KM, Adams J. Back pain sufferers' attitudes toward consultations with CAM practitioners and self- prescribed CAM products: A study of a nationally representative sample of 1310 Australian women aged 60-65 years. Complement Ther Med 2015; 23:782-8. [PMID: 26645516 DOI: 10.1016/j.ctim.2015.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 07/22/2015] [Accepted: 09/07/2015] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To analyze back pain sufferers' attitudes toward consultations with complementary and alternative medicine (CAM) practitioners and self-prescribed CAM products. METHODS A cross-sectional survey of a nationally representative sample of Australian women aged 60-65 years. RESULTS A significant number of women with back pain consulted a massage therapist (41.4%, n=578), a chiropractor (37.3%, n=488), an acupuncturist (13.3%, n=174), used self-prescribed supplements (59.2%, n=776), vitamins/minerals (45.2%, n=592) and/or herbal medicines (13.1%, n=172). Women who perceived CAM as providing greater control over their body/health were more likely to have consulted a chiropractor (OR=4.21; 95% CI; 2.16, 8.19) and/or self- prescribed supplements (OR=2.38; 95% CI: 1.05, 3.49) than those who did not perceive CAM as providing greater control over their body/health. Women who perceived CAM as natural (OR=1.56; 95% CI: 1.02, 2.37) or promoting a holistic approach to health (OR=2.73; 95% CI: 1.60, 4.64) were more likely to have self-prescribed vitamins/minerals than those who did not perceive CAM as natural and promoting a holistic approach to health. Women who expressed that knowledge about evidence of CAM as important to them were more likely to have self-prescribed herbal medicines (OR=7.15; 95% CI: 1.72, 29.64) than those who did not express an interest in knowledge about evidence of CAM. CONCLUSION Certain key attitudes toward CAM influence back pain sufferers' choice of CAM use, highlighting the need for back pain care providers to ensure appropriate enquiry and discussion with their patients regarding consulting CAM practitioners and/or self-prescribing CAM products for back pain.
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Affiliation(s)
- Vijayendra Murthy
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, UTS, Level 7, Building 10, 235-253 Jones Street, Ultimo, NSW 2006, Australia
| | - David Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, UTS, Level 7, Building 10, 235-253 Jones Street, Ultimo, NSW 2006, Australia
| | - Alex Broom
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, UTS, Level 7, Building 10, 235-253 Jones Street, Ultimo, NSW 2006, Australia
| | - Emma Kirby
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, UTS, Level 7, Building 10, 235-253 Jones Street, Ultimo, NSW 2006, Australia
| | - Jane Frawley
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, UTS, Level 7, Building 10, 235-253 Jones Street, Ultimo, NSW 2006, Australia
| | - Kathryn M Refshauge
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, UTS, Level 7, Building 10, 235-253 Jones Street, Ultimo, NSW 2006, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, UTS, Level 7, Building 10, 235-253 Jones Street, Ultimo, NSW 2006, Australia.
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Clobert M, Saroglou V, Van Pachterbeke M. Who Turns to Acupuncture? The Role of Mistrust of Rationality and Individualist Success. J Altern Complement Med 2015; 21:466-71. [PMID: 26090703 DOI: 10.1089/acm.2014.0229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE In this postmodern society, people tend to abandon conventional medicine for alternative medical systems, such as acupuncture. What are the reasons for this defiance regarding modern rationality and individualist success? Who turns to acupuncture? METHODS This study (n=89) examined whether world views opposed to the predominance of rationality (i.e., mistrust of science, spirituality, paranormal beliefs) and individualist success or consumerism (i.e., power, achievement, and materialism), typically associated with the postmodern era, might explain this attraction toward acupuncture. Participants were recruited through Internet forums interested in complementary and alternative medicine and completed the questionnaire voluntarily. RESULTS Attraction to acupuncture related negatively with materialism and achievement as well as positively with spirituality, paranormal beliefs, and mistrust in science. Spirituality, paranormal beliefs, and low achievement were the main predictors of attraction to acupuncture and explained 44% of the variance. The mistrust in science mediated the relationship between spiritual and paranormal beliefs and the attraction toward acupuncture. Low achievement explained the link between low materialism and positive attitudes toward acupuncture. CONCLUSION The general mistrust of our rational and individualist modern society is indeed an important predictor of attraction toward acupuncture, in addition to demographic variables.
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Affiliation(s)
- Magali Clobert
- 1 Université Catholique de Louvain , Louvain-la-Neuve, Belgium .,2 Belgian National Fund for Scientific Research , Brussels, Belgium .,3 Stanford University , Stanford, CA
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Wang JW, Yang ZQ, Liu C, Chen SJ, Shen Q, Zhang TR, Partike NS, Yuan ZP, Yu JM. Cancer survivors' perspectives and experience on western medicine and traditional Chinese medicine treatment and rehabilitation: a qualitative study. Patient Prefer Adherence 2015; 9:9-16. [PMID: 25565779 PMCID: PMC4274133 DOI: 10.2147/ppa.s76617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In the People's Republic of China, both western medicine (WM) and traditional Chinese medicine (TCM) are the main treatment and rehabilitation options for cancer patients. This study aimed to explore cancer survivors' perspectives and experience of treatment and rehabilitation, in order to promote patient-centered activities of treatment and rehabilitation. METHODS Using a qualitative research approach, 68 cancer survivors were recruited from eight community cancer rehabilitation organizations in Shanghai, People's Republic of China. Eight focus group interviews were conducted. All these interviews were transcribed verbatim, and the data were analyzed by theme analysis. RESULTS WM was the main choice in treatment phase though study participants noted more side effects. TCM was primarily used in the recovery phase. The lack of communication between doctors and cancer patients appears to affect treatment adherence and impair the doctor-patient relationship. WM was expensive for diagnostic procedures and treatment, while the cumulative costs of frequent use of TCM in the long rehabilitation period were also high. Both treatment options created significant perceived economic burden on patients. Conflicting information about dietary supplements tended to make cancer survivors confused. CONCLUSION Improving the communication between doctors and cancer patients helps to ameliorate cancer patient adherence and the effect of treatments. It is essential to educate cancer patients about the effect and cost of both WM and traditional TCM. Meanwhile, marketing management and guidance to consumers regarding use of dietary supplements in the cancer rehabilitation field are also necessary.
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Affiliation(s)
- Ji-Wei Wang
- School of Public Health, Key Laboratory of Public Health Safety, Fudan University, Shanghai, People’s Republic of China
| | - Zhi-Qi Yang
- School of Public Health, Key Laboratory of Public Health Safety, Fudan University, Shanghai, People’s Republic of China
| | - Cong Liu
- School of Public Health, Key Laboratory of Public Health Safety, Fudan University, Shanghai, People’s Republic of China
| | - Si-Jia Chen
- School of Public Health, Key Laboratory of Public Health Safety, Fudan University, Shanghai, People’s Republic of China
| | - Qian Shen
- School of Public Health, Key Laboratory of Public Health Safety, Fudan University, Shanghai, People’s Republic of China
| | - Tian-Rui Zhang
- School of Public Health, Key Laboratory of Public Health Safety, Fudan University, Shanghai, People’s Republic of China
| | - Nancy S Partike
- School of Public Health, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Zheng-Ping Yuan
- Shanghai Cancer Rehabilitation Club, Shanghai, People’s Republic of China
| | - Jin-Ming Yu
- School of Public Health, Key Laboratory of Public Health Safety, Fudan University, Shanghai, People’s Republic of China
- Correspondence: Jin-Ming Yu, School of Public Health, Key Laboratory of Public Health Safety, Fudan University, 130 Dong-An Road, Shanghai 200032, People’s Republic of China, Tel +86 21 5423 7868, Email
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Complementary/alternative therapies use in older women with arthritis: Information sources and factors influencing dialog with health care providers. Geriatr Nurs 2015; 36:15-20. [DOI: 10.1016/j.gerinurse.2014.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 07/31/2014] [Accepted: 08/11/2014] [Indexed: 01/08/2023]
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Tangkiatkumjai M, Boardman H, Praditpornsilpa K, Walker DM. Reasons why Thai patients with chronic kidney disease use or do not use herbal and dietary supplements. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:473. [PMID: 25481733 PMCID: PMC4295480 DOI: 10.1186/1472-6882-14-473] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/02/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite a high prevalence of herbal and dietary supplement use (HDS) in pre-dialysis patients, the reasons are unknown as to why they decide to use HDS. Objectives of the cross-sectional and qualitative studies were to determine reasons for the use and non-use of HDS in Thai patients with chronic kidney disease (CKD). METHODS This prospective study recruited 421 patients with stage 3-5 CKD from two kidney clinics in Thailand, and 357 were followed up regarding their HDS use over 12 months. Patients receiving renal replacement therapy at baseline were excluded. Participants were interviewed at baseline and in the twelfth month regarding their HDS use, and reasons for their use or non-use of HDS. Among HDS users, 16 patients were enrolled in a qualitative study and were interviewed using eight-open ended questions about reasons for HDS use. Descriptive and thematic analyses were performed. RESULTS Thirty-four percent of patients with CKD consistently used HDS over the 12 months and 17% of all patients intermittently took them during the follow-up period. At baseline, family or friends' recommendation was the most common reason for HDS use (35%), followed by having a perception of benefits from using HDS (24%). During the follow-up period, perceived benefits of HDS was a frequently reported reason for either continuing with HDS use (85%) or starting to use HDS (65%). Negative experience from using HDS influenced patients to stop using them (19%). Although the main reason for non-use of HDS was trust in a doctor or effectiveness of conventional medicine (32%), doubt about the benefits from HDS or concerns about negative effects were frequently reported reasons for non-use (23%). Doctor's recommendations to avoid using HDS were the main influence for non-users (19%) and for those who had stopped using HDS (23%). The media and patients' social network had an impact on HDS use. CONCLUSIONS Patients who perceived benefits from HDS use were more likely to use HDS, whilst non-users had negative attitudes towards HDS. Health professionals therefore should educate patients and their relatives about the risks and benefits from using HDS.
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Affiliation(s)
- Mayuree Tangkiatkumjai
- />Division of Primary Care, School of Medicine, University of Nottingham, QMC, Nottingham, NG7 2UH UK
| | - Helen Boardman
- />Division of Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Kearkiat Praditpornsilpa
- />Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Dawn-Marie Walker
- />Division of Primary Care, School of Medicine, University of Nottingham, QMC, Nottingham, NG7 2UH UK
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Steel A, Adams J, Sibbritt D, Broom A, Gallois C, Frawley J. Determinants of Women Consulting with a Complementary and Alternative Medicine Practitioner for Pregnancy-Related Health Conditions. Women Health 2014; 54:127-44. [DOI: 10.1080/03630242.2013.876488] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kretchy IA, Owusu-Daaku F, Danquah S. Patterns and determinants of the use of complementary and alternative medicine: a cross-sectional study of hypertensive patients in Ghana. Altern Ther Health Med 2014; 14:44. [PMID: 24495363 PMCID: PMC3936816 DOI: 10.1186/1472-6882-14-44] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/31/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND The use of complementary and alternative medicine (CAM) is widespread and high utilization rates are associated with people who have chronic conditions like hypertension which management requires adherence to conventional treatment. Often however, the use of alternative medicines has been linked to negative health outcomes. The purpose of the study therefore was to evaluate the pattern, determinants and the association between CAM use and the adherence behaviour of hypertensive patients in Ghana. METHODS A cross-sectional study was conducted using 400 hypertensive patients attending Korle-bu and Komfo Anokye Teaching Hospitals in Ghana from May to July, 2012. Information was gathered on the socio-demographic characteristics of patients, CAM use, and adherence using the 8-item Morisky Medication Adherence Scale (MMAS). RESULTS Out of the 400 study participants, 78 (19.5%) reported using CAM with the majority (65.38%) utilizing biological based therapies. About 70% of CAM users had not disclosed their CAM use to their healthcare professionals citing fear and the lack of inquiry by these health professionals as the main reasons for non-disclosure. Males were 2.86 more likely to use CAM than females [odds ratio (OR) = 2.86 (95% CI 1.48-5.52), p = 0.002]. Participants who could not afford their medications had 3.85 times likelihood of CAM use than those who could afford their medicines [OR = 3.85 (1.15-12.5), p = 0.029]. In addition, a significant relationship between CAM use and experiences of anti-hypertensive side effects was observed, X2 = 25.378, p < 0.0001. CAM users were 2.22 times more likely to be non-adherent than participants who did not use CAM [OR = 2.22 (0.70-7.14), p = 0.176]. CONCLUSION Hypertensive patients in Ghana have shown utilization for CAM. It is important that healthcare providers understand the patterns and determinants of CAM use among their patients. Intervention programmes can then be incorporated to enhance the desired health outcomes of patients.
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Hardy-Pickering R, Adams N, Sim J, Roe B, Wallymahmed A. The use of complementary and alternative therapies for fibromyalgia. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331907x222930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Bishop FL, Smith R, Lewith GT. Patient preferences for technical skills versus interpersonal skills in chiropractors and physiotherapists treating low back pain. Fam Pract 2013; 30:197-203. [PMID: 23123436 DOI: 10.1093/fampra/cms066] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Little is known about which characteristics of chiropractors and physiotherapists matter to patients and influence their preferences when seeking care. OBJECTIVE To examine the impact of four factors (patient gender, practitioner gender, practitioner specialty-chiropractor or physiotherapist and practitioner reputation-technical ability or interpersonal skills) on patients' choice of therapist to treat low back pain. METHODS Questionnaire-based vignette study in which participants sampled from the general population rated the likelihood of consulting eight fictional therapists. Each fictional therapist represented a different combination of the three practitioner factors (e.g. male chiropractor with reputation for good technical ability). The study was administered as a postal survey to a simple random sample of residences in one postal town in England. RESULTS Respondents (n = 657) consistently reported that they considered a practitioner's qualifications and technical skills important when choosing either a physiotherapist or a chiropractor; and just less than a third thought it was important that a practitioner was a good listener. As hypothesized, female respondents preferred female practitioners and respondents had a general preference for physiotherapists over chiropractors. Contrary to our hypothesis, the practitioner's reputation had the largest effect on respondents' preferences and all practitioners with a reputation for technical ability were preferred over those with a reputation for interpersonal skills. CONCLUSION Similar factors are important to patients whether they are choosing an individual chiropractor or physiotherapist; patients particularly value information about technical competence. An awareness of these factors should help primary care providers to direct patients to relevant information and support their decision-making.
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Affiliation(s)
- Felicity L Bishop
- Centre for Applications of Health Psychology, Faculty of Social and Human Sciences, University of Southampton, Building 44, Highfield Campus, Southampton SO17 1BJ, UK.
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Balneaves LG, Truant TLO, Verhoef MJ, Ross B, Porcino AJ, Wong M, Brazier AS. The Complementary Medicine Education and Outcomes (CAMEO) program: a foundation for patient and health professional education and decision support programs. PATIENT EDUCATION AND COUNSELING 2012; 89:461-6. [PMID: 22305188 DOI: 10.1016/j.pec.2012.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 01/03/2012] [Accepted: 01/09/2012] [Indexed: 05/24/2023]
Abstract
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.
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Bishop FL, Bradbury K, Hj Jeludin NN, Massey Y, Lewith GT. How patients choose osteopaths: a mixed methods study. Complement Ther Med 2012; 21:50-7. [PMID: 23374205 DOI: 10.1016/j.ctim.2012.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 10/19/2012] [Accepted: 10/22/2012] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To explore how patients choose individual osteopaths to consult; to test whether patients' preferences for osteopaths depend on gender, the osteopath's qualifications, and the cost of treatment; to explore patients' perspectives. DESIGN An explanatory mixed methods design incorporating a quasi-experimental study administered by postal survey and a qualitative interview study. SETTING One sample of patients at a private-sector complementary therapy clinic in the UK completed a survey; a second sample of patients recruited from osteopathy clinics took part in qualitative interviews. MAIN OUTCOME MEASURES In the survey, male and female respondents (n=176) rated the likelihood of consulting each of 8 fictional osteopaths, representing all possible combinations of 3 factors (practitioner gender, biomedically qualified or not, working in a public sector or private clinic). Semi-structured qualitative interviews (n=19) about patients' experiences of osteopathy were analysed deductively and inductively. RESULTS Survey respondents preferred osteopaths who were also biomedical doctors, F(1,174)=67.21, p<0.001, η(2)=0.28. Qualitative data showed that, when choosing an osteopath, patients valued personal recommendations from a trusted source and such recommendations overrode other considerations. First impressions were important and were based on patients' perceptions of an osteopath's competence, interpersonal fit, and immediate treatment effect. CONCLUSIONS Word of mouth appears to be the primary mechanism by which patients choose individual osteopaths; in the absence of personal recommendations, some patients prefer biomedically qualified practitioners. Trustworthy and appropriate information about practitioners (e.g. from professional regulatory bodies) could empower patients to make confident choices when seeking individual complementary practitioners to consult.
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Affiliation(s)
- Felicity L Bishop
- Primary Care and Population Sciences, University of Southampton School of Medicine, Southampton, UK.
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Tsui T, Boon H, Boecker A, Kachan N, Krahn M. Understanding the role of scientific evidence in consumer evaluation of natural health products for osteoarthritis an application of the means end chain approach. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 12:198. [PMID: 23107559 PMCID: PMC3517436 DOI: 10.1186/1472-6882-12-198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 10/12/2012] [Indexed: 11/12/2022]
Abstract
Background Over 30% of individuals use natural health products (NHPs) for osteoarthritis-related pain. The Deficit Model for the Public Understanding of Science suggests that if individuals are given more information (especially about scientific evidence) they will make better health-related decisions. In contrast, the Contextual Model argues that scientific evidence is one of many factors that explain how consumers make health-related decisions. The primary objective was to investigate how the level of scientific evidence supporting the efficacy of NHPs impacts consumer decision-making in the self-selection of NHPs by individuals with osteoarthritis. Methods The means-end chain approach to product evaluation was used to compare laddering interviews with two groups of community-dwelling Canadian seniors who had used NHPs to treat their osteoarthritis. Group 1 (n=13) had used only NHPs (glucosamine and/or chondroitin) with “high” scientific evidence of efficacy. Group 2 (n=12) had used NHPs (methylsulfonylmethane (MSM) and/or bromelain) with little or no scientific evidence supporting efficacy. Content analysis and generation of hierarchical value maps facilitated the identification of similarities and differences between the two groups. Results The dominant decision-making chains for participants in the two scientific evidence categories were similar. Scientific evidence was an important decision-making factor but not as important as the advice from health care providers, friends and family. Most participants learned about scientific evidence via indirect sources from health care providers and the media. Conclusions The Contextual Model of the public understanding of science helps to explain why our participants believed scientific evidence is not the most important factor in their decision to use NHPs to help manage their osteoarthritis.
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Development and Validation of an Instrument for Measuring Attitudes and Beliefs about Complementary and Alternative Medicine (CAM) Use among Cancer Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:798098. [PMID: 22693532 PMCID: PMC3369496 DOI: 10.1155/2012/798098] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 03/25/2012] [Accepted: 03/27/2012] [Indexed: 11/17/2022]
Abstract
Despite cancer patients' extensive use of complementary and alternative medicine (CAM), validated instruments to measure attitudes, and beliefs predictive of CAM use are lacking. We aimed at developing and validating an instrument, attitudes and beliefs about CAM (ABCAM). The 15-item instrument was developed using the theory of planned behavior (TPB) as a framework. The literature review, qualitative interviews, expert content review, and cognitive interviews were used to develop the instrument, which was then administered to 317 outpatient oncology patients. The ABCAM was best represented as a 3-factor structure: expected benefits, perceived barriers, and subjective norms related to CAM use by cancer patients. These domains had Eigenvalues of 4.79, 2.37, and 1.43, and together explained over 57.2% of the variance. The 4-item expected benefits, 7-item perceived barriers, and 4-item subjective norms domain scores, each had an acceptable internal consistency (Cronbach's alpha) of 0.91, 0.76, and 0.75, respectively. As expected, CAM users had higher expected benefits, lower perceived barriers, and more positive subjective norms (all P < 0.001) than those who did not use CAM. Our study provides the initial evidence that the ABCAM instrument produced reliable and valid scores that measured attitudes and beliefs related to CAM use among cancer patients.
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Emmerton L, Fejzic J, Tett SE. Consumers' experiences and values in conventional and alternative medicine paradigms: a problem detection study (PDS). BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 12:39. [PMID: 22490367 PMCID: PMC3349512 DOI: 10.1186/1472-6882-12-39] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 04/10/2012] [Indexed: 09/03/2023]
Abstract
Background This study explored consumer perceptions of complementary and alternative medicine (CAM) and relationships with CAM and conventional medicine practitioners. A problem detection study (PDS) was used. The qualitative component to develop the questionnaire used a CAM consumer focus group to explore conventional and CAM paradigms in healthcare. 32 key issues, seven main themes, informed the questionnaire (the quantitative PDS component - 36 statements explored using five-point Likert scales.) Results Of 300 questionnaires distributed (Brisbane, Australia), 83 consumers responded. Results indicated that consumers felt empowered by using CAM and they reported positive relationships with CAM practitioners. The perception was that CAM were used most effectively as long-term therapy (63% agreement), but that conventional medicines would be the best choice for emergency treatment (81% agreement). A majority (65%) reported that doctors appeared uncomfortable about consumers' visits to CAM practitioners. Most consumers (72%) believed that relationships with and between health practitioners could be enhanced by improved communication. It was agreed that information sharing between consumers and healthcare practitioners is important, and reported that "enough" information is shared between CAM practitioners and consumers. Consumers felt comfortable discussing their medicines with pharmacists, general practitioners and CAM practitioners, but felt most comfortable with their CAM practitioners. Conclusions This PDS has emphasized the perceived importance of open communication between consumers, CAM and conventional providers, and has exposed areas where CAM consumers perceive that issues exist across the CAM and conventional medicine paradigms. There is a lot of information which is perceived as not being shared at present and there are issues of discomfort and distrust which require resolution to develop concordant relationships in healthcare. Further research should be based on optimisation of information sharing, spanning both conventional and CAM fields of healthcare, due to both the relevance of concordance principles within CAM modalities and the widespread use of CAM by consumers.
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Cancer patients' experience of combined treatment with conventional and traditional Chinese medicine: a biopsychosocial phenomenon. Cancer Nurs 2012; 34:495-502. [PMID: 21372696 DOI: 10.1097/ncc.0b013e31820d4da9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Abstract
Athletes are high achievers who may seek creative or unconventional methods to improve performance. The literature indicates that athletes are among the heaviest users of complementary and alternative medicine (CAM) and thus may pioneer population trends in CAM use. Unlike non-athletes, athletes may use CAM not just for prevention, treatment or rehabilitation from illness or injuries, but also for performance enhancement. Assuming that athletes' creative use of anything unconventional is aimed at "legally" improving performance, CAM may be used because it is perceived as more "natural" and erroneously assumed as not potentially doping. This failure to recognise CAMs as pharmacological agents puts athletes at risk of inadvertent doping.The general position of the World Anti-Doping Authority (WADA) is one of strict liability, an application of the legal proposition that ignorance is no excuse and the ultimate responsibility is on the athlete to ensure at all times whatever is swallowed, injected or applied to the athlete is both safe and legal for use. This means that a violation occurs whether or not the athlete intentionally or unintentionally, knowingly or unknowingly, used a prohibited substance/method or was negligent or otherwise at fault. Athletes are therefore expected to understand not only what is prohibited, but also what might potentially cause an inadvertent doping violation. Yet, as will be discussed, athlete knowledge on doping is deficient and WADA itself sometimes changes its position on prohibited methods or substances. The situation is further confounded by the conflicting stance of anti-doping experts in the media. These highly publicised disagreements may further portray inconsistencies in anti-doping guidelines and suggest to athletes that what is considered doping is dependent on the dominant political zeitgeist. Taken together, athletes may believe that unless a specific and explicit ruling is made, guidelines are open to interpretation. Therefore doping risk-taking behaviours may occur because of the potential financial, social and performance gains and the optimistically biased interpretation (that trying alternatives is part of the "spirit of sport") and doping risk-taking behaviours may occur.This discussion paper seeks to situate the reader in a world where elite level sports and CAM intersects. It posits that an understanding of the underlying motivation for CAM use and doping is currently lacking and that anti-doping rules need to be repositioned in the context of the emerging phenomenon and prevalence of CAM use.
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Affiliation(s)
- Benjamin Koh
- Independent Medical Practitioner and Researcher, Management Discipline Group, University of Technology (UTS)
| | - Lynne Freeman
- Lecturer in Qualitative Research, Marketing Discipline Group, UTS
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Grimaldi-Bensouda L, Engel P, Massol J, Guillemot D, Avouac B, Duru G, Lert F, Magnier AM, Rossignol M, Rouillon F, Abenhaim L, Begaud B. Who seeks primary care for sleep, anxiety and depressive disorders from physicians prescribing homeopathic and other complementary medicine? Results from the EPI3 population survey. BMJ Open 2012; 2:e001498. [PMID: 23180389 PMCID: PMC3532988 DOI: 10.1136/bmjopen-2012-001498] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To describe and compare patients seeking treatment for sleep, anxiety and depressive disorders (SADD) from physicians in general practice (GPs) with three different practice preferences: strictly conventional medicine (GP-CM), mixed complementary and conventional medicine (GP-Mx) and certified homeopathic physicians (GP-Ho). DESIGN AND SETTING The EPI3 survey was a nationwide, observational study of a representative sample of GPs and their patients, conducted in France between March 2007 and July 2008. PARTICIPANTS 1572 patients diagnosed with SADD. PRIMARY AND SECONDARY OUTCOMES The patients' attitude towards complementary and alternative medicine; psychotropic drug utilisation. RESULTS Compared to patients attending GP-CM, GP-Ho patients had healthier lifestyles while GP-Mx patients showed similar profiles. Psychotropic drugs were more likely to be prescribed by GP-CM (64%) than GP-Mx (55.4%) and GP-Ho (31.2%). The three groups of patients shared similar SADD severity. CONCLUSION Our results showed that patients with SADD, while differing principally in their sociodemographic profiles and conventional psychotropic prescriptions, were actually rather similar regarding the severity of SADD in terms of comorbidities and quality of life. This information may help to better plan resource allocation and management of these common health problems in primary care.
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Affiliation(s)
- Lamiae Grimaldi-Bensouda
- Equipe d'accueil “Pharmacoépidémiologie et maladies infectieuses”, Institut Pasteur, Paris, France
- LA-SER, Paris, France
| | | | - Jacques Massol
- UFR de Médecine, Université de Franche Comté, Besançon, France
| | - Didier Guillemot
- Institut Pasteur, Paris, France
- Cyklad Group, Rillieux-la-Pap, France
| | | | | | - France Lert
- INSERM U1018, Centre for Epidemiology and Population Health, Villejuif, France
| | | | - Michel Rossignol
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- LA-SER Centre for Risk Research, Montreal, Canada
| | - Frederic Rouillon
- Centre Hospitalier Sainte-Anne, Université Paris V René Descartes, Paris, France
| | - Lucien Abenhaim
- Department of Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- LA-SER Europe Limited, London, United Kingdom
| | - Bernard Begaud
- INSERM U657, Université Bordeaux Segalen, Bordeaux, France
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DeBar LL, Elder C, Ritenbaugh C, Aickin M, Deyo R, Meenan R, Dickerson J, Webster JA, Jo Yarborough B. Acupuncture and chiropractic care for chronic pain in an integrated health plan: a mixed methods study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 11:118. [PMID: 22118061 PMCID: PMC3256110 DOI: 10.1186/1472-6882-11-118] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 11/25/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Substantial recent research examines the efficacy of many types of complementary and alternative (CAM) therapies. However, outcomes associated with the "real-world" use of CAM has been largely overlooked, despite calls for CAM therapies to be studied in the manner in which they are practiced. Americans seek CAM treatments far more often for chronic musculoskeletal pain (CMP) than for any other condition. Among CAM treatments for CMP, acupuncture and chiropractic (A/C) care are among those with the highest acceptance by physician groups and the best evidence to support their use. Further, recent alarming increases in delivery of opioid treatment and surgical interventions for chronic pain--despite their high costs, potential adverse effects, and modest efficacy--suggests the need to evaluate real world outcomes associated with promising non-pharmacological/non-surgical CAM treatments for CMP, which are often well accepted by patients and increasingly used in the community. METHODS/DESIGN This multi-phase, mixed methods study will: (1) conduct a retrospective study using information from electronic medical records (EMRs) of a large HMO to identify unique clusters of patients with CMP (e.g., those with differing demographics, histories of pain condition, use of allopathic and CAM health services, and comorbidity profiles) that may be associated with different propensities for A/C utilization and/or differential outcomes associated with such care; (2) use qualitative interviews to explore allopathic providers' recommendations for A/C and patients' decisions to pursue and retain CAM care; and (3) prospectively evaluate health services/costs and broader clinical and functional outcomes associated with the receipt of A/C relative to carefully matched comparison participants receiving traditional CMP services. Sensitivity analyses will compare methods relying solely on EMR-derived data versus analyses supplementing EMR data with conventionally collected patient and clinician data. DISCUSSION Successful completion of these aggregate aims will provide an evaluation of outcomes associated with the real-world use of A/C services. The trio of retrospective, qualitative, and prospective study will also provide a clearer understanding of the decision-making processes behind the use of A/C for CMP and a transportable methodology that can be applied to other health care settings, CAM treatments, and clinical populations. TRIAL REGISTRATION ClinicalTrials.gov: NCT01345409.
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Adams J, Sibbritt D, Broom A, Loxton D, Pirotta M, Humphreys J, Lui CW. A comparison of complementary and alternative medicine users and use across geographical areas: a national survey of 1,427 women. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 11:85. [PMID: 21981986 PMCID: PMC3198987 DOI: 10.1186/1472-6882-11-85] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 10/07/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Evidence indicates that people who reside in non-urban areas have a higher use of complementary and alternative medicine (CAM) than people who reside in urban areas. However, there is sparse research on the reasons for such differences. This paper investigates the reasons for geographical differences in CAM use by comparing CAM users from four geographical areas (major cities, inner regional, outer region, rural/remote) across a range of health status, healthcare satisfaction, neighbourhood and community factors. METHODS A cross-sectional survey of 1,427 participants from the Australian Longitudinal Study on Women's Health (ALSWH) conducted in 2009. RESULTS The average total cost of consultations with CAM practitioners was $416 per annum and was highest for women in the major cities, declining with increasing distance from capital cities/remoteness (p < 0.001). The average total cost of self-prescribed CAM was $349 per annum, but this did not significantly differ across geographical areas. The increased use of CAM in rural and remote areas appears to be influenced by poorer access to conventional medical care (p < 0.05) and a greater sense of community (p < 0.05) amongst these rural and remote residents. In contrast to the findings of previous research this study found that health status was not associated with the differences in CAM use between urban and non-urban areas. CONCLUSION It appears that a number of factors influence the different levels of CAM use across the urban/non-urban divide. Further research is needed to help tease out and understand these factors. Such research will help support health care policy and practice with regards to this topic.
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Affiliation(s)
- Jon Adams
- Faculty of Nursing Midwifery and Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Network of Researchers in the Public Health of Complementary and Alternative Medicine (NORPHCAM), Faculty of Nursing, Midwifery and Health, University of Technology, Level 7 Building 10, 235-253 Jones St, Ultimo New South Wales, 2007, Australia
| | - David Sibbritt
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
- Network of Researchers in the Public Health of Complementary and Alternative Medicine (NORPHCAM), Faculty of Nursing, Midwifery and Health, University of Technology, Level 7 Building 10, 235-253 Jones St, Ultimo New South Wales, 2007, Australia
| | - Alex Broom
- School of Social Science, University of Queensland, Brisbane, Queensland, Australia
- Network of Researchers in the Public Health of Complementary and Alternative Medicine (NORPHCAM), Faculty of Nursing, Midwifery and Health, University of Technology, Level 7 Building 10, 235-253 Jones St, Ultimo New South Wales, 2007, Australia
| | - Deborah Loxton
- Priority Research Centre for Gender, Health and Ageing, University of Newcastle, New South Wales, Australia
| | - Marie Pirotta
- Department of General Practice, University of Melbourne, Victoria, Australia
| | - John Humphreys
- School of Rural Health, Monash University, Bendigo, Victoria, Australia
| | - Chi-Wai Lui
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
- Network of Researchers in the Public Health of Complementary and Alternative Medicine (NORPHCAM), Faculty of Nursing, Midwifery and Health, University of Technology, Level 7 Building 10, 235-253 Jones St, Ultimo New South Wales, 2007, Australia
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Verhoef MJ, Rose MS, White M, Balneaves LG. Declining conventional cancer treatment and using complementary and alternative medicine: a problem or a challenge? Curr Oncol 2011; 15 Suppl 2:s101-6. [PMID: 18769571 PMCID: PMC2528553 DOI: 10.3747/co.v15i0.281] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Several studies have shown that a small but significant percentage of cancer patients decline one or more conventional cancer treatments and use complementary and alternative medicine (cam) instead. Objectives Here, drawing on the literature and on our own ongoing research, we describe why cancer patients decide to decline conventional cancer treatments, who those patients are, and the response by physicians to patients who make such decisions. Results Poor doctor–patient communication, the emotional impact of the cancer diagnosis, perceived severity of conventional treatment side effects, a high need for decision-making control, and strong beliefs in holistic healing appear to affect the decision by patients to decline some or all conventional cancer treatments. Many patients indicate that they value ongoing follow-up care from their oncologists provided that the oncologists respect their beliefs. Patients declining conventional treatments have a strong sense of internal control and prefer to make the final treatment decisions after considering the opinions of their doctors. Few studies have looked at the response by physicians to patients making such a decision. Where research has been done, it found that a tendency by doctors to dichotomize patient decisions as rational or irrational may interfere with the ability of the doctors to respond with sensitivity and understanding. Conclusions Declining conventional treatment is not necessarily an indicator of distrust of the medical system, but rather a reflection of many personal factors. Accepting and respecting such decisions may be instrumental in “keeping the door open.”
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Affiliation(s)
- M J Verhoef
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB.
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Ho EY, Robles JS. Cultural resources for health participation: examining biomedicine, acupuncture, and massage therapy for HIV-related peripheral neuropathy. HEALTH COMMUNICATION 2011; 26:135-146. [PMID: 21298583 DOI: 10.1080/10410236.2010.541991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In this article we use a culture-centered approach to understand people's experiences of treatment options for human immunodeficiency virus (HIV)-related peripheral neuropathy. We present from often unheard and marginalized voices the stories of how people live with this chronic illness and negotiate treatment options. Based on individual and group interviews, participants reported that biomedical pills were an important context for understanding decision making regarding neuropathy treatment. While most people spoke of the necessity of these drugs for their survival, they also expressed deep resentment and frustration with biomedically prescribed pills. Complaints about the pills worked to frame the holistic alternatives of acupuncture and massage therapy as better options for neuropathy and to establish a foundation for understanding how participants made particular health treatment decisions. Through strategically refusing certain drugs and choosing holistic treatments instead, participants asserted agency and control over their health decision making. By choosing holistic therapies, these clients were able to make choices about their neuropathy treatment in light of the many issues surrounding drug toxicity and treatment efficacy.
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Affiliation(s)
- Evelyn Y Ho
- Department of Communication Studies, University of San Francisco, San Francisco, CA, USA.
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Brien SB, Bishop FL, Riggs K, Stevenson D, Freire V, Lewith G. Integrated medicine in the management of chronic illness: a qualitative study. Br J Gen Pract 2011; 61:e89-96. [PMID: 21276333 PMCID: PMC3026175 DOI: 10.3399/bjgp11x556254] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 05/04/2010] [Accepted: 05/20/2010] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Complementary and alternative medicine (CAM) is popular with patients, yet how patients use CAM in relation to orthodox medicine (OM) is poorly understood. AIM To explore how patients integrate CAM and OM when self-managing chronic illness. DESIGN OF STUDY Qualitative analysis of interviews. METHOD Semi-structured interviews were conducted with individuals attending private CAM practices in the UK, who had had a chronic benign condition for 12 months and were using CAM alongside OM for more than 3 months. Patients were selected to create a maximum variation sample. The interviews were analysed using framework analysis. RESULTS Thirty five patient interviews were conducted and seven categories of use were identified: using CAM to facilitate OM use; using OM to support long-term CAM use; using CAM to reduce OM; using CAM to avoid OM; using CAM to replace OM; maximising relief using both CAM and OM; and returning to OM. Participants described initiating CAM use following a perceived lack of suitable orthodox treatment. Participants rejecting OM for a specific condition never totally rejected OM in favour of CAM. CONCLUSION Patients utilise CAM and OM in identifiably different ways, individualising and integrating both approaches to manage their chronic conditions. To support patients and prevent potential adverse interactions, open dialogue between patients, OM practitioners, and CAM practitioners must be improved.
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Affiliation(s)
- Sarah B Brien
- Faculty of Health Sciences, University of Southampton, Southampton, UK.
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Menk Otto L, Howerter A, Bell IR, Jackson N. Exploring measures of whole person wellness: integrative well-being and psychological flourishing. Explore (NY) 2010; 6:364-70. [PMID: 21040885 PMCID: PMC2975622 DOI: 10.1016/j.explore.2010.08.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Whole systems of complementary and alternative medicine (WSCAM) emphasize positive emergent outcomes for the patient, for example, a sense of well-being. This paper presents a questionnaire-based study in healthy young adults for the purpose of exploring individual differences that contribute to the sense of well-being and to identify characteristics of flourishing versus nonflourishing individuals in terms of nonlinear dynamical systems concepts. METHODS Young adult college students (N = 856) completed questionnaires assessing global well-being (Arizona Integrative Outcomes Scale [AIOS]), global physical health, positive and negative mood (Positive and Negative Affect Schedule [PANAS]), resilience (Connor- Davidson Resilience Scale), and repressive defensiveness. Next, subjects were divided into flourisher/languisher groups by a previously determined ratio of positive/negative scores established by a study using complex systems methods. RESULTS Positive-to-negative affect (P:N) ratio accounted for more variance in AIOS (R(2) = 0.19; P < .001) than did separate positive or negative PANAS scores or physical health. Flourishers (14.5% of the sample) were significantly higher than languishers in defensiveness and resilience. CONCLUSIONS Positive-to-negative affect explains a substantial portion of the variance in well-being of healthy young adults. The low percentage of flourishers in this nonclinical sample is consistent with previous population-based studies and suggests that flourishers are a minority, even in nonclinical settings. Positive-to-negative affect may be a useful variable for subsequent prospective studies of applied WSCAM treatments and in well and clinical populations. The well-being measure used in this study is easy to complete, sensitive, and may be a useful clinical measure to track change with treatment over time.
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Affiliation(s)
- Laurie Menk Otto
- Department of Family & Community Medicine, The University of Arizona, Tucson, AZ, USA
| | - Amy Howerter
- Department of Family & Community Medicine, The University of Arizona, Tucson, AZ, USA
- Division of Family Studies and Human Development, The University of Arizona, Tucson, AZ, USA
| | - Iris R. Bell
- Department of Family & Community Medicine, The University of Arizona, Tucson, AZ, USA
- Department of Psychiatry, The University of Arizona, Tucson, AZ, USA
- Department of Psychology, The University of Arizona, Tucson, AZ, USA
- Department of Medicine, The University of Arizona, Tucson, AZ, USA
- College of Public Health, The University of Arizona, Tucson, AZ, USA
| | - Nicholas Jackson
- Department of Family & Community Medicine, The University of Arizona, Tucson, AZ, USA
- College of Public Health, The University of Arizona, Tucson, AZ, USA
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Caspi O, Shalom T, Holexa J. Informed consent in complementary and alternative medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2010; 2011:170793. [PMID: 19376838 PMCID: PMC3146982 DOI: 10.1093/ecam/nep032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Accepted: 03/03/2009] [Indexed: 11/13/2022]
Abstract
The objective of this study was to examine complementary and alternative medicine (CAM) practitioners' (i) attitudes toward informed consent and (ii) to assess whether standards of practice exist with respect to informed consent, and what these standards look like. The design and setting of the study constituted face-to-face qualitative interviews with 28 non-MD, community-based providers representing 11 different CAM therapeutic modalities. It was found that there is great deal of variability with respect to the informed consent process in CAM across providers and modalities. No unique profession-based patterns were identified. The content analysis yielded five major categories related to (i) general attitude towards the informed consent process, (ii) type and amount of information exchange during that process, (iii) disclosure of risks, (iv) discussions of alternatives, and (v) potential benefits. There is a widespread lack of standards with respect to the practice of informed consent across a broad range of CAM modalities. Addressing this problem requires concerted and systematic educational, ethical and judicial remedial actions. Informed consent, which is often viewed as a pervasive obligation is medicine, must be reshaped to have therapeutic value. Acknowledging current conceptions and misconception surrounding the practice of informed consent may help to bring about this change. More translational research is needed to guide this process.
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Affiliation(s)
- Opher Caspi
- Integrative Medicine Unit, Rabin Medical Center and the Tel-Aviv University, Petah Tikva 49100, Israel
| | - Tamar Shalom
- Department of Health System Management, Ben-Gurion University, Israel
| | - Joshua Holexa
- Department of Emergency Medicine, University Medical Center, Tucson, AZ, USA
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Abstract
This study investigates conventional medicine utilization by wellness-motivated, complementary and alternative medicine (CAM) consumers. While CAM consumers are typically characterized as high health care utilizers, negative correlations have been found between CAM-based wellness programs and the consumption of conventional medical care. We use a nationally representative sample to analyze both illness- and wellness-motivated CAM users, with an interest in whether CAM therapies used for wellness replace conventional medicine, thus potentially offering cost offsets. Results indicate that motivation for CAM use is neither associated with a lower probability nor a lower rate of conventional medicine utilization. Increasingly, individuals, workplaces, and governments incorporate wellness programs involving CAM modalities into health care and policy; as the conventional and unconventional medical spheres begin to integrate and influence one another, understanding our pluralistic medical environment and its consumers will better enable policy makers to balance health and wellness initiatives with economic imperatives.
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Affiliation(s)
- Viji Diane Kannan
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Shorofi SA, Arbon P. Complementary and alternative medicine (CAM) among hospitalised patients: An Australian study. Complement Ther Clin Pract 2010; 16:86-91. [DOI: 10.1016/j.ctcp.2009.09.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 09/12/2009] [Accepted: 09/14/2009] [Indexed: 10/20/2022]
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Lindeman M. Biases in intuitive reasoning and belief in complementary and alternative medicine. Psychol Health 2010; 26:371-82. [PMID: 20419560 DOI: 10.1080/08870440903440707] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Very little is known about the reasoning underlying beliefs in complementary and alternative medicine (CAM). This study examined whether CAM beliefs can be better explained with intuitive reasoning, paranormal beliefs and ontological confusions of physical, biological and mental phenomena than with 12 variables that have typically been used to explore the popularity of CAM, namely gender, education, income, age, health, desire to control treatment, satisfaction with conventional medicine and world view (unconventional, feministic, environmentalist, exotical and natural). A representative sample of Finnish people (N = 1092) participated in the study. The results showed that intuitive thinking, paranormal beliefs and ontological confusions predicted 34% of the variation in CAM beliefs, whereas the 12 other variables increased the prediction only by 4%. The results help to explain individual, cultural and situational differences in the popularity of CAM and to differentiate between CAM statements that can be scientifically examined from those that cannot.
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Affiliation(s)
- Marjaana Lindeman
- Department of Psychology, University of Helsinki, Helsinki 00014, Finland.
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van der Schee E, Groenewegen PP. Determinants of public trust in complementary and alternative medicine. BMC Public Health 2010; 10:128. [PMID: 20226015 PMCID: PMC2848199 DOI: 10.1186/1471-2458-10-128] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Accepted: 03/12/2010] [Indexed: 12/02/2022] Open
Abstract
Background In the Netherlands, public trust in conventional medicine is relatively high. There is reason to believe that public trust in complementary and alternative medicine (CAM) is rated lower. The aim of this study is to gain insight into public trust in CAM and the determinants that lie at the root of it. We hypothesized that public trust in CAM is related to (perceived) institutional guarantees, media information on CAM, information from people's social network, personal experiences, the role of general practitioners (GPs) and trust in conventional medicine. Methods A postal questionnaire on public trust in CAM was mailed to 1358 members of the Health Care Consumer Panel. 65% of the questionnaires were returned. Data were analysed using frequencies, ANOVA, post hoc testing and linear regression analyses. Results In the total sample, the level of public trust in CAM was a 5.05 on average on a scale of 1-10. 40.7% was CAM user (current or past) and displayed significantly higher levels of trust toward CAM than CAM non users. In the total sample, public trust in CAM was related to institutional guarantees, negative media information, positive and negative information reported by their social network and people's personal experiences with CAM. For non users, trust is mostly associated with institutional guarantees. For users, personal experiences are most important. For both users and non users, trust levels in CAM are affected by negative media information. Public trust in CAM is for CAM users related to positive information and for non users to negative information from their network. Conclusions In the Netherlands, CAM is trusted less than conventional medicine. The hypotheses on institutional guarantees, media information, information from the network and people's personal experiences are confirmed by our study for the total sample, CAM non users and users. The other hypotheses are rejected.
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Affiliation(s)
- Evelien van der Schee
- ParnassiaBavogroep, Brijder Addiction Care, Parnassia Addiction Research Center, The Hague, Monsterseweg 83, 2553 RJ, The Netherlands.
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Fejzic J, Emmerton L, Tett SE. Towards concordance in healthcare: perspectives of general practitioners, complementary and alternative medicine practitioners and pharmacists in Australia. J Clin Pharm Ther 2010; 35:309-21. [DOI: 10.1111/j.1365-2710.2009.01093.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jorgensen AMS, Sheppard LA. Self-regulation in a small professional group is an important step toward professionalization: the Chiropractic Association in Singapore. JOURNAL OF CHIROPRACTIC HUMANITIES 2009; 16:32-43. [PMID: 22693465 PMCID: PMC3342802 DOI: 10.1016/j.echu.2010.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Revised: 06/05/2009] [Accepted: 07/01/2009] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The chiropractic profession is immersed in the process of professionalization with particular consideration of self-regulation as an avenue toward state recognition in Singapore. The purpose of this article is to discuss the emergence of chiropractic as a profession in Singapore and the Chiropractic Association (Singapore). DISCUSSION The concept of professionalization is varied and context based, and the institutionalization of formal knowledge plays an important role in the socialization of how a profession forms a unifying identity. The difference in institutional socialization of the professions plays a role in the way a profession is perceived in the hierarchy of societal power. Continuing professional development is an essential part of professionalism and is best done within the realm of self-regulation and autonomous control of the profession itself. CONCLUSION The social process of professionalization can be a process of internal conflict and external battles almost from the profession's inception with university training only entering late in its development, rather than being a linear development. A sequential progress ensued as with other professions, with the seeking of legal protection and a code of ethics as the final areas reached toward becoming an acknowledged member of the health care system.
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Affiliation(s)
| | - Lorraine A. Sheppard
- Professor, University of South Australia and James Cook University, Adelaide, South Australia, Australia
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Mercurio R, Eliott JA. Trick or treat? Australian newspaper portrayal of complementary and alternative medicine for the treatment of cancer. Support Care Cancer 2009; 19:67-80. [PMID: 19943067 DOI: 10.1007/s00520-009-0790-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 11/11/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE Many cancer patients within developed nations cite the media as informing their decisions to use complementary and alternative medicine (CAM). The present study describes (1) Australian newspaper coverage of CAM use for cancer between 1998 and 2007; (2) trends in reporting frequency and characteristics; and (3) how the Australian press framed stories on CAM use for cancer. MATERIALS AND METHODS This study is a content analysis featuring quantitative and qualitative techniques, the latter guided by 'media framing', of targeted newspaper articles. RESULTS One hundred nineteen articles focused on CAM use for the treatment of cancer were identified. Quantitative analysis found that biologically based CAMs were most frequently described and breast cancer most mentioned. Two thirds of all articles described CAM use in the context of a cure, with approximately half of these opposing this reason for use. Potential benefits of CAM were discussed more frequently than potential risks, and information on costs and how to access CAM were uncommon. Recommendations included advice to use complementary, not alternative therapies, yet advice to discuss CAM with a medical doctor was rare. Qualitative analysis found six CAM cancer-related frames, four in support of CAM use for cancer treatment. The dominant frame constructed CAM as legitimate tools to assist biomedicine (even to cure), with others depicting CAM as normal and necessary or as addressing limitations of biomedicine. Negative frames depicted CAM as questionable and risky practices and the industry/practitioners as possessing malevolent intent. CONCLUSION These findings have implications for biomedical practitioners attempting to determine, respect and assist patient choices about their treatment.
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Affiliation(s)
- Reegan Mercurio
- School of Psychology, The University of Adelaide, Level 4, Hughes Building, Adelaide, SA, 5005, Australia
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