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ABSTRACT: While complementary and alternative medicine (CAM) can improve quality of life at end of life, little research exists on hospice residents' interest in using and sharing CAM experiences with a partner/friend/other family member. A pilot study conducted in British Columbia, Canada explored the extent of hospice residents' interest and openness to CAM use. A convenience sample of 48 hospice residents from 9 hospice sites completed questionnaire-based interviews. The majority of participants were Caucasian women over 60 years old. 81 percent expressed interest in receiving CAM; 79 percent used CAM prior to entering the hospice setting. 50 percent of those interested in using CAM felt their partner/friend/other family member would also be interested in receiving CAM, and half of that 50 percent reported personal interest in sharing the experience. Reasons reported for CAM interest were to enhance well-being, relaxation, and for pain relief. Further research could explore how resident-caregiver dyads may benefit from shared CAM experiences over the illness trajectory.
Journal of palliative care 01/2011; 27(2):134-40. · 0.93 Impact Factor
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ABSTRACT: Cancer care is multifactorial and patient centered. It can be described as a complex package of interventions, delivered at different times and places with different intentions, which interacts and cannot be evaluated in isolation. The authors discuss the evolving nature of cancer care and address the challenges faced by biomedical research methodology when applied to cancer care. In addition, they identify new research directions to meet these challenges. These include qualitative research, mixed methods research, and approaches based on systems thinking.
Hematology/Oncology Clinics of North America 08/2008; 22(4):671-82, viii-ix. · 2.64 Impact Factor
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ABSTRACT: The purpose of this short review is to provide a commonly accepted definition of complementary and alternative medicine (CAM), to illustrate the widespread use of CAM by people affected by cancer around the world, and to highlight the research contributions of the Cancer Complementary and Alternative Medicine (CCAM) research team and its colleagues.
Based on research conducted by CCAM and several European colleagues, a collection of articles was compiled, reviewed, and edited.
CAM modalities play a role in supportive care and cancer. Because of the high CAM utilization, it is critical to help cancer patients make safe, informed, evidence-based decisions for their care. In addition, advances in research methodology, outcomes, and measurement in CAM studies are suggested to better account for individual and collective experiences.
This special issue provides clinicians with a summary of information about CAM and perspectives for better responding to cancer patient's needs.
Supportive Care Cancer 09/2007; 15(8):909-12. · 2.60 Impact Factor
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ABSTRACT: There is long history of anecdote and surmise linking psychosocial factors to cancer incidence and survival. However, over the past three decades, an increasing number of rigorous studies have investigated the possibility of a mind-cancer survival connection. The objective of this paper is (1) to review the past 30 years of psycho-oncology research on the mind-cancer survival question, (2) to review the methodological debate and interpretations of the research findings, and (3) to consider future research directions.
Over the past three decades, a small number of studies have been published. Some observational and quasi-experimental studies suggest the possibility that coping and psychological factors may influence disease outcomes, but clinical trials suggest that psychosocial interventions do not prolong survival. Methodological comment and interpretation about the significance of these trials vary. Some researchers view the mind-cancer survival question as resolved and negative, whereas others identify conceptual and methodological challenges and view the possible impact of psychosocial factors on survival as simply unproven. We take the position that the question is unanswered.
Recommended future research directions include: (1) more trials based on testable theories, targeted interventions, and greater specificity in the measurement model and (2) new research questions and more rigorous observational, prospective, and longitudinal studies, case studies, mixed methods, and innovative design approaches being developed by complementary and alternative medicine researchers. Further research is warranted on the mind-cancer survival question.
Supportive Care Cancer 09/2007; 15(8):923-30. · 2.60 Impact Factor
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ABSTRACT: INTRODUCTION: Cancer care can be described as a system or complex network of interventions delivered at various times and places with different intentions. CANCER CARE AS A SYSTEM: Cancer care can include medical treatments, psychosocial care, complementary and alternative medicine, self-care, as well as the process of healing and the context in which care is delivered. EVALUATING CANCER CARE: Whereas evaluating individual cancer treatments can be difficult, evaluating cancer care is even more challenging and requires a research framework that relies on methodologies capable of addressing its holistic, individualized, and complex nature. IN SUMMARY: We suggest that research frameworks focused on studying complex or whole systems are a promising evaluation approach and an opportunity for further exploration.
Supportive Care Cancer 09/2007; 15(8):905-7. · 2.60 Impact Factor
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ABSTRACT: This study assessed the impact of acculturation on the prevalence of traditional Chinese medicine and other complementary and alternative medicine (TCM/CAM) use in newly diagnosed Chinese cancer patients. The individual determinants of TCM/CAM use among patients were also investigated.
A consecutive sample of Chinese cancer patients treated at the British Columbia Cancer Agency was surveyed at admission using a 15-item questionnaire. Items included TCM/CAM use, sociodemographics, as well as medical and cultural factors. Data were analyzed using bivariate methods including Pearson's X (2) test and Student's t test. As well, multiple logistic regression was used to obtain the final causal model.
Of the 230 respondents, 57% completed the survey in Chinese and 94% were immigrants. The average age was 59. Participants had a mean disease duration of approximately 2 months and 79% had already received at least one conventional treatment. Overall, TCM/CAM was used by 47% of respondents. Herbal remedies, vitamins/minerals, and prayer were the most commonly used therapies. Multivariable analysis showed that prior TCM/CAM use (p < 0.001), having received conventional treatment(s) (p = 0.029), and being less acculturated (p = 0.028) were associated with TCM/CAM use.
Prevalence and type of use were found to vary as a function of the degree of acculturation. Health care practitioners would be well advised to discuss TCM/CAM use with their patients, especially those who are less acculturated to Western society, since they are the most likely users of TCM/CAM.
Supportive Care Cancer 09/2007; 15(8):985-92. · 2.60 Impact Factor
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ABSTRACT: Complementary and alternative medicine (CAM) often consists of whole systems of care (such as naturopathic medicine or traditional Chinese medicine (TCM)) that combine a wide range of modalities to provide individualised treatment. The complexity of these interventions and their potential synergistic effect requires innovative evaluative approaches. Model validity, which encompasses the need for research to adequately address the unique healing theory and therapeutic context of the intervention, is central to whole systems research (WSR). Classical randomised controlled trials (RCTs) are limited in their ability to address this need. Therefore, we propose a mixed methods approach that includes a range of relevant and holistic outcome measures. As the individual components of most whole systems are inseparable, complementary and synergistic, WSR must not focus only on the "active" ingredients of a system. An emerging WSR framework must be non-hierarchical, cyclical, flexible and adaptive, as knowledge creation is continuous, evolutionary and necessitates a continuous interplay between research methods and "phases" of knowledge. Finally, WSR must hold qualitative and quantitative research methods in equal esteem to realize their unique research contribution. Whole systems are complex and therefore no one method can adequately capture the meaning, process and outcomes of these interventions.
Complementary Therapies in Medicine 10/2005; 13(3):206-12. · 1.87 Impact Factor
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ABSTRACT: Although several instruments have been developed to measure the quality of life (QOL) of palliative care patients, a rigorous research study has not specifically asked patients themselves what is important to their QOL. It is, therefore, not clear whether these instruments measure what is most important to these patients' QOL.
To understand the primary determinants of the QOL of palliative care patients with cancer.
The study used a qualitative paradigm. Participants were interviewed concerning what was important to their QOL. A systematic content analysis of the transcripts was carried out by all the investigators.
Five broad domains were found to be importnat determinants of patient QOL: (1) the patient's own state, including physical and cognitive functioning, psychological state, and physical condition; (2) quality of palliative care; (3) physical environment; (4) relationships; and (5) outlook.
Existing instruments cover many of these domains, but no single instrument includes all of the relevant content. The McGill Quality of Life Questionnaire, which we developed previously, has been revised based on these data.
Journal of palliative care 02/2002; 18(1):48-58. · 0.93 Impact Factor
