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Researching Complementary and Alternative Medicine

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Abstract

Researching Complementary and Alternative Medicine provides a valuable and timely resource for those looking to understand, initiate and expand CAM research. This collection brings together leading international CAM researchers with backgrounds and expertise in a variety of areas including health social science, qualitative methodology, general practice, health services research and public health. Drawing upon their own research work and experience, the contributors explain and review core methods and research issues pertinent to contemporary CAM and its future development. Topics discussed include: the use and limitation of evidence in CAM research the issues facing practitioners (GPs, therapists, nurses, etc) who wish to conduct research how and why qualitative methods should be combined alongside quantitative methods to help explore CAM how the randomised control trial (RCT) method relates to CAM the future direction of CAM research in terms of public health and policy-related agendas. Researching Complementary and Alternative Medicine is essential reading for students, academics and researchers in CAM, health studies, medicine, nursing, medical sociology and public health. It will also appeal to CAM and allied health practitioners. © 2007 selection and editorial matter, Jon Adams. All rights reserved.
... As well, many CAM practices incorporate multiple methods of engagement—including physical touch or chemical input, psychological intervention, and accommodation to the patient’s social context—and may even engage with realms that are not yet readily studied—such as energy work and spiritual dimensions(34,35). Furthermore, all these engagements are often conceived of as an intricate whole on which any treatment will likely have both specific and generalized effects—hence, the designation “complex systems”(31). Much has been written on the complexities of CAM practices and, hence, of research into them(31,33,36–41). ...
... Some researchers may use terms such as “parallel methods” or “multiple methods studies.” Verhoef and Vanderheyden recommend using “combined methods” when integration of the quantitative and qualitative components occurs in most or all components of a research project(31). This article uses “mixed methods” for all degrees of integration of quantitative and qualitative methods within a single study. ...
... Furthermore, all these engagements are often conceived of as an intricate whole on which any treatment will likely have both specific and generalized effects—hence, the designation “complex systems”(31). Much has been written on the complexities of CAM practices and, hence, of research into them(31,33,36–41). ...
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Mixed methods research is the integration of quantitative and qualitative components in a research project. Whether you are reading or designing a mixed methods research project, it is important to be familiar with both qualitative and quantitative research methods and the specific purposes for which they are brought together in a study: triangulation, complementarity, expansion, initiation, or development. In addition, decisions need to be made about the sequencing and the priority or importance of each qualitative and quantitative component relative to the other components, and the point or points at which the various qualitative and quantitative components will be integrated. Mixed methods research is increasingly being recognized for its ability to bring multiple points of view to a research project, taking advantage of the strengths of each of the quantitative and qualitative components to explain or resolve complex phenomena or results. This ability becomes critical when complex healing systems such as therapeutic massage are being studied. Complex healing systems may have multiple physiologic effects, often reflected in changes throughout the patient’s body. Additionally, the patient’s experience of the treatment may be an important outcome.
... When people work with their hearts or spirit they find meaning and purpose. " (Petchsawang & Duchon, 2009 Qualitative research methods are selected for this work because qualitative research enables us to understand people's stories, their narratives, and to get an expression of the participant's experiences (Adams, 2007; Lee, 1999), to embed their stories in the context of what is being studied. Qualitative research methods help us understand actions, experiences and perspectives in areas that may be " little known in the world of research projects " (Glaser, 1992, p. 12), and there is little known about this topic of inquiry. ...
... The richness of the subjective realms of people's experiences, available through the use of qualitative research methods (Adams, 2007), is essential to the study and theory development in the area of wellness, as it gives more than just an account of their medical vital signs. Subjective experience is some of the language used to develop the theory essential to both define the conceptual propositions, and to understand whether these propositions are viable. ...
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Concern with employee health and wellbeing and the resulting financial cost of rising healthcare, absenteeism and loss of productivity, has seen the wide-spread incorporation of workplace wellness practice. Wellness has different meanings for different groups. Workplace wellness programs tend to focus on the illness and health related aspects of the workforce and have also been criticized for not incorporating elements for healthy people within the workforce. Redefining wellness and its connection to engagement and the workplace, has been suggested as a new approach for business strategy, and involves thinking outside the realm of health promotion techniques to therapies which have evidence of supporting employee wellness. Traditionally, spas and wellness centers are ideal places for the practice of wellness. Massage and meditation, two modalities offered at spas and wellness centers have been researched in depth and through this literature and practice, significant evidence indicates that they are shown to be effective and have lasting benefits for workers. This study uses the qualitative methodologies of grounded theory and exploratory case study to consider the plausibility of a spa industry and workplace wellness program integration, through the use of spa modalities of massage and meditation, with the purpose of providing more effective wellness outcomes for employees. The grounded theory component succeeds in its aims and determines, through a research synthesis of 25 studies conducted in a workplace environment and three meta-analyses, that both massage and meditation are efficacious therapies for reducing or at least managing stress and anxiety, improving mood, emotions, alertness, attention and self-awareness in employees in the workplace. They are therapies that are easy and cost effective to implement and have high compliance and utilization amongst the workforce. The exploratory case study design, although not yet concluded, proposes to investigate the construct that spas and wellness centers are best placed to provide these therapies, and that integration may better support employee wellness in the workplace. The results of this study may be a catalyst for the development of an integrative model of wellness programs which can be taken into the workplace. It suggests that workplace wellness program design should account for the needs and desires of all employees to attain optimum wellness, regardless of health status. Implementing the strategy has the potential to enable research on a much wider scale with future work involving wellness assessments of employees who use the therapies provided by the proposed integration in order to build empirical evidence and develop best practice for
... Complementary and alternative medicine (CAM) is now identified as a major public health issue with important implications for both individual providers and patients as well as health systems more generally [1,2]. High prevalence rates of CAM use across general populations have been reported for a range of countries including Australia, the USA, Canada and elsewhere [3,4] and concurrent to this community support has been the development of interest in these medicines from across conventional health care ranks [5]. ...
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to determine the factors associated with complementary and alternative medicine (CAM) use among older Australian women over time. a longitudinal analysis of postal questionnaires completed in 1996, 1999, 2002 and 2005 as part of the Australian Longitudinal Study on Women's Health. the percentage of women who consulted a CAM practitioner in the years 1996, 1999, 2002 and 2005 were 14.6%, 12.1%, 10.9% and 9.9%, respectively. Use of CAM increased as the number of reported symptoms increased and physical health deteriorated, for non-urban residents compared to urban residents. use of CAM amongst older women appears to be strongly influenced by poor physical health. There is also a suggestion that lack of access to conventional health care providers increases CAM use. There is also an overall decline in the use of CAM among older women as they age.
... Increasing prevalence of CAM usage by cancer patients reflects the growing use of CAM over time [92]. Our review suggests a higher CAM prevalence compared with a prevalence of 31.4%, and a range of 7-64%, reported by Ernst [93]. ...
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ABSTRACT: Chinese medicine has been used to treat a variety of cancer-related conditions. This study aims to examine the prevalence and patterns of Chinese medicine usage by cancer patients. We reviewed articles written in English and found only the Chinese medicine usage from the studies on complementary and alternative medicine (CAM). Seventy four (74) out of 81 articles reported rates of CAM usage ranging from 2.6 to 100%. Acupuncture was reported in 71 out of 81 studies. Other less commonly reported modalities included Qigong (n = 17), Chinese herbal medicine (n = 11), Taichi (n = 10), acupressure (n = 6), moxibustion (n = 2), Chinese dietary therapy (n = 1), Chinese massage (n = 1), cupping (n = 1) and other Chinese medicine modalities (n = 19). This review also found important limitations of the English language articles on CAM usage in cancer patients. Our results show that Chinese medicine, in particular Chinese herbal medicine, is commonly used by cancer patients. Further research is warranted to include studies not written in English.
... Research focusing on the use of complementary and alternative medicine during pregnancy has intensified over recent years. Sixteen of the 24 articles covered in this paper were published over the past 5 years, and this trend is in line with a growing interest in the use of complementary medicine in general (35,36). Nevertheless, the review has identified several gaps in scientific literature. ...
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The use of complementary and alternative medicine has attracted much attention and debate in recent years. The objective of this critical review is to examine the evidence base on use of complementary products and therapies during pregnancy. It examines an important but neglected issue in maternity care. A database search was conducted in MEDLINE, CINAHL, AMED, and Maternity and Infant Care. A total of 24 papers published between 1999 and 2008 met the selection criteria and were included in the review. Findings of these 24 papers were extracted and reported under four themes: "user prevalence and profile,"motivation and condition of use,"perception and self-reported evaluation," and "referral and information sources." This review highlights four research gaps in the literature, a lack of: large representative samples; in-depth understanding of user experiences and risk perceptions; research comparing consumption patterns across cultures and over time; and work exploring the nature of the therapeutic encounter with complementary practitioners in this area of women's health care.
... Complementary and alternative medicines (CAM)—usually defined as treatments, therapies, and systems of healing which exist 'outside' of the dominant health-care system (Adams, 2007)—are an increasingly prevalent part of contemporary health care. Increasing prevalence of use of CAM often occurs alongside, and in conjunction with, conventional treatments provided by conventional health-care professionals (Adams, Magin, & Broom, 2013). ...
Article
Complementary and alternative medicine (CAM) is an increasingly prevalent part of contemporary health care. Whilst there have been some attempts to understand the dynamics of CAM integration in the health care system from the perspective of conventional care providers and patients, little research has examined the view of CAM practitioners. This study aims to identify the experiences of integration within a conventional healthcare system as perceived by naturopaths. Qualitative semi-structured interviews were conducted using a purposeful sample of 20 practising naturopaths in South East Queensland, Australia to discuss their experiences and perceptions of integrating with conventional medical providers. Analysis of the interviews revealed five broad challenges for the integration of CAM according to naturopaths: competing paradigms between CAM and conventional medicine; co-option of CAM by conventional medical practitioners; the preservation of separate CAM and conventional medical worlds by patients and providers due to lack of formalised relations; negative feedback and biases created through selective or limited experience or information with CAM; and indifferent, reactive and one-sided interaction between CAM and conventional medical providers. Naturopaths support the integration of health services and attempt to provide safe and appropriate care to their patients through collaborative approaches to practice. The challenges identified by naturopaths associated with integration of CAM with conventional providers may impact the quality of care of patients who choose to integrate CAM and conventional approaches to health. Given the significant role of naturopaths in contemporary health-care systems, these challenges require further research and policy attention.
... The types and classifications of complementary and alternative medicine (CAM) differ by country because CAM modalities are individually related to a country’s conventional health system and medical curriculum [1]. Furthermore, the evidence base for CAM remains relatively weak, although recent years have seen increased scientific rigor for the study of CAM modalities. ...
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The purpose of this study was to estimate the prevalence and patterns of CAM use in Korean children via a telephone based survey. We also investigated parent satisfaction, a proxy for their child, with CAM therapy and determined the factors affecting satisfaction with CAM use. This study used a landline telephone-based survey to examine a random sample representative of Korean children, aged 0 to 18 years. We assigned and surveyed 2,000 subjects according to age group, gender, and geographical distributions by proportionate quota and systematic sampling of children throughout Korea in 2010. A household of 1,184 with a 18.6% response rate was projected to yield 2,077 completed data. We performed statistical analyses using sampling weight. The prevalence of CAM use was 65.3% for the Korean children in our sample population. The most commonly used CAM category was natural products (89.3%). More than half of CAM user's parents reported satisfaction with their therapies (52.7%), but only 29.1% among them had consulted a Western trained doctor regarding the CAM therapies used. Doctor visits were associated with lower satisfaction with CAM use but not with consultation rate with a doctor. Our study suggests that CAM is widely used among children in Korea. Medical doctors should actively discuss the use of CAM therapies with their patients and provide information on the safety and efficacy of diverse CAM modalities to guide the choices of CAM users.
Article
There is a plethora of complementary and alternative medicines (CAM) used by sufferers of skin diseases. For the most part, the use of these therapies is based on anecdotal evidence or on traditional patterns of use. Relatively little empirical evidence exists for the use of CAM therapies in skin diseases. Those studies that have examined CAM skin disease therapies have often been flawed methodologically. A small number of CAM therapies have been accepted or are on the cusp of acceptance in dermatological practice. Even here, the evidence for CAM use is often limited or equivocal. Equally, issues of poorly documented adverse effect profiles, quality control of preparations and product adulteration and contamination hamper the integration of CAM therapies into orthodox dermatology practice. Thus, it may be more appropriate to consider `pluralism' rather than `integration' in the relationship of CAM and conventional medicine.
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Complementary and alternative medicine (CAM) use--of which naturopathy constitutes a significant proportion--accounts for approximately half of all health consultations and half of out-of-pocket expenditure in Australia. Data also suggest CAM use is highest amongst rural Australians. Unfortunately little is known about the grass-roots reality of naturopathy or other CAM use in rural regions. Semi-structured interviews were conducted with 20 naturopaths practising in the Darling Downs region of South-East Queensland to assess their perceptions and experiences of rural patients and demand for their services. Naturopaths described strong demand in rural areas for their services and perceived much of this demand as attributable to cultural traits in rural communities that served as pull factors for their naturopathic services. Such perceived traits included a cultural affinity for holistic approaches to health and disease and the preventive philosophy of naturopathy and an appreciation of the core tenet of naturopathic practice to develop closer therapeutic relationships. However, cost and a rural culture of self-reliance were seen as major barriers to naturopathic practice in rural areas. Demand for naturopathic services in rural areas may have strong underlying cultural and social drivers. Given the apparent affinity for and increasingly large role played by CAM services, including naturopathic medicine, in rural areas it is imperative that naturopathic medicine and the CAM sector more broadly become a core focus of rural health research.
Article
The increasing prevalence of complementary and alternative medicine (CAM) use is a significant health care issue in contemporary societies and researchers have identified CAM as holding potential for treating and coping with chronic illness and other conditions experienced in later life. This paper focuses upon contemporary research literature to provide a critical review of the prevalence, correlates, conditions, perceptions and communication of CAM use in later life. Evidence from recent research illustrates the substantial prevalence and complexity of CAM use amongst older people and such ‘community’ use requires all providers, regardless of their experience or perception of the worth of CAM, to at least acknowledge and enquire with their older patients about the potential use of these other medicines.
Article
There is evidence of asthma patients using complementary and alternative medicine (CAM). This article reports the findings of the first ever longitudinal study of CAM use among women with asthma from a large nationally representative sample. A longitudinal analysis of questionnaires completed in 1996, 2000, 2003, and 2006 as part of the Australian Longitudinal Study on Women's Health. The cohort began with 14,701 randomly selected young women (aged 18-22 years). CAM use was defined as a consultation with a range of complementary practitioners in the 12 months prior to each survey. Statistical analyses included the use of generalized estimating equations. Over the 10-year period, approximately 26% of the women were asthmatic. Asthmatic women were significantly more likely to use CAM (19%, 22%, and 36% for surveys 2-4, respectively) than non-asthmatic women (15%, 20%, and 32% for surveys 2-4, respectively). CAM use increased as time since asthma diagnosis increased. However, only the increase in consultations with a naturopath/herbalist remains statistically significant when the CAM modalities are considered individually alongside asthma status. The longitudinal model suggests that women with asthma are 1.13 (95% CI: 1.05-1.21) times more likely to consult with a CAM practitioner (p< .001). The study also shows that CAM users have a higher dissatisfaction with conventional healthcare services and consultations when compared to CAM non-users. These findings suggest that women with asthma may turn to CAM after conventional care fails to adequately address their healthcare needs.
Article
In the past two decades, complementary therapies have grown in popularity in Western countries. The interest in complementary therapies could be explained by a "new consciousness" and the shift to a postmodern society. These therapies, embracing holistic practice, are derived from traditions of Eastern healing. There are many advantages of the complementary therapies that are playing a therapeutic role in the health care of individuals and, through the use of such therapies, nursing is developing a richness in holistic care. However, there are still barriers to be overcome; namely, the reluctance to accept complementary therapies in many contemporary healthcare settings. Through research and education, these barriers can be overcome.
Article
Introduction: This metaethnography provides an interpretative synthesis of complementary medicine (CM) practitioners' perceptions toward their health model and the healing process. CM is commonly described on the basis of its distinction from biomedicine with limited research available on CM practitioners' understanding of what the essence of their practice is and how healing transpires as a result. This is despite the significant patronage of CM and high rates of couse with biomedical services. Materials and Methods: An extensive and systematic search of the literature was conducted across seven databases (AMED, SINAHL, Medline, PsycINFO, PUBMED, Science Direct, and Scopus) with no date, language, or region restrictions applied. The basis for the search was MeSH terms and keywords relating to (1) CM practitioners, (2) perceptions, and (3) healing. A screening process was conducted and articles were identified for inclusion based on their addressing the research question. These articles were then quality appraised. A seven-stage metaethnographic framework was utilized to assist with identifying and interpreting the themes within the data. Results: Following the screening process, merely 10 qualitative studies were identified, which represented practitioner views across 22 CM professions. CM practitioners believe they provide a distinct model of care informed by a traditional shared holistic and vitalistic philosophy. Nonspecific factors, such as an augmented therapeutic relationship, empathy, and patient empowerment, are actively and deliberately incorporated into the treatment process alongside specific interventions and afforded equal valued. Conclusions: This metaethnographic synthesis brings together the perceptions of CM practitioners on how healing transpires within the CM clinical setting. In a context of medical pluralism and aspirational integrative health care, this synthesis highlights the understanding and approach CM practitioners bring to health management and may assist in further defining CM philosophy and practice, and the positioning of CM in the contemporary health care landscape.
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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. A cross-sectional survey of 1,427 participants from the Australian Longitudinal Study on Women's Health (ALSWH) conducted in 2009. 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. 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.
Article
To document the narratives of nursing staff in a Thai rehabilitation centre where complementary therapies are used and to discuss perceived progress of these complementary therapies on stroke patients. Specific complementary therapies used at this rehabilitation centre include Thai massage and herbal therapies. In Thailand, there is cultural acknowledgement of a range of traditional therapies (including complementary therapies) widely used in Thai health care. For example, meditation enjoys wide acceptance in Thai culture and attracts strong participation from visitors to Thai Buddhist centres because of growing interest in developing a personal health regime for future preventative health problems. Qualitative study using narrative inquiry and discourse analysis framed by poststructural theory. Six nursing staff and six stroke patients were interviewed about their involvement in complementary therapy practice and treatments and their experiences of these therapies in rehabilitation. This paper reports the six nurses' narratives of their involvement with patients and complementary therapies. The overall findings revealed two strong themes: nurses' professional landscape and changes in stroke patients' embodiment. These two themes were interwoven in a main discourse of nurses attending to and enabling holistic care. The contexts of temporality, spatiality and other people influencing the progress of patients' recovery are significant in this study. In particular, the findings illustrate the importance of the nurses' discourse in preparing stroke patients for a state of readiness to heal. The nurses' role becomes much more significant in health care as demonstrated through these stories. Their part in establishing a holistic approach through motivating, advising, educating, calming and imparting a sense of family enables a strong connection with mind, body and spirit potentiating recovery for stroke patients.
Article
To explore how complementary and alternative medicine (CAM) users make decisions about CAM use. Specifically, an exploration of the processes used by people with Type 2 diabetes, related to the assessment of information sources, factors influencing decision-making and the role of other key individuals, was undertaken. Patients with chronic illnesses increasingly seek to use CAM to improve their well-being. Currently, however, the decision-making processes related to CAM use among people with Type 2 diabetes are poorly understood. An exploratory study using a naturalistic design, with in-depth semi-structured interviews, was undertaken. Purposive sampling was used to recruit participants with Type 2 diabetes who used CAM alongside conventional medicine. The data were analysed in a three-step coding process. Ethical approval was gained from a human research ethics committee. Evidence about CAM use from interview data was consistent with a multi-dimensional decision-making processes used by participants. Four major categories emerged: recognising the need for using CAM; assessing the potential CAM before use; matching CAM use to personal philosophy; and ongoing evaluation of CAM. As diabetes affects the entirety of a person's being self-management, incorporating CAMs has become a way of controlling the condition and improving well-being. It is important for health professionals to consider clients' CAM use and to incorporate this information, where appropriate, into management plans. Health care professionals should be aware of patients who use CAM while under conventional medical care and should discuss CAM use at various points in the client journey to facilitate better communication.
Article
Background: The Study of Jamu Registry has been done, which is an observational longitudinal study to record the treatment of herbal medicine by physician practices. Respondents are a network of physicians who practice herbal medicine as complementary services. Methods: As researchers did not introduce any interventions, the study is basically observational study. Result: From patient’s jamu medical data records, wich is delivered to Registry Center, there were 1452 patients visited, divided into 908 initial visits and 544 follow-up visits. The most usage of the modalities was jamu (63.5%), followed by combination of jamu and conventional drug (22.26%) and jamu combined body-based therapy (5.2%). Assessment holistic therapy can be enhanced by the patient’s symptoms (anamnesis) and scores of Quality of Life (QoL) on the second visit (372 patients). There were a decrease of all the symptoms, the most decrease was common symptom (30%), respiratory tract (21.3%), musculoskeletal (15.5%), neurological (11.4%), gastrointestinal (10.2%), cardio vascular (1.5%) and urinary tract symptoms (3.8%). Based on the modalities given to the patient, who stands out is that the administration of jamu, lowering the general, musculoskeletal and neurological symptom. The combination of herbal medicine and conventional drug lowers the common and neurological symptom. Improvement of Quality of life patients can described as Qol “improved” category rising 20.1%, Qol “settled” category decreased 20.0% and “worsten” category decreased 1%. Conclusion: Based on type of modality used, there was increasing the value of improved QoL categories, respectively: the combination of herbal and conventional drugs, a combination of herbs and body based therapy, and combination jamu, body based therapy and conventional drugs. Recommendation: improvement of holistic therapy in the registry jamu can be used as a baseline formula of jamu, which can be developed for clinical observational studies or clinical trials.
Article
This paper reviews recent advances in missing data research using graphical models to represent multivariate dependencies. We first examine the limitations of traditional frameworks from three different perspectives: \textit{transparency, estimability and testability}. We then show how procedures based on graphical models can overcome these limitations and provide meaningful performance guarantees even when data are Missing Not At Random (MNAR). In particular, we identify conditions that guarantee consistent estimation in broad categories of missing data problems, and derive procedures for implementing this estimation. Finally we derive testable implications for missing data models in both MAR (Missing At Random) and MNAR categories.
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Purpose: This research aimed to explore the perceptions and experiences of cancer patients receiving osteopathic treatment as a complementary therapy when it is used in addition to conventional treatment for cancer pain. Methods: This qualitative study employed semi structured interviews of cancer patients in a palliative care unit in Lyon, France, who received treatment from an osteopath alongside their conventional cancer treatment. We analysed data using grounded theory and qualitative methods. Results: We interviewed 16 patients. The themes identified through the analysis included a low awareness of osteopathy among the population and an accompanying high level of misconceptions. The benefits of osteopathy were described as more than just the manual treatments with participants valuing osteopathy as a holistic, meditative, and non-pharmaceutical approach. Participants also described the osteopathic treatments as assisting with a range of cancer-related health complaints such as pain, fatigue, and sleep problems. Offering osteopathic treatment at an accessible location at low or no cost were identified by participants as enablers to the continued use of osteopathy. Conclusions: The findings of this study provides preliminary data which suggests, when delivered alongside existing medical care, osteopathy may have health benefits for patients with complex conditions such as cancer.
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Concomitant complementary medicine (CM) and conventional medicine use is frequent and carries potential risks. Yet, CM users frequently neglect to disclose CM use to medical providers. Our systematic review examines rates of and reasons for CM use disclosure to medical providers. Observational studies published 2003–2016 were searched (AMED, CINAHL, MEDLINE, PsycINFO). Eighty-six papers reporting disclosure rates and/or reasons for disclosure/non-disclosure of CM use to medical providers were reviewed. Fourteen were selected for meta-analysis of disclosure rates of biologically-based CM. Overall disclosure rates varied (7–80%). Meta-analysis revealed a 33% disclosure rate (95%CI: 24% to 43%) for biologically-based CM. Reasons for non-disclosure included lack of inquiry from medical providers, fear of provider disapproval, perception of disclosure as unimportant, belief providers lacked CM knowledge, lacking time, and belief CM was safe. Reasons for disclosure included inquiry from medical providers, belief providers would support CM use, belief disclosure was important for safety, and belief providers would give advice about CM. Disclosure appears to be influenced by the nature of patient-provider communication. However, inconsistent definitions of CM and lack of a standard measure for disclosure created substantial heterogeneity between studies. Disclosure of CM use to medical providers must be encouraged for safe, effective patient care.
Article
CONTEXTS: The consumption of complementary and alternative medicine (CAM) in rural areas is a significant contemporary health care issue. An understanding of CAM use in rural health can provide a new perspective on health beliefs and practice as well as on some of the core service delivery issues facing rural health care generally. This article presents the first review and synthesis of research findings on CAM use and practice in rural communities. A comprehensive search of literature from 1998 to 2010 in CINAHL, MEDLINE, AMED, and CSA Illumina (social sciences) was conducted. The search was confined to peer-reviewed articles published in English reporting empirical research findings on the use or practice of CAM in rural settings. Research findings are grouped and examined according to 3 key themes: "prevalence of CAM use and practice,"user profile and trends of CAM consumption," and "potential drivers and barriers to CAM use and practice." Evidence from recent research illustrates the substantial prevalence and complexity of CAM use in rural regions. A number of potential gaps in our understanding of CAM use and practice in rural settings are also identified.
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