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Therapeutic pluralism: Exploring the experiences of cancer patients and professionals
Abstract
The profile of complementary and alternative medicine (CAM) has risen dramatically over the last decade and cancer patients represent its most prolific users. As a result, the NHS and UK cancer services are attempting to develop a wider range of therapeutic options for patients. Despite such developments, little is known about why cancer patients use CAM, its perceived benefits and the perspectives of the doctors and nurses involved. Drawing on extensive fieldwork in the UK, Therapeutic Pluralism includes over 120 interviews with cancer patients and professionals, plus innovative 'diary' data which, for the first time, detail the experiences of CAM users. It gives a systematic analysis of issues such as: The development of patient preferences and influences on decision making Expectations of CAM and interpretations of 'success' in cancer treatment The nature and importance of 'evidence' and 'effectiveness' for patients The organisational dynamics involved in integrating CAM into the NHS Pathways to CAM and the role of the Internet The role of oncology clinicians in patients' experiences of cancer and their use of CAMs Therapeutic Pluralism is essential reading for students and researchers of medical sociology, complementary and alternative medicine and cancer. It will also be useful to medical and health professionals, and policy-makers with an interest in complementary and alternative medicine.
... Tal como referem Broom e Tovey (2007, 2008, as MCA são uma entidade dinâmica e construída, variável histórica e culturalmente. Esta entidade contém elementos concretos (artefactos básicos, como por exemplo as agulhas da acupunctura), bem como elementos abstratos (ideologia ou perspetivas sobre a relação terapêutica). ...
... Alguns autores optam pelo termo biomedicina, para referir a base científica das práticas geralmente reconhecidas como caracterizando a medicina convencional, isto é, técnicas baseadas na aplicação dos princípios das ciências naturais, em particular da biologia e da bioquímica (Broom e Tovey, 2008). Outros recorrem a um critério de localização geográfica e preferem o termo medicina ocidental (Janes, 1999). ...
... A diversidade de designações para as MCA e ausência de consenso em torno dessas designações -quer do ponto de vista das análises sociológicas sobre o fenómeno, quer do ponto de vista dos atores sociopolíticos -dá indicações sobre diferentes tipos de abordagens e formas de perspetivar o conteúdo dos saberes e das práticas que as fundamentam, mas também sobre o lugar que ocupam (ou ambicionam ocupar) por relação à medicina convencional (Coulter e Willis, 2007). A utilização de diferentes categorias está ideologicamente ancorada (Broom e Tovey, 2008) e associada a objetivos políticos, económicos e profissionais (Bombardieri e Easthope, 2000). Nessa medida, os termos utilizados são reveladores das lutas simbólicas, não só inter-sistemas terapêuticos (medicina convencional versus MCA), mas também intra-MCA. ...
“Complementary and alternative medicines” (CAMs) is one of the more common terms used to designate a range of medicines, therapies and therapeutic practices that both find themselves on the margins of so-called “conventional medicine” and are enjoying a growing social visibility in contemporary western societies. Based on a bibliographical review of the existing studies on this subject, the author responds to the need to delimit this field by offering a sociological reflection on the relevant social classifications. The article is organised along three lines: (i) definitions - what CAMs encompass; (ii) designations - the meanings of the terms; (iii) demarcations - the boundaries between these and other therapeutic practices.
... When possible, we argue, these problems should be highlighted not as negative attributes but as part of the empirical reality that is central to any developed understanding of CAM use. Likewise, Broom and Tovey (2008) highlighted how unquestioned categorizations of Western, orthodox, or modern medicine are also problematic because of the a priori geopolitical and ideological distinctions inherent in such terms. ...
... Although in this article we prefer the term biomedicine, because it better situates the ideas and practices under consideration (Broom & Tovey, 2008), the complex problems in understanding biomedicine are again issues that need to be in the foreground in any analysis. ...
... They also noted that the users' choice of treatment was based largely on the type of illness they were suffering from, with those suffering from chronic illness more likely to engage CAM. The evidence showed patients were not wholly skeptical of biomedicine and blindly accepting of CAM (Britten, 2008;Broom & Tovey, 2008). ...
Commentators such as Goldacre, Dawkins, and Singh and Ernst are worried that the rise in complementary and alternative medicine (CAM) represents a flight from science propagated by enemies of reason. We outline what kind of problem CAM use is for these commentators, and find that users of CAM have been constituted as duped, ignorant, irrational, or immoral in explaining CAM use. However, this form of problematization can be described as a flight from social science. We explore CAM use in light of a rigorous and robust social scientific body of knowledge about how individuals engage with CAM. By pointing to the push and pull factors, CAM user's experiences of their body, and the problem of patient choice in CAM use, we summarize some of the key findings made by social scientists and show how they trouble many of the reasoned assumptions about CAM use.
... The crucial role played-from the standpoint of the users-by these medicines was also pointed out facing the treatment of severe or chronic diseases such as cancer (Broom & Tovey, 2008;Singh, Maskarinec, & Shumay, 2005;Tavares, 2003), diabetes (Schoenberger, Stoller, Kart, Perzynski, & Chapleski, 2004), asthma (Freidin & Timmermans, 2008), and diverse mental disorders. In fact, according to various international studies, most patients with mental disorders resort to a more extensive use of alternative therapies (Jorm, 1994(Jorm, , 2000Jorm, Angermeyer, & Katschnig, 2000;Jorm & Griffiths, 2006;Mamtani & Cimino, 2002) or an unconventional type of medicine. ...
... In this direction, Ernst and White (2000) noticed that in England, users spend 1.6 billion pounds a year in the consumption of alternative and complementary therapies, destined to treating different illnesses and the search of well-being. Now, although the use of complementary-alternative therapies is a widely proven fact about which there is consensus in the social scientists community, the definition of what (or which) is considered an alternative therapy and in which categories to group them is still one of the main objects of debate on the matter-a debate yet to be concluded (Broom & Tovey, 2008). ...
... In the United States, the National Center for Complementary and Alternative Medicine (2002) defined alternative medicine as "a group of medical and health care systems, practices and products that are not currently considered as part of conventional medicine" (National Institute of Health, 2003). Some authors have problematized this category stating that the use of therapies in individual trajectories is what allows appointing them as complementary or alternative to the biomedical treatment (Broom & Tovey, 2008;Idoyaga Molina, 2005), showing the limits of the classifications of the etic type and underlining the importance of taking the social actors' experiences into account when considering such distinctions. Other lines of analysis have called "alternative medicine" to all medicines that are presented as a parallel resource for health care for mid and mid-high urban sectors that also show a convergent alternation between biomedical attention and exotic resources (Alexander, 1992;Heelas, 1996;Martins, 1999;Shimazono, 1999). ...
In this article, the authors describe the phenomenon of therapeutic complementarity between alternatives therapies and biomedicine in public hospitals of Buenos Aires (Argentina). They contextualize the phenomenon in a global and local field. Features specific to Argentina make this phenomenon interesting. The first of these is that biomedicine is the only type of medicine that is legally authorized to act on the body; nevertheless, alternative practices have flourished not only in the private health sector but also in the public hospitals run by the state. A second feature refers to the alternative practices in the Mental Health Area that bring about a singular interaction between two different therapeutic models. Based on a qualitative study in public hospitals, the authors look into the reasons that generate the phenomenon, underlining the forms in which it expresses itself and the complexity of a field under construction that implies the resignification of the concepts related to health and disease.
... Here, the focus lies not on RCT-testable, standardized treatments for specific diseases, but on the individualized care of the respective patient, addressing his particular needs, his suffering; therapy is oriented toward the whole person, providing a comfortable, holistic environment for him or her. Anecdotal evidence, clinical judgement, intuition, and adaption to the patient are central; EBM evidence is secondary 30,79 ("some people would say highgrade evidence is worse than what you see in front of you" 79 ). In the mental health field, evidence-based practice is the subject of vigorous controversy-whether the results from the clinical trials can be generally applied to individual patients, or can only be applied to a few standard situations for which clinicians choose the respective intervention anyway, with or without EBM algorithms. ...
... Paradigmatic and ideological barriers stand in the way, and insurmountable obstacles are created by using the term evidence very restrictively, despite the general acknowledgment that conventional medicine's evidence base is limited as well and is often far below the required gold standard. 79 The considerable discrepancy between the ideal of EBM and the actual organizational practice easily leads to flexible and opportunistic adaptivity which is open to subjectivity, influence of medical stakeholders, political constellations, and the professional status and the persuasive power of the specialist. Strict evidence is primarily demanded when therapies are considered not appropriate and when the logic behind the therapy is questioned. ...
... This has been characterized as a "double standard," used instrumentally to exclude CAM. 79,118,119 A rather interesting view of research evidence is presented by the patients: they see the research results as basically important and as not necessarily flawed, but they are largely sceptical of them, particularly when conventional scientists perform research on CAM. Quite generally they doubt that statistical results are of major relevance for their own case. ...
Complementary and alternative medicine (CAM) is becoming an integral part of modern medicine. Complementary and alternative medicine therapy systems include natural medicinal products, nonpharmacological treatments, and counselling on health and lifestyle issues. Complementary and alternative medicine concepts are often elaborate, transcending biophysical models and employing the principles of salutogenesis. Evaluations of CAM therapy systems need to be integrative and cover the dimensions of: (1) therapeutic professionalism; (2) patient perspective and public demand; (3) conceptuality; (4) safety, effectiveness, and costs. Complex research strategies are required, which reverse the phases of conventional drug assessment. The predominant use of randomized trials would introduce structural bias and create an artificial picture. Important are evaluations of the whole system in real-world conditions, and surveys on component evaluations. Systemic CAM assessments should consist of a broad array of high-quality research methods: well-conducted randomized and nonrandomized studies, cohort studies, qualitative research, high-quality case reports and case series, studies on patient perspective, safety analyses, economic analyses, etc. Good clinical judgement, a core epistemic element of medicine based on nonstochastic principles, should also be integrated and could reflect routine patient care.
... A une échelle plus pratique, certains travaux examinent le pluralisme thérapeutique dans les établissements de soins. Cette échelle micro-sociale permet d'étudier les négociations de l'agencement d'une offre plurielle de soins entre les acteurs en présence, aboutissant à des configurations analysées comme des « poches d'intégration sélectives » (Cohen et al., 2015, chapitre 3 ;Broom et Tovey, 2008). Cela révèle une situation française ambiguë présentant des frontières poreuses entre ce qui relèverait de la médecine officielle et ce qui resterait en-dehors. ...
Nous souhaitons étudier comment les sages-femmes font leur entrée dans le champ du dépistage du cancer du col de l’utérus et mettent en place des logiques d’action pour renforcer la reconnaissance de leur métier. Nous avons enquêté dans deux départements (Bas-Rhin et Gironde qui proposent une organisation différente du dépistage), dans lesquels nous avons réalisé de nombreuses observations et interviewé 98 professionnels de santé et patientes. Nous montrerons, tout d’abord, comment le groupe professionnel a vu dans un élargissement des compétences une opportunité pour gagner en légitimité. Puis, nous insisterons sur les difficultés que les professionnelles peuvent rencontrer dans le travail de collaboration avec les gynécologues médicaux en montrant comment se rejoue un conflit de territoire.
... A une échelle plus pratique, certains travaux examinent le pluralisme thérapeutique dans les établissements de soins. Cette échelle micro-sociale permet d'étudier les négociations de l'agencement d'une offre plurielle de soins entre les acteurs en présence, aboutissant à des configurations analysées comme des « poches d'intégration sélectives » (Cohen et al., 2015, chapitre 3 ;Broom et Tovey, 2008). Cela révèle une situation française ambiguë présentant des frontières poreuses entre ce qui relèverait de la médecine officielle et ce qui resterait en-dehors. ...
... A une échelle plus pratique, certains travaux examinent le pluralisme thérapeutique dans les établissements de soins. Cette échelle micro-sociale permet d'étudier les négociations de l'agencement d'une offre plurielle de soins entre les acteurs en présence, aboutissant à des configurations analysées comme des « poches d'intégration sélectives » (Cohen et al., 2015, chapitre 3 ;Broom et Tovey, 2008). Cela révèle une situation française ambiguë présentant des frontières poreuses entre ce qui relèverait de la médecine officielle et ce qui resterait en-dehors. ...
Depuis quelques décennies, une des priorités de l’action publique est
l’amélioration de la coordination entre opérateurs du système de santé,
que ce soit au niveau organisationnel ou au niveau individuel. Différents
facteurs permettent d’expliquer ce mouvement. En sus des explications
fréquemment avancées d’ordre démographique, la spécialisation médicale mais aussi les processus de rationalisation à l’œuvre au sein des
systèmes de santé et de recherche peuvent être invoqués. Cette action
publique se traduit par « plus » d’organisation(s). Cette prolifération organisationnelle ne passe pas seulement par la conception de nouveaux
outils, la création de nouvelles organisations de type bureaucratique
ou la fusion d’organisations ; elle se traduit aussi par la création d’entités organisationnelles censées coordonner des acteurs sans disposer
d’autorité hiérarchique ni de moyens financiers conséquents. Face à ces
mouvements susceptibles de remettre en question leur autonomie et
leur place centrale dans les systèmes de santé, les médecins adoptent
différentes stratégies ; certains d’entre eux, qualifiés de « médecins organisateurs », jouent un rôle moteur dans ces tentatives de réorganisation.
... El estudio coincide con otras investigaciones sobre cómo la pluralidad terapéutica está ligada a las trayectorias biográficas, igual que al contexto histórico-cultural, económico y político (4,5,6,8). No obstante, en comparación con estudios realizados en Europa, aspectos que intervienen en el pluralismo terapéutico en torno al cáncer, como la pluralidad poblacional por las diásporas o las políticas nacionales contra el cáncer que propugnan un enfoque más complementario y menos biomédico (4,5), difieren de los hallados en nuestra investigación. ...
Objetivos
Analizar las características del pluralismo terapéutico en torno al cáncer de adultos, atendidos en un hospital de cancerología, a partir de sus trayectorias de salud/enfermedad/atención-desatención.
Métodos
Estudio analítico-explicativo, etnográfico, transversal-aplicado y de carácter cualitativo. Se realizaron registros etnográficos, observación participante y entrevistas semiestructuradas. Para el artículo se tomaron los datos proporcionados por diez personas participantes con cáncer, atendidas en el Centro Estatal de Cancerología de Veracruz. La identificación de participantes se hará mediante seudónimos, para preservar la privacidad de datos personales. Los instrumentos de trabajo estuvieron conformados por guías de observación, guías de entrevistas semiestructuradas y expedientes clínicos del hospital mencionado.
Resultados
Se muestran dos resultados principales: 1) caracterización de la diversidad de terapias de acuerdo con las referencias de los participantes, y lo que utilizaron durante toda su trayectoria biográfica en torno a procesos salud/enfermedad/ atención-desatención; 2) identificación de los aspectos socioculturales que intervienen en estos procesos complejos de pluralidad terapéutica, estrechamente relacionados con la aparición del cáncer.
Conclusión
Los aspectos socioculturales están entretejidos con la pluralidad terapéutica emergente en los procesos complejos de la enfermedad del cáncer. La implicación de dichos factores en los procesos salud/enfermedad/atención-desatención al cáncer se manifiestan incluso antes de los primeros síntomas, es decir, en las acciones cotidianas del autocuidado y acciones de atención preventiva. El mestizaje terapéutico registrado da cuenta de los efectos de la globalización, característica de las sociedades capitalistas, en la que el pluralismo de terapias deviene en un fenómeno óptimo de comercialización y consumo.
... Leur crédibilité scientifique peut être ainsi questionnée à l'aune des conclusions scientifiques de ce rapport ( Les divers discours sur le jeûne, accessibles aux patients et à leurs proches, pourraient prendre le pas sur les recommandations des autorités scientifiques pour la pratique clinique. Des investigations sur le comportement des patients seraient ainsi nécessaires dans la lignée des travaux déjà publiés sur les recours non conventionnels des personnes atteintes de cancer (Broom 2008, Bégot 2010, Cohen 2011b, Cohen 2016. En attendant une conceptualisation plus détaillée sur ce sujet, les contenus des ouvrages grand public ici traités, donnent des repères en la matière. ...
... Complementary and alternative medicine (CAM) is generally used to refer to a range of nonindigenous, unorthodox practices including homeopathy, naturopathy, herbalism, etc. [5] TM has often been the dominant means of treatment for health problems for centuries, and in some cases, it continues to dominate health care beliefs and practices. [6] India's indigenous systems of medicine, such as Ayurveda, Siddha, and Unani, are more than 5,000 years old, and in rural areas, the Indian population has relied heavily on these practices, particularly Ayurveda and Homeopathy. [7,8] ...
... Leur crédibilité scientifique peut être ainsi questionnée à l'aune des conclusions scientifiques de ce rapport ( Les divers discours sur le jeûne, accessibles aux patients et à leurs proches, pourraient prendre le pas sur les recommandations des autorités scientifiques pour la pratique clinique. Des investigations sur le comportement des patients seraient ainsi nécessaires dans la lignée des travaux déjà publiés sur les recours non conventionnels des personnes atteintes de cancer (Broom 2008, Bégot 2010, Cohen 2011b, Cohen 2016. En attendant une conceptualisation plus détaillée sur ce sujet, les contenus des ouvrages grand public ici traités, donnent des repères en la matière. ...
... The label "alternative medicine" has been historically removed considering that non-conventional medicines usually represent rather complementary than alternative options to conventional treatments. This goes in hand with the development of the "medical pluralism" (i.e., the use of multiple forms of healthcare [8,10]) that has dramatically increased in most industrialized countries [11][12][13] but also in low and middle income countries [14][15][16][17]. However, independent of the kind of medicine, ICHA are used by consumers sometimes in addition to, sometimes in place of conventional treatments. ...
Background
Integrative and complementary health approaches (ICHA) are often pursued by patients facing chronic illnesses. Most of the studies that investigated the factors associated with ICHA consumption have considered that the propensity to use ICHA is a stable or fixed characteristic of an individual. However, people may prefer using ICHA in some situations and not in others, depending on the characteristics of the illness to face. Moreover, the attitude toward ICHA may differ within a single individual and between individuals so that ICHA can be used either in addition to (i.e., complementary attitude) or in place of (i.e., alternative attitude). The present study aimed at examining distinct patterns of attitudes toward ICHA in people hypothetically facing chronic illnesses that differed according to severity and clinical expression.
Methods
We conducted a web-based study including 1807 participants who were asked to imagine that they had a particular chronic illness based on clinical vignettes (mental illnesses: depression, schizophrenia; somatic illnesses: rheumatoid arthritis, multiple sclerosis). Participants were invited to rate their perceived distress and social stigma associated with each illness as well as its perceived treatability. They also rated their belief in treatment effectiveness, and their treatment preference. Four patterns of treatment choice were determined: strictly conventional, weak or strong complementary, and alternative. Bayesian methods were used for statistical analyses.
Results
ICHA were selected as complementary treatment option by more than 95% of people who hypothetically faced chronic illness. The complementary attitude towards ICHA (in addition to conventional treatment) was more frequent than the alternative one (in place of conventional treatment). Factors driving this preference included employment status, severity of illness, age and perceived distress, social stigma and treatability of the illness. When the label of illnesses was included in the vignettes, patterns of treatment preference were altered.
Conclusions
This study provides evidence that “medical pluralism” (i.e., the integration of ICHA with conventional treatment) is likely the norm for people facing both mental or somatic illness. However, our result must be interpreted with caution due to the virtual nature of this study. We suggest that taking attitudes toward ICHA into account is crucial for a better understanding of patients’ motivation to use ICHA.
Electronic supplementary material
The online version of this article (10.1186/s12906-019-2490-z) contains supplementary material, which is available to authorized users.
... Patients in oncology consultation identified themselves as managers who actively took part in palliating their symptoms using medication and food to exercise their 'individual agency' and 'subjectivity'. Patients' desire to retain an active role in the healing process has also been identified as one of the reasons why cancer patients utilise complementary and alternative medicine (CAM) (Broom 2015;Broom and Tovey 2008). Patients identified themselves as active agents who organised and managed the different aspects of their lives to live the remainder of their life as normally as they could. ...
This paper explores advanced cancer patients’ self-identification from a grammatical-concordance perspective. It combines corpus linguistics tool of concordance and transitivity analysis to investigate the grammatical choices that advanced cancer patients make to identify and construct themselves during an oncology consultation. The data comprises 69 oncology consultations between advanced cancer patients (and in some consultations a companion or companions) and their oncologist. Findings reveal that these advanced cancer patients identified themselves with an active and informed role in terms of self-care, decision-making and other administrative activities; they identified their everyday life as an indispensable part of the domain of medicine; and they did not associate themselves with emotive mental processes during the consultation.
... Whereas the dynamics between biomedicine and complementary and alternative medicine (CAM) in Western contexts has been defined by exclusive State legitimation of biomedicine (Broom & Tovey, 2008), in India, many traditional practices are supported and, at least in part, funded by the State, and have been the primary providers of healthcare for centuries (Cant & Sharma,1999;Khan, 2006). Moreover, there have been sporadic but concerted efforts to encourage traditional practices including the efforts of Mahatma Gandhi who pushed for State support (Alter, 2000). ...
... Traditional medicine (TM) refers to local indigenous practice and belief systems that are used largely in developing countries for healthrelated purposes (Bodekar et al.2002). Complementary and alternative medicine (CAM) is generally used to refer to a range of non-indigenous, unorthodox practices including homeopathy, naturopathy, herbalism, etc. (Broom et al.,2008). TM has often been the dominant means of treatment for health problems for centuries, and in some cases, it continues to dominate health care beliefs and practices. ...
One of the most visible and sound change that rural area is
experiencing at present is ‘depeasantation’. Peasantry is losing its
importance not just as source of livelihood but way of life also
and this is happening all around in developing countries. Youth of
rural area are now not able to see their future in agriculture. It is
expected that those who are leaving agriculture and allied activities,
a large proportion of them may opt for out-migration. Migration
can not be understood as symmetric distribution of population
over the space. It is not a linear outcome of economic factor but
it involves several social and cultural factors also. Besides material
and human capital (education, skills, knowledge), social capital is a
third, crucial migration resource in (1) enabling and (2) inspiring
people to migrate. The study aims to understand the mass exodus
of youth from the area and its demographic outcome and try to
understand the role of social network in migration process.
... Traditional medicine (TM) refers to local indigenous practice and belief systems that are used largely in developing countries for healthrelated purposes (Bodekar et al.2002). Complementary and alternative medicine (CAM) is generally used to refer to a range of non-indigenous, unorthodox practices including homeopathy, naturopathy, herbalism, etc. (Broom et al.,2008). TM has often been the dominant means of treatment for health problems for centuries, and in some cases, it continues to dominate health care beliefs and practices. ...
In a general sense livelihood can be understood as means
of living. All that means which is being used by a person or a
family for their survival is called their livelihood. A livelihood
is sustainable which has potential to fulfill the basic needs of a
household and which can cope with and recover from stresses and
shocks. With the recent pace of development in globalization,
livelihood pattern of rural poor is also expected to be changed.
New livelihood opportunity is emerging in rural non-farm sector,
while there is less hope in traditional agricultural sector. Thus it
is necessary to see how the pattern of livelihood is changing with
emergence of new opportunities and constrains and which are the
household, able to access and secure their livelihood in present
context. The IHDS survey data is used to fulfill the objective
of study, which is collected in 2004-05. The result suggest that
in rural area a big non-farm sector has emerged but its benefit
is limited to only a smaller section of population. The majority
population which depends upon agricultural or non-agricultural
laborer, poverty and insecurity is widespread among them.
Education has emerged as the most important factor which leads
the household to access the secured source of income and thus is a
potent tool of social mobility in present context.
... Many GRTs report experiencing discrimination and exclusion on a regular basis with suspicion and apprehension towards societal institutions and their representatives often consistent with situational factors, rather than evidence of a distinctive value system. Further, such sentiments are not exceptional and mirror increasing public scepticism towards official health advice and biomedical treatment and prevention of disease (Broom & Tovey, 2008). ...
Gypsies, Roma and Travellers (GRT) experience a significantly high number of measles cases and have low levels of MMR immunisation. There is little evidence on why immunisation levels are low; beliefs and practices surrounding the Measles Mumps and Rubella MMR vaccine or the factors that promote or hinder uptake. This paper presents data from 5 focus groups with 16 GRT mothers in Kent South East England. Between them they had 66 children of whom just under half had not received the course of vaccinations. Focus groups explored the issues GRT parents consider when making vaccination decisions in the context of wider social, ideological, material and practical considerations. Four interrelated themes were identified: way of life and access; engaging with healthcare staff; perceptions and evaluations of risk, and strategies to minimise MMR related risks. Our findings provide little support for explanations that emphasise cultural values or practices in shaping immunisation behaviour. Poor service provision, situational constraints related to living circumstances, and multifaceted and severe health issues, which precede and inform decisions over childhood immunisation were more significant in explaining low uptake.
... As such, integration may be more about strategic co-option of certain CAM procedures and technologies than the sole coming together of CAM and conventional medicine. 121 While influences such as education, communication, and attention to processes, guidelines, protocols and resources may be important, successful models of integration are the exception, and much work needs to be done before successful models of integration that focus more on client-centred care, and less on authoritarian power dynamics and control by individual practitioners is the central focus of inte-grated health care services. In time, the struggle to find labels to describe the changing relationship between conventional medicine and CAM may be resolved. ...
To determine what models of integrative medicine (IM) are being employed in contemporary health care settings, and how and which factors affect and facilitate the success of IM in terms of the integration of complementary and alternative medicine (CAM) and conventional medicine in primary health care (PHC).
Literature review.
Australian and international PHC settings, and hospitals.
Australian and international peer-reviewed literature identified from database searches, reference lists, desktop searches, texts, and relevant website searches (e.g., government and health-related departments and agencies). Focus was literature with the keywords 'integrative' or 'integrated' in conjunction with 'medicine' or 'health care'. Articles were analysed for descriptions of continuous and integrative services involving contemporary IM practices, their background, characteristics, and implementation.
Classifications of IM in the literature present various ways that IM can be implemented, and it appears that strategies have been successfully developed to facilitate integration. Although few of the barriers to the integration of CAM and conventional medicine have been resolved, concerns over the legitimacy of CAM in health care (e.g., safety, biomedical evidence, and efficacy) are being overcome by the use of evidence-based practice in IM delivery. There are two dominant models of IM that have been developed. One is the selective combination of both biomedical evidence and experience-based evidence of both CAM and conventional medicine. The other is the selective incorporation of exclusively evidence-based CAMs into conventional medicine. The two model types signify different levels of equity between CAM and conventional medicine in regard to the power, autonomy, and control held by each. However, the factors common to all IM models, whether describing CAM as supplementary (and subordinate) or complementary (and partnered) to conventional medicine, is the concept of a health care model that aspires to be client-centred and holistic, with focus on health rather than disease as well as mutual respect among peer practitioners.
The growth and viability of IM will depend on evidence-based practices, non-hierarchal IM practices, and identifying the successful influences on the integration of CAM and conventional medicine for recognition of its inherent value in PHC.
India's public health system aims to foster pluralism by integrating AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy) with mainstream biomedical care. This policy change provides an opportunity to explore the complexity of health system innovation, addressing the relationship between biomedicine and complementary or alternative medicine. Implementing health policy depends on local, societal, and political contexts that shape intervention in practice. This qualitative case study explores contextual features that have influenced AYUSH integration and examines the extent to which practitioners are able to exercise agency in these contexts. Health system stakeholders were interviewed (n = 37) and integration activities observed. The analysis identifies contextual factors in health administration, health facilities, community, and wider society which influence the integration process. In the administrative and facility spheres, pre-existing administrative measures, resource and capacity deficits limit access to AYUSH medicines and opportunities to build relationships between biomedical and AYUSH doctors. At the community and society levels, rural AYUSH acceptance facilitates integration into formal healthcare, while professional organisations and media support integrative processes by holding health services accountable. The findings also demonstrate how, amid these contextual influences, AYUSH doctors navigate the health system hierarchies, despite issues with system knowledge against a background of medical dominance.
In this study, the authors present the appropriation of Eastern notions in cognitive behavioral therapy in the Autonomous City of Buenos Aires, Argentina, inscribing this phenomenon on a wider field of interest for social science and psychotherapy. The supply of Eastern alternative therapies and the new developments of cognitive behavioral therapy in the area of study are introduced. Based on a survey conducted in CBT training institutions of the Autonomous City of Buenos Aires, three categories are proposed to understand the phenomena: 1) the desacralization of yoga; 2) the incorporation of Eastern traditions into cognitive behavioral psychotherapy, and 3) scopes and limits of therapeutic complementariness between cognitive behavioral therapy and Eastern practices. The authors conclude that this appropriation produces a desacralization of the original contents of the Eastern tradition, because in this fusion the focus is on the practice that produces well-being more than on the Eastern practices.
With the increasing offer of fertility treatment by a largely privatised sector, which has involved the proliferation of treatment add‐ons lacking evidence of effectiveness, In‐Vitro Fertilisation (IVF) patients are expected to make informed choices on what to include in their treatment. Drawing on interviews with 51 individuals undergoing fertility treatment, this article explores patients’ approaches to medical evidence interpretation and its role in their decisions to include add‐ons. While most IVF patients share understandings of what counts as medical evidence, our findings show how their approaches also differ. Our analysis focuses on how patients negotiate the notion of medical evidence and its relation to other forms of experience or knowledge. We present four different approaches to evidence in IVF: (1) delegating evaluations of evidence to experts; (2) critically assessing available evidence; (3) acknowledging the process of making evidence; and (4) contextualising evidence in their lived experience of infertility. We suggest that patients’ choice to include add‐ons is not due to a lack of information on or understanding of evidence, but rather should be interpreted as part of the complexity of patients’ experiences of infertility.
This book provides a contemporary and comprehensive examination of cancer in everyday life, drawing on qualitative research with people living with cancer, their family members and health professionals. It explores the evolving and enduring affects of cancer for individuals, families and communities, with attention to the changing dynamics of survivorship, including social relations around waiting, uncertainty, hope, wilfulness, obligation, responsibility and healing. Challenging simplistic deployments of survivorship and drawing on contemporary and classical social theory, it critically examines survivorship through innovative qualitative methodologies including interviews, focus groups, participant produced photos and solicited diaries. In assembling this panoramic view of cancer in the twenty-first century, it also enlivens core debates in sociology, including questions around individual agency, subjectivity, temporality, normativity, resistance, affect and embodiment. A thoughtful account of cancer embedded in the undulations of the everyday, narrated by its subjects and those who informally and formally care for them, Survivorship: A Sociology of Cancer in Everyday Life outlines new ways of thinking about survivorship for sociologists, health and medical researchers and those working in cancer care settings.
Background: An interprofessional and cross-cultural pedagogical project in community health for students in nursing, social work, anthropology and medicine at the end of the bachelor’s degree begun in 2014. After a rural context fieldwork in several Santal villages of West Bengal (India), students had to conduct a research project, based on a community-health topic.
Aims: This paper describes how such a pedagogical project, introducing students to ethnographic research, can initiate new ways of thinking for possible future health interventions in rural communities.
Methods: An inductive approach based on ethnography was used during the fieldwork, including observations, interviews, focus groups and local documentation.
Results: Our observations led to the finding that actions in rural health cannot be initiated without: promoting an interprofessional/interdisciplinary perspective and a culture of complexity and reflectivity; considering local populations in transition and not in a fixed homogenous situation; understanding more than imposing; taking into account local disease classification and local pragmatic solutions; considering the dialogue between bio-medicine and therapeutic pluralism; considering local perceptions and practices; considering care itineraries/pathways; and finally being conscious of our apostolic function.
Conclusion: Our interprofessional pedagogical project promotes a bottom-up approach in dialogue with a global health vision.
El pluralismo médico ha sido un concepto ampliamente utilizado en las ciencias sociales y, en los últimos años, en las ciencias aplicadas en salud. Se han señalado en diversos trabajos sus principales limitaciones, por ejemplo no considerar los procesos estructurales en el análisis de la diversidad de recursos de asistencia en salud, pero son muy escasas las aportaciones conceptuales y epistémicas desde su problematización. Se propone el concepto nomadismo terapéutico para generar ejes de indagación epistémica sobre la atención médica y la cronicidad desde el análisis de los procesos de estratificación social y las estrategias de vida de los actores y grupos sociales. Para ello, se presentan dos estudios de caso en la atención en salud mental dirigida a personas migrantes en Bruselas (Bélgica) y en el apego al tratamiento antirretroviral de personas mayas con VIH en Chiapas (México).
Disponible en: http://digital.publicacionsurv.cat/index.php/purv/catalog/download/61/49/123-1?inline=1
El autor expone las particularidades metodológicas más notables en la relación que estableció, fruto de las exigencias de su trabajo de campo, como antropólogo e investigador/terapeuta en la consulta etnopsiquiátrica del hospital Brugmann de Bruselas.
Al mismo tiempo, analiza las especificidades metodológicas emblemáticas
de esta práctica etnopsiquiátrica a la luz de un estudio de caso; propone algunos de sus aciertos en la eficacia terapéutica, y comenta aspectos problemáticos para el debate.
The author discusses the most notable methodological
particularities in the relationship that he established during
his fieldwork as an anthropologist, researcher/therapist in the
ethno-psychiatric Brugmann hospital in Brussels. At the same
time, the author analyzes the methodological specificities that
are emblematic of this ethno-psychiatric practice in the light of a
case study, comments on the efficacy of some of their therapeutic
successes, and highlights some problem areas for discussion.
Se exponen algunos de los resultados de una investigación etnográfica llevada a cabo en Guayaquil (Ecuador), en 2014-2015, con personas de estrato socioeconómico bajo seropositivas, sus familiares y los médicos tratantes de dos clínicas de atención al VIH a las que acuden. Se realizó dos meses de observación participante y 59 entrevistas en profundidad a usuarios, familiares, personal de salud y tomadores de decisiones. El objetivo principal es la dilucidación de la mediación del género y la trayectoria sociocultural de las personas con VIH en la falta de adherencia al tratamiento antirretroviral debido a la violencia de género, al estigma sufrido por ser seropositivo y/o a la homofobia en tres campos sociales: a) El ámbito familiar (unidad doméstica); b) el comunitario, en concreto el barrio y el ámbito laboral en Guayaquil; c) el institucional médico especializado en VIH.
This article proposes some results of a ethnographic research carried out in Guayaquil (Ecuador), in 2014-2015, with low socioeconomic status population HIV positive, their families and physicians in HIV clinics. We carried out 59 in-deep interviews to patients, relatives, health care providers and decisions makers. Its main objective is the elucidation of gender and sociocultural backgrounds, of people living with HIV, mediation in the antiretroviral treatment non adherence due to gender violence, stigma suffered by being HIV positive and homophobia in three social fields: a) The family (household); b) the Community, in particular the neighborhood and the workplace in Guayaquil; c) the medical institution specialized in HIV.
Se proponen y discuten tres modelos de intervención terapéutica intercultu-ral, que representan algunas de las prácticas interculturales en salud mental en Bélgica y España, a partir del análisis de tres estudios de caso corres-pondientes a la formulación cultural de casos psiquiátricos del Hospital Uni-versitario Puerta de Hierro (Madrid), la clínica etnopsiquiátrica del Hospital Universitario Brugmann y la antipsiquiatría intercultural de las casas comuni-tarias peul (Bruselas). A su vez, se analizan dichas prácticas desde el diálogo crítico de saberes, la síntesis y la producción de conocimientos nuevos y los cuestionamientos disciplinares de sus aproximaciones de corte transdiscipli-nario, interdisciplinario y contradisciplinario, respectivamente. PALABrAs cLAve: migración, etnopsiquiatría, antipsiquiatría, interculturalidad, interdisciplinariedad I propose and discuss three models of intercultural therapy in mental health, which include some of the intercultural practices in this field in Belgium and Spain, from the analysis of three case studies belonging to the cultural formulation of psychiatric diagnosis clinical praxis in Puerta de Hierro University Hospital (Madrid), the ethnopsychiatric therapy in Brugmann University Hospital, and intercultural anti-psychiatry praxis in community peul houses (Brussels). in turn, these practices are analyzed from the point of view of a critical dialogue of knowledge, synthesis and production of new knowledge and disciplinary questionings of their approaches which are, respectively, transdisciplinary, interdisciplinary, and antidisciplinary.
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El presente capítulo comprende dos estudios de caso desarrollados en la investigación que llevé a cabo en el marco de mi tesis doctoral, relativa a las praxis interculturales en salud mental emergentes en el ámbito asociativo e institucional de Bélgica y España. En este texto expongo las características y problemáticas de dos prácticas sanitarias, emblemáticas, de tipo intercultural en Bruselas. Estas son, la consulta etnopsiquiátrica del Hospital Público Brugmann, y la práctica antipsiquiátrica intercultural de la casas comunitarias peul, llevada a cabo por la asociación «L’autre Lieu». El objetivo aquí es plantear para el debate las especificidades de estas praxis como propuestas, creativas y eficaces de actores situados en los campos sociales institucional y asociativo, en su relación con la mejora al acceso y disfrute del proceso de atención sanitaria/curación de aquellas personas con itinerarios socio-culturales diversos de origen autóctono y extranjero.
Para ello parto de una posición expositiva y analítica que se encuentra entre la llamada antropología médica crítica y la de carácter aplicado en la búsqueda de propuestas terapéuticas eficaces y democráticas.
Se presentan los resultados de una investigación etnográfica
sobre la incidencia del estigma estructural y la violencia
institucional hacia las personas vih positivas en la desadherencia
al tratamiento antirretroviral de lo usuarios/as de un hospital
especializado en la atención a esta infección en Guayaquil,
Ecuador; desde el análisis de su articulación con tres dimensiones
de la cultura organizacional de cuidados existente en el
mismo: a) El primer nivel de atención y la masificación del hospital,
b) la carencia de medicamentos antirretrovirales y pruebas
cd4 y Carga Viral y las representaciones sociales y praxis, en
este sentido, de los usuarios/as y médicos/as, y c) la implicación
de la sociedad civil, las áreas no médicas y la participación del
paciente en dicha cultura.
In this article, I present the results of an ethnographic
study related to the impact of structural stigma and institutional
violence, toward HIV positive people, in non-adherence to
antiretroviral treatment for patients in a hospital specialized
in medical care to this infection in Guayaquil, Ecuador; from
the analysis of health care organizational culture within three
dimensions: a) the primary care and overcrowded hospital
attention, b) the lack of arvs, cd4 and viral load tests and the
Social Representations and Praxis, related with this, of patients
and doctors, and c) the involvement of civil society, non-medical
areas and patient engagement in that culture
In this article, I present the results of an ethnographic study related to the impact of structural stigma and institutional violence, toward HIV positive people, in non-adherence to antiretroviral treatment for patients in a hospital specialized in medical care to this infection in Guayaquil, Ecuador; from the analysis of health care organizational culture within three dimensions: a) the primary care and overcrowded hospital attention, b) the lack of arvs, cd4 and viral load tests and the Social Representations and Praxis, related with this, of patients and doctors, and c) the involvement of civil society, non-medi-cal areas and patient engagement in that culture. © 2018, Universidad Nacional Autonoma de Mexico. All rights reserved.
By exploring ‘embodied expertise’ in alternative treatments, this chapter endeavours to help us to account for the popularity of alternative medicine. Embodied expertise has been a much-neglected area in healthcare research for alternative medicine compared with ‘negative’ explanations such as studies of practitioners’ (lack of) education, treatment effects and effectiveness, or users’ dissatisfaction with conventional healthcare. Drawing on a concept of expertise different from ‘expert’ and ‘profession’ allows us to identify dimensions such as skills, knowledge, and spatiality developed not only by practitioners but also in the practitioner-user encounter. Based on a study of three of the most popular forms of alternative medicine in Denmark, we demonstrate how these dimensions are central to developing relationships between (1) expert and lay, (2) experience and evidence-based knowledge, and (3) clinic and home. We argue that such relationships develop the embodied expertise of practitioners, as well as that of users of alternative medicine.
Chinese qigong practices provide an interesting case in point of the varying and often incommensurate production of alternative health modalities in the social worlds of practitioners, scholars, and medical scientists. Drawing on publications from each social world, this chapter argues that the term qigong, rather than referring to a set of internally consistent Chinese ‘meditation’ or ‘breathing exercises’, may be more usefully understood as a catch-all term which belies the cultural-nationalist production of such practices during the Chinese qigong movement, emphasises their social and political significance at the expense of their practical value—in particular with regard to the vitalistic notion of qi—and disregards the methodological issues pertaining to studying a perplexing diversity of practice styles, schools, and traditions.
The results of the investigation that I expose elucidate some of the barriers, related with the characteristics of a health care organizational culture, for antiretroviral therapy access and adherence of indigenous people living with HIV-AIDS in the Highlands of Chiapas. From a theoretical approach that emphasizes the structural and institutional violence operating through discrimination by ethnicity, socio/economic situation and HIV-AIDS disease, I describe and analyze a case study discussing some of the difficulties that indigenous residing in a community have for the antiretroviral therapy access and adherence in the "Servicio de Atención Integral a personas que viven con VIH" of San Cristobal de Las Casas.
En este texto se abordan algunas de las problemáticas en el acceso, por parte de los usuarios, a los cuidados en prevención/atención/control del VIH-sida del consultorio médico del Servicio de Atención Integral (SAI), perteneciente a una clínica de la Secretaría de Salud en San Cristóbal de Las Casas (Chiapas). En particular aquellas vinculadas con la discriminación, y concretamente la relacionada con la orientación sexual y el itinerario socio/cultural del usuario del SAI, en la relación médico-paciente-institución. Para ello analizo las representaciones sociales de los médicos del consultorio con respecto a las prácticas sexuales (y preventivas de VIH-sida) y a los modelos explicativos del trinomio salud/enfermedad/atención de los sujetos y colectivos destinatarios, y las praxis de cuidados en dicho consultorio.
HEALTH CARE, ADHERENCE TO ANTIRETROVIRAL THERAPY AND DISCRIMINATION.
Some issues in healh care for people living with HIV-aids, from an anthropological perspective
This text addresses some problems regarding access by users to HIV-AIDS prevention/care/control services at the medical office of Servicio de Atención Integral (SAI by its acronym in Spanish), pertaining to a Mexican Health Department clinic in San Cristóbal de Las Casas, Chiapas. It specifically focuses on discrimination-related issues, concretely regarding the user’s sexual orientation and socio-cultural trajectory through SAI, as well as the doctor-patient-institution relationship. The representations of the clinic’s doctors regarding sexual and HIV-AIDS preventive practices as well as the explicatory models of the health/disease/care triad of the subjects and collective recipients, and the clinic’s health care praxis are analyzed
A través de la narrativa de jóvenes y viejos, legos y expertos, podemos apreciar cierta convergencia de concepciones y prácticas que provienen de sistemas médicos diferentes. Algunos de ellos en el pasado, poseyeron cierta primacía, y de acuerdo a los más ancianos constituían la única opción. En la actualidad la pluralidad de voces y de perspectivas conlleva nuevos espacios donde pobladores de diferentes generaciones, junto a los representantes de la medicina oficial, ponen en juego en una trama de encuentros, diferencias o distancias culturales y sociales que otrora constituyeron barreras infranqueables
Complementary and alternative medicines (CAM) are popular amongst cancer patients in the Brazilian context, however little is known about oncology health professionals’ attitudes toward the role of CAM and their perspectives on the potential for integration into oncological care. In this study, drawing on a series of interviews with oncology professionals (i.e. doctors, nurses, nutritionists, pharmacologists and psychologists), we provide insight into their views on the rise, validity, and role of CAM in cancer care. The results reveal two key dynamics in relation to CAM in cancer care in Brazil. First, that doctors, nurses and other allied professionals hold considerably different views on the value and place of CAM, and in turn ascribe it varying levels of legitimacy potentially limiting integration. Second, that while some health professionals may articulate a degree of support for CAM, this is limited by perceptions of CAM as lacking efficacy and intruding on their respective jurisdictional claims. Further research is needed in the Brazilian context to explore patient and professional perspectives on experiences on CAM in cancer care, including how oncology professionals’ varying positions on CAM may influence what patients are prepared to use, or discuss, in the context of cancer care.
El presente artículo compendia el resultado de una investigación, llevada a cabo en el marco de la tesis doctoral del autor, sobre las praxis profesionales de mediación intercultural sanitaria que se desarrollan en la actualidad en Bélgica y España. Desde una perspectiva antropológica de carácter aplicado se abordan en él las particularidades más notables de dichas prácticas, en ambos países, proponiendo para el debate sus debilidades y fortalezas desde el punto de vista de su relevancia en la mejora en el acceso y disfrute de los cuidados sanitarios, institucionales, de las personas de origen extranjero
Cancer self-health programmes are a popular form of healthcare in the UK, Australia, and North America. This article explores how they bring together heterogeneous and possibly incommensurable modes of healthcare (including complementary and alternative medicine, self-help, psychotherapy, and systems theory from bioscience) to form programmes of self-health. Through a discourse analysis of four programmes – The Bristol Approach; Health Creation Programme; CANCERactive; and The Healing Journey – this article explore how these programmes promote: (1) Strategies to delineate spheres of living, such as mind, body, and spirit; (2) Relational practices such as holism, connectedness, listening, and healing; (3) Empirically pragmatic attitudes that individualise techniques and practices; and (4) Purposes to life that emphasise a dialogical movement between dichotomised positions. Significantly, through these strategies, techniques and practices cancer self-health programmes are able to promote an ethos that seeks to affect the user, without determining an individual's specific needs or choices.
Le programme " Des systèmes médicaux pluriels de recours non conventionnels pour les personnes atteintes de cancer " développé par une dizaine de chercheurs répartis sur cinq sites utilise une approche socio-anthropologique comparative entre trois pays (France, Belgique, Suisse). La notion de " non conventionnel ", ou celles utilisées couramment pour désigner les mêmes recours - médecine " douces ", " alternatives ", " parallèles", " holistiques ", " traditionnelles ", " non orthodoxes ", etc. - utilisent toutes des terminologies qui soulignent des oppositions bipolaires avec une référence et des normes. Ce système de référence se définit lui-même de " conventionnel ", d' "orthodoxe ", de " scientifique ", de " légitime " ou d' " officiel ", et qui peut être identifié comme agressif (par opposition à médecine douce) ou plutôt d'invasif, de parcellaire et de sectorisé (par opposition à une approche holistique du corps et de la personne), et dont les pratiques et les paradigmes jugés non satisfaisants sont source de recherche d'autres conceptions du corps (alternatives, parallèles).
Nas últimas décadas, terapias alternativas têm se tornado cada vez mais comuns entre a população geral em cidades industrializadas, embora sua aceitação como opções válidas no sistema de saúde ainda esteja em discussão. No entanto, na Cidade de Buenos Aires (Argentina), oficinas emergiram dentro de hospitais gerais que oferecem terapias alternativas / complementares, serviços associados e profissionais de saúde mental. A partir de um estudo qualitativo em dois hospitais públicos da Cidade Autônoma de Buenos Aires, vamos investigar as razões que dão origem a este fenômeno, destacando as formas de expressão que adquirem e a complexidade de um campo em construção.
Los resultados de esta investigación dilucidan algunas problemáticas que la cultura organizacional de cuidados médicos conlleva en el acceso y adherencia al tratamiento antirretroviral de las personas indígenas que viven con VIH-Sida en Los Altos de Chiapas desde un eje teórico centrado en la violencia estructural e institucional que opera a través de la discriminación por el origen étnico, la condición socioeconómica y ser portador del VIH-Sida.
Initially in favour of complementary and alternative medicine (CAM) and strongly opposed to orthodox medicine, Léa Simon entered medical school with reluctance then pursued private training to qualify in acupuncture before becoming a specialist in a teaching hospital. This atypical case draws our attention to the crucial role of medical studies and raises the issue of Dr Simon’s engagement in medicine despite her exclusive interest in CAM. Studying a single case allows for a deep analysis of two central processes behind an individual trajectory: professional self-fulfillment and the means for legitimating CAM. Using the methods of life narrative and action regimes, we reveal an itinerary composed of two regimes of engagement: the contradictory regime of medical studies and the coherent regime of the beginning of a professional career (first militant then adaptive). An analysis of Dr Simon’s system of values reveals the coexistence of humanist, pragmatic and ideological values. It also underlines the importance of the acupuncture medical identity she eventually found and the importance of care in this construction.
In recent decades an important social movement related to Complementary and Alternative Medicine has been identified worldwide. In Brazil, although homeopathy was recognized as a specialist medical area in 1980, few medical schools offer courses related to it. In a previous study, 176 resident doctors at the University of Campinas Medical School were interviewed and 86 (49%) rejected homeopathy as a subject in the core medical curriculum. Thus, this qualitative study was conducted to understand their reasons for refusing. 20 residents from 15 different specialist areas were interviewed. Very few of them admitted to a lack of knowledge for making a judgment about homeopathy; none of them made a conscientious objection to it; and the majority demonstrated prejudice, affirming that there is not enough scientific evidence to support homeopathy, defending their position based on personal opinion, limited clinical practice and on information circulated in the mass media. Finally, resident doctors' prejudices against homeopathy can be extended to practices other than allopathic medicine.
Sociological and anthropological analyses of hope in health-care contexts have tended to address institutional processes, especially the power dynamics that function through such systems or political economies of hope, which in turn shape interactions through which hopes are managed. This article extends this approach through a more detailed consideration of the experience of hoping itself. Our post-formal analysis denotes the tensions that are intrinsic and defining features of lifeworlds around hope, emphasising the dissonance and fragility of hoping. Drawing upon interview and observational data involving patients with advanced-cancer diagnoses who were taking part in clinical trials, we explore three main tensions which emerged within the analysis: tensions involving time and liminality between future and present; ontological tensions involving the concrete and the possible, the 'realistic' and the positive; and tensions in taken-for-grantedness between the reflective and the mundane, the specific and the ambiguous. Rather than three separate sets of tensions, those involving time, ontology and taken-for-grantedness are very much interwoven. In denoting the influence of social processes in engendering tensions, we bridge sociological and anthropological approaches with a more definition-oriented literature, developing understandings of hoping and its key characteristics in relation to other processes of coping amidst vulnerability and uncertainty.
Complementary and alternative medicine (CAM) is frequently used in cancer patients, often with contribution of the significant others (SOs), but without consultation of healthcare professionals. This research explored how cancer patients integrate and maintain CAM use in their everyday life, and how SOs are involved in it.
In this qualitative study, male participants were selected from a preceding Australian survey on CAM use in men with cancer (94 % response rate and 86 % consent rate for follow-up interview). Semistructured interviews were conducted with 26 men and 24 SOs until data saturation was reached. Interview transcripts were coded and analyzed thematically, thereby paying close attention to participants' language in use.
A major theme associated with high CAM use was "CAM routines and rituals," as it was identified that men with cancer practiced CAM as (1) functional routines, (2) meaningful rituals, and (3) mental/spiritual routines or/and rituals. Regular CAM use was associated with intrapersonal and interpersonal benefits: CAM routines provided men with certainty and control, and CAM rituals functioned for cancer patients and their SOs as a means to create meaning, thereby working to counter fear and uncertainty consequent upon a diagnosis of cancer. SOs contributed most to men's uptake and maintenance of dietary-based CAM in ritualistic form resulting in interpersonal bonding and enhanced closeness.
CAM routines and rituals constitute key elements in cancer patients' regular and satisfied CAM use, and they promote familial strengthening. Clinicians and physicians can convey these benefits to patient consultations, further promoting the safe and effective use of CAM.
The counselling and psychotherapy profession is undergoing considerable change as a result of government intervention in the form of regulation, funding and efficacy research. In this paper we argue that these changes, even though they challenge some of the basic ways of thinking which have come to underpin the profession since its inception, also offer an opportunity to stimulate debate and thought in regard to how the profession might contribute to the development of healthcare systems in the future. We argue that this could be enhanced if therapists can learn from the experience of practitioners in the field of complementary and alternative medicine (CAM), which has been experiencing similar changes in recent years. Indeed, both fields of clinical activity adopt many similar underlying clinical principles and, according to Samuels (2001), have similar political outlooks. With reference to anthroposophic psychotherapy which, as well as being a form of psychotherapy, is also part of a ‘whole systems’ approach to CAM, we will examine those characteristics of psychotherapy and CAM that can inform the thinking of healthcare systems as a whole.
Cancer is emerging as a key disease in India, but there has been virtually no research exploring understandings of cancer and practices of communication within oncology settings. This is despite the fact that the Indian context presents clinicians, patients, and family members with a range of unique challenges, including those related to disease awareness, interpersonal dynamics, and the use of traditional, complementary, and alternative medicines (TCAM). Drawing on a series of qualitative interviews with 22 Delhi-based oncology clinicians, in this article we examine clinicians' accounts of communication with their cancer patients. The interviews reveal the challenges of communication given cancer's relative novelty, cultural practices around collective negotiation, and rhetorical practices evident in advice-giving regarding TCAM. We conclude that with cancer set to become a major burden in India, research exploring competing forms of expertise, the politics of representation, and the nexus between traditional beliefs and techno-scientific development is urgently needed.
It has been argued that on-line networked communication can enable the establishment of ‘virtual communities’. Empirical data from an electronic discussion group for general medical practitioners (GPs) are used to evaluate these claims, and to explore the similarities and discrepancies between on-line and face-to-face interactions.
A distinct social order for this ‘community’ is reported, and the strategies to establish this order in a textual environment are discussed. Participants went through a cycle of integration into membership, and some generated distinctive virtual identities or personae. The notion of a ‘virtual community’ is critically discussed. Participants interacted as if they were part of a community, but it is suggested that the interactions on the list are best understood as extensions of the wider social relations of general practice. The study of virtual communities may thus have relevance for wider issues of social inclusion and citizenship. The paper also includes reflections on ‘cyberethnography’, and suggestions for further research are offered.
Educational interventions may ultimately impact on patient care as well as affecting individuals' learning. Critical evaluation of educational literature by those involved in designing and developing educational interventions is therefore important. A checklist instrument for critically appraising reports of educational interventions is described.
The instrument was developed by an iterative process and piloted. The instrument consists of nine questions: 1. Is there a clear question which the study seeks to answer? 2. Is there a clear learning need which the intervention seeks to address? 3. Is there a clear description of the educational context for the intervention? 4. Is the precise nature of the intervention clear? 5. Is the study design able to answer the question posed by the study? 6. Are the methods within the design capable of appropriately measuring the phenomena which the intervention ought to produce? 7. Are the outcomes chosen to evaluate the intervention appropriate? 8. Are there any other explanations of the results explored in the study? 9. Are any unanticipated outcomes explained? A worked example is given to illustrate how the instrument can be used in practice.
The Department of General Practice in Glasgow.
Young general practitioners and the Educational Journal Club.
The instrument was feasible.
The use of the checklist allows the reader to critically appraise reports of educational interventions and helps in the practice of evidence-based education.
This study describes and compares the pathological prognostic factors and surgeon assessment of stage of breast cancer of women living in affluent and deprived areas to assess whether clinical stage at presentation may explain the known poorer survival outcomes for deprived women.
A population-based review of the case records of 417 women with breast cancer was carried out.
No difference in pathological criteria was found between the 88% of women living in affluent and deprived areas for whom such data were available. Clinical assessment of the remaining 50 cases showed that women living in deprived areas were more likely to present with locally advanced or metastatic disease.
The poorer survival of women from deprived areas with breast cancer may be explained by more deprived women presenting with advanced cancers.
The quality of surgical information on the Internet is variable. Content variation limits the use of the Internet as a reliable and safe information source both for both health professionals and patients. Medical information is a particularly sensitive area. Incorrect or misleading information may lead to potentially dangerous health behaviour, patients reading information intended for health professionals may misunderstand information or may get wrong expectations regarding treatment options.
British Journal of Cancer (2002) 87, 479–480. doi:10.1038/sj.bjc.6600513 www.bjcancer.com
© 2002 Cancer Research UK
Interest in complementary and alternative medicine (CAM) continues to grow at an exponential rate despite the advances made by conventional medicine. Complementary and alternative medicine use is increasingly manifest across a wide range of health care settings, and is particularly prevalent in cancer and palliative care. In these arenas, patient groups and self-help organizations play a significant supportive role. There is evidence that they are a key informative and pragmatic resource in the provision of CAM services to patients. However, there is a significant paucity of research dealing with the functional aspects of these groups and the way in which they advocate, promote and supply CAM. In this paper we provide a critical review of the literature pertaining to themes around CAM provision and cancer care, and suggest that for a more complete picture of the field, the impact of group mediation of CAM needs to be addressed, and attention focused on the social and interactional dynamics that underpin these groups and organizations.
The aim of the study is to investigate associations between deprivation and self-reported social difficulties and psychological distress in cancer patients. A total of 304 men and 305 women (age range 18-88 years) with a range of cancer diagnoses and living in a socially diverse region (Carstairs and Morris index) completed the Hospital Anxiety and Depression Scale and the Social Difficulties Inventory. Univariate analyses of variance revealed statistically significant differences in reported social difficulties between groups (F (67, 576)=2.4, P<0.0001) with stage of disease (F (5, 576)=7.6, P<0.0001), age (F (2, 576)=4.8, P=0.009) and to a lesser extent deprivation (F (1, 576)=4.0, P=0.048) making significant contributions. Significantly more social difficulties were reported by less affluent patients with locally recurrent disease or 'survivors'. No other interactions were found. Significant differences in levels of reported psychological distress were found between groups (F (67, 575)=1.723, P=0.001) for stage of disease, sex and deprivation but no interactions observed. In conclusion, deprivation is associated with reported psychological distress and, to a lesser extent, social difficulties. Patients at particular risk cannot be identified with confidence by socio-demographic and clinical means supporting the recommendation from National Institute for Clinical Excellence for provision of psychosocial assessment for individual cancer patients.
Cost effectiveness data form a crucial part of the debate surrounding the integration of complementary treatments into the NHS. To our knowledge, studies of the cost effectiveness of complementary therapies in the United Kingdom have not previously been reviewed.
Objective:
To meet the increasing patient interest in complementary and alternative medicine (CAM), conventional physicians need to understand CAM, be willing to talk with their patients about CAM, and be open to recommending selected patients to appropriate CAM modalities. We aimed to raise physicians' awareness of, and initiate attitudinal changes towards CAM in the context of integrative medical practice. We developed and implemented a professional development program involving experiential learning and conceptual change teaching approaches.
Methods:
A randomized controlled study with a pre-post design in a large academic medical center. The 8-hour intervention used experiential and conceptual change educational approaches. Forty-eight cardiologists were randomized to participant and control groups. A questionnaire measured physicians' conceptions of, and attitudes to CAM, the likelihood of changing practice patterns, and the factors most important in influencing such changes. The questionnaire included an embedded control question on a topic that was not the focus of this program. We administered the questionnaire before (pretest) and after (posttest) the intervention. We compared differences in pre- and post-intervention scores between the participant (N = 20) and control (N = 16) groups. We used both groups to identify factors that influenced their practice patterns. The study was NIH-funded and IRB-exempt.
Results:
Both groups initially had little knowledge about, and negative attitudes to CAM. The participant group had significant positive changes in their conceptions about, and attitudes to CAM after the program, and significant improvements when compared with the control group. Participant physicians significantly increased in their willingness to integrate CAM in their practices. Physicians (combined groups) rated research evidence as the most important factor influencing their willingness to integrate CAM. They requested more research evidence for CAM efficacy, and more information on non-conventional pharmacology. Participants reflected enthusiasm for the experiential program.
Conclusions:
The participants were able to experience the positive effects of selected CAM modalities. It is possible to increase physician knowledge and change attitudes towards integrative medicine with an eight-hour intervention using experiential and conceptual change teaching approaches.
Practice implications:
Professional development on integrative medicine can be offered to medical practitioners using experiential learning and conceptual change teaching approaches, with the help of local CAM practitioners.
This paper uses two case studies to examine the scope for medical practitioners to utilize alternative forms of diagnosis and treatment. The first is a specific study of a medical practitioner who was deemed to have transgressed the boundaries of orthodox medicine. The second is a general case study which examines the possible effects of a new medical practitioners bill and the New Zealand health reforms. It is suggested that when the medical profession is faced with external threats it attempts to strengthen itself at the cost of limiting the autonomy of its membership.
The informed patient isn't always well-informed, as you've undoubtedly experienced. How can you enhance your relationship with patients who want to learn as much as they can about their health but are sometimes misled?
Medi-fraud remains a significant drain on the resources of the health system in Australia, despite the monitoring of doctor practices via Medicare. Federal and state governments have been unwilling to address the systemic causes of medi-fraud. However, the rise of managerialism and the consequent influence of economic rationalism over health policy is resulting in the medical system coming under scrutiny as hospital administrators search for cost containment. The required quantification of hospital practices and the introduction of competition principles into the public health sector have the potential to curtail medical autonomy and combat medi-fraud. Whilst such reforms may combat medi-fraud, they consequently may undermine the access and equity tenets of universal health insurance and result in the ultimate demise of Medicare itself.
The growth of complementary and alternative medicine (CAM) in the West entails complex geographies of health, identity and knowledge. Debates about why people are attracted to CAM highlight the importance of consumer agency and increasing access to health care information. The article explores a key space within which information on CAM is produced and negotiated: health and lifestyle magazines. Drawing upon interviews with the editors of eight British titles, the article outlines three ways in which CAM is discursively framed: as a pragmatic medical tool kit brought to bear on the diseased body; as a means of achieving 'total well-being' in everyday metropolitan space; and as a central pillar of an alternative lifestyle. The final section of the article considers how editors understand and address their predominantly female readerships, with an emphasis on how CAM is articulated within an ostensibly emancipatory project of self-responsibility and personal empowerment against the ambivalent backdrop of consumer culture.
In this paper I begin by discussing the reinforcement offered to ontological dualism by biomedicine. It then describes some parallels between the development of feminist health activism and that of professional, non-medically qualified homoeopathy, going on to ask whether alternative medicine can offer a ‘political’ challenge to ontological dualism. Three aspects of the feminist critique of biomedicine are discussed in relation to contemporary, feminist, homoeopathy. They include the power dynamics within the clinical encounter, the degree to which social and environmental issues are incorporated within medical diagnosis and treatment, and the manner in which the patient’s subjective experience is used during case-taking. I conclude that contemporary feminist homoeopathy does address the concerns relating to dualism and power raised by the health activists of second wave feminism; it therefore must be considered a ‘feminist’ form of medicine. However, its very success in this regard raises a new set of difficulties and tensions. Although holistic forms of medicine do have the potential to address the ontological dualism which is inherent to biomedicine, they may also increase the capacity practitioners have to construct and enforce normative forms of behaviour through their clinical practice. In addressing one set of feminist concerns relating to biomedicine, homoeopathic practice may actually intensify the dangers relating to a second set of feminist concerns.
To illustrate the importance of considering the researcher's written reflections on the qualitative research process as a valuable source of data and as a means of enhancing ethical and methodologic rigour.
Excerpts from the researcher's reflexive journal are presented as evidence of an audit trail. Ethical and methodologic concerns arising during the research process are outlined and the value of reflecting on these issues is addressed.
A hermeneutic-phenomenologic study, conducted in Scotland, included in-depth interviews with six problem drinkers to explore the lived experience of their suffering. The researcher was considered to be a primary data-collection tool, whose reflections on the research process added to the contextual richness of the study. For an interpretative approach to data analysis, the researcher found metaphors to convey the participants' stories to a new audience. This intuitive, creative process was analysed and reported in the reflexive journal.
The researcher's self-awareness, fostered by the use of a reflexive journal, is mirrored by the participants' ability to reflect on the final interpretation of their stories and on the therapeutic benefits of the research process. The researcher's reflexive journal reveals previously hidden contextual information which enhances the prime ethical and methodologic aim of the study—to understand the lived experience of suffering by problem drinkers.
This paper reports the findings of a study of nonconventional medicine in Israel. Data regarding patterns and correlates of consultations with alternative medicine practitioners were obtained from structured face-to-face interviews with a representative sample of 2030 Jewish adults aged 45 to 75. In addition, in-depth open-ended interviews were conducted with a convenience sample of 20 primary care physicians in order to explore their beliefs, attitudes and behaviors regarding nonconventional medicine. Six percent of the respondents interviewed in the population study visited an alternative practitioner in the year prior to the interview. For most of them, the consultation was a consequence of disappointment with the lack of success of conventional medical treatment. Most felt that the alternative medicine treatment had helped. Nearly 40% were seeing their regular primary care physician at the same time as they were seeing an alternative medical practitioner. Women were more likely than mean to consult an alternative medicine practitioner; consulters rated their health status more negatively than non-consulters. Consulters had a higher level of education than non-consulters, but the two groups did not differ in terms of age or economic status. Nearly all of the physicians stated that they refer patients to alternative practitioners; in most cases, the referrals are in response to patients' requests. Although skeptical of the scientific basis of alternative medicine therapies, most of the physicians believed that some therapies, even if only because of the "placebo effect", were effective in some cases. Almost all felt that the Ministry of Health, which today does not recognize any form of alternative medicine, should establish control over the training and practice of alternative medical practitioners. The findings from both parts of the study suggest that patients and primary care physicians in Israel do not view nonconventional medicine as a threat to conventional medicine, but rather as complementary to it.
Florence Nightingale lived at a time when allopathy and homeopathy were competing for dominance in medical care. Nightingale's philosophy of health and healing was more similar to the holistic philosophy of homeopathy than to the mechanistic philosophy of allopathy. Why, then, did Nightingale align organized nursing with allopathic medicine? Perhaps Nightingale, always the pragmatist, understood that allopathy would gain the dominant position in medicine. Perhaps aligning nursing with allopathy was a way to ensure the survival and legitimacy of nursing as a profession. Modern nursing can reconnect with Nightingale's holistic philosophy by preparing graduates conversant with holistic philosophy and by encouraging research that focuses on how the natural healing process is facilitated.
The information age, combining rapidly developing information technology and massive growth in biomedical and clinical data, is placing special demands on healthcare workers. Further, radical changes in access to information in our society are affecting the doctor-patient relationship. These changes necessitate a new approach to primary and continuing medical education. A number of imperatives for medical education are identified and some practical changes to a medical curriculum are described.
An estimated 60 million Americans use some from of complementary and alternative medicine, though approximately 70% do not tell their physicians about this use. Open communication between conventional medical providers and patients in this area is therefore lacking.
To explore the dynamics that could potentially contribute to communication breakdown between physicians and patients over the use of alternative therapies.
Mail-in, self-administered questionnaire.
96 practitioners in primary care and medical subspecialties representing the local county medical society, Stark county, Ohio.
Data were obtained on the following: (1) physicians' level of familiarity with 23 different alternative therapies, (2) the question of whether physicians used the therapies themselves, (3) physicians' assessment of the potential benefits and harm of each therapy, and (4) physicians' response to the prospect of their patients using these therapies.
Respondents reported the use of myriad alternative therapies. Only 28%, however, referred patients for alternative therapies. The physicians demonstrated clear preferences for specific therapies (i.e., when asked about benefits, familiarity, and reactions to patient use, they responded differently depending on the therapy). Indication that the doctor-patient relationship might be terminated as a result of alternative therapy use was more common among subspecialists than among primary care practitioners.
Overall, physicians demonstrated an open attitude toward alternative therapies. This finding indicates that patients should disclose their use of alternative therapies to their doctors. Increased referral to alternative healthcare providers may require both ongoing peer-reviewed studies of efficacy and increased physician access to information concerning therapies that have undergone definitive study.
Acupuncture gained considerable attention in anglophone countries in the 1970s. As part of that popularity many medical practitioners became interested in the therapy and learned acupuncture techniques. A number of studies have indicated that medical practitioners were able to take up the practice of acupuncture without threatening the cultural authority of medicine so long as they limited the scope of its practice and redefined acupuncture concepts in Western biomedical terms. These analyses tend to present the medical profession as monolithic and emphasize a dichotomous relationship between biomedicine and alternative therapies such as acupuncture. This study examines the ways in which acupuncture has been represented in different medical forums, suggesting that in order to understand the relationships between biomedicine and alternative medicine we need to be more aware of the changing nature of these representations and their dependency upon the context of the representation. Rather than emphasizing a duality between orthodox medicine and alternative medicine, it is argued here that there are pluralities of medical and healing worldviews.
Diary data enhancing rigour: analysis framework and verification tool
This paper outlines a stage-by-stage framework for the analysis of data obtained from qualitative semistructured diaries. As the framework for analysis was developed, it became apparent that the methodological problem of verifying the initial analysis, required serious consideration. The research literature available was found simply to identify the difficulty, but offered no solutions. Recognizing that trustworthiness is a hallmark of qualitative research, a data analysis verification tool (DAViT) was designed. This proved to be extremely effective in enhancing the trustworthiness of a qualitative study in a number of ways. The analysis framework and verification tool together offers an eclectic approach for qualitative diary data analysis. It is further advocated that they are amenable to the analysis and verification of qualitative data obtained from semistructured interviews.
The Standards of Holistic Nursing Practice were developed by the American Holistic Nurses Association (AHNA) as a public statement regarding the practice of holistic nursing as a specialty. This article reviews the development of the practice standards, and presents the philosophies and values which underpin holistic nursing. Certification in the speciality is awarded through the American's Holistic Nurses' Certification Corporation (AHNCC) to nurses able to demonstrate knowledge and skills described in the Standards. The relationship between holistic nursing practice and complementary and alternative modalities is discussed.
to examine predictors of use of complementary therapies reported by women who had also received standard medical treatment for early-stage breast cancer.
A volunteer sample of 231 black, Hispanic, and non-Hispanic white patients with early-stage breast cancer (diagnosed within the preceding year) reported their use of complementary therapies. We examined predictors of the use of each therapy from among a set of demographic and quality of life measures.
Most women reported using 1 complementary therapy or more, most commonly psychotherapy, support groups, meditation, and spiritual healing. Use of psychotherapy related to age, education, and elevated distress. Use of other complementary therapies was not related to distress. More black than Hispanic or non-Hispanic white patients used herbal therapies and spiritual healing. Use of complementary therapies did not relate to expectation of recurrence, dissatisfaction with medical care, or (among relevant patients) concerns about the consequences of chemotherapy.
Use of healing therapies that do not replace medical treatment should be viewed as attempts to increase potential benefit and not as signs of distress or dissatisfaction. Use of complementary therapies also varies across racial and ethnic groups.
Complementary and alternative medicine (CAM) teaching is limited in undergraduate medical curricula. Increasingly doctors are asked to advise on suitability of CAM therapies. This study evaluated whether early undergraduate CAM experience affected subsequent recognition and confidence in answering questions. Students with prior experience of CAM topics were more aware of CAM usage in later observed clinical practice. Students recognized the development of skills in critical evaluation but remained reluctant to advise patients about CAM therapies.
In summary, patients in both groups generally enjoyed their therapy and there were few possible adverse effects.
In recent years what can loosely be described as a sociology of complementary and alternative medicine (CAM) has begun to emerge. Although work has been conducted with lay therapists, orthodox practitioners, and consumers, overall, research in this area remains patchy and underdeveloped. Despite its role at the forefront of integration, the sociological study of the apparent affinity between nursing and CAM is virtually non-existent. This paper provides an exploratory analysis of how writers within the CAM nursing sub-world adopt a recourse to history (nostalgic and nostophobic referencing) as a strategy to authenticate the relationship between nursing and CAM and so facilitate continuing integration. A text analysis, of articles written on CAM in four nursing journals, was conducted. Eighty papers satisfied the inclusion criteria. Evidence is presented of the way in which writers attempt to authenticate integration of CAM through reference to its apparent interconnectedness with the historically grounded core of nursing values, and more specifically, with the key historical figure of the nurse Florence Nightingale (1820-1910). It is argued that these rhetorical strategies can be understood in the context of the need to engage in (primarily) intra-professional persuasion: to protect and develop the values of their nursing sub-world over alternatives. The findings are preliminary. Themes identified are illustrative of the potential offered by an analysis of nostalgic and nostophobic referencing in this context, and not a definitive account of it. Further research should examine individually produced texts from other sources, and documents produced by relevant professional bodies.
A comparative review of temazepam and zolpidem use in managing insomnia in the hospice patient was undertaken to determine whether treatment with temazepam is a more cost-effective approach for this patient population.
A MEDLINE search was conducted to identify pertinent literature, including clinical trials and reviews that involved temazepam or zolpidem. Published data was used as background information and provided in the discussion.
This retrospective analysis, conducted from June 2002 through November 2002, focused on the prescribing patterns of temazepam and zolpidem in our hospice practice setting. We examined the reasons for discontinuation of each agent, along with the frequency of therapeutic change from temazepam to zolpidem. The top 10 ICD-9 codes associated with each treatment modality were investigated to determine any prescribing patterns.
A total of 4,752 participants were prescribed either temazepam or zolpidem during this six-month period. Of the 4,065 patients prescribed temazepam 9.9 percent had the agent discontinued, whereas, 13.0 percent of those taking zolpidem (n = 687) terminated therapy. Reasons for discontinuation included change in dose, incomplete efficacy, change in patient status, adverse drug reaction, cultural/social issues and “other.” Analyses of prescribing patterns and the reasons for termination of each drug therapy were completed and compared with results found in the primary literature.
Due to the limited financial resources available for hospice care, our goal is to provide the most clinically appropriate and cost-effective agents for hospice patients. With the lack of data pertaining to the hospice patient, physicians often are faced with challenges in deciding the most appropriate therapy. They may prefer one agent over another based on current medical opinion rather than sound clinical evidence. After review of the primary literature and the prescribing patterns in our setting, there is currently no evidence in our patient population to support that zolpidem is superior to benzodiazepines for the treatment of insomnia.
Computers are potentially powerful tools for patient education. E-health, which refers to health services and information delivered through the Internet, is a growing phenomenon within the health-care field. We sought to describe computer use and interest in e-health resources among patients with head and neck cancer.
A questionnaire was administered to 207 patients with head and neck cancer attending oncology follow-up clinics at a single comprehensive cancer center.
Forty-eight percent had never used a computer; 43% used one more than once a week. E-health information had been sought by 31%. Likelihood to access e-health information increased with education and income but decreased with age (p < or = .05).
Many patients with head and neck cancer welcome information technology, but most prefer more traditional sources of information. Interventions to improve computer access and/or skills are largely undesired. Individuals seem to either embrace technology or not. In this respect, patients with head and neck cancer are similar to, rather than unique from, other patients with cancer.
There is increasing awareness of a need for rigorous research into complementary and alternative medicine, but as yet, limited guidance has been given to researchers, practitioners and students as to the range and scope of the various methodologies available and how existing methods can be modified for CAM research. This research methods series provides an outline of the main methods for researching CAM-related issues, including clinical trials, cross-sectional studies and qualitative methodologies. Drawing on the experiences of a range of experts in CAM research, each article in this series addresses the scope and strengths of a particular methodological approach. This series aims to convey the basis and objectives of particular methodologies within the context of CAM research, and thus, each paper will draw on actual examples of CAM research. It is intended to be of value both to inexperienced researchers and to those who are more experienced but are looking to broaden their range of knowledge. In this introduction, we outline some of the fundamental concepts for researching CAM, providing an overall sense of where each methodological approach outlined in this series fits in the 'order of things'. We outline different design strategies, the philosophical differences underpinning particular approaches to collecting data, and the issue of bias in research design and analysis.
Genetic science is making ever-expanding claims about the (mal)functioning of the body. The 'geneticisation' of health and medicine is extending from rare single gene conditions to more common multi-factorial disease, such as heart disease. The dominant behavioural and socio-spatial explanations of heart disease are now being challenged by genetic claims of deterministic biological causes. This paper builds an account of the transformation of heart disease in the new genetics era, by applying actor network theory (ANT) to the production of genetic knowledge of one aspect of heart disease-hypertension-within a medical genetics laboratory in Glasgow, Scotland. Using this approach, the paper shows that there is no straightforward geneticisation of heart disease. Instead, there is a contested, complex and uncertain understanding of heart disease as genetic, a product of the many people, technologies, natural elements and spaces involved in the network of genetic science knowledge making. The paper concludes that a 'critical' ANT could be developed that acknowledges the inherent unevenness of the network, and connects genetic and socio-spatial explanations of heart disease.
To review written resources disclosing reliable facts and knowledge in cancer complementary and alternative medicine (CAM).
Conventional and biomedical and complementary and alternative medicine journals, electronic media, full text databases, electronic resources, and newsletters.
Sources of CAM information are numerous. The inherent quality of this information fluctuates. High-quality sources of cancer CAM information are available and accessible for health care providers.
As the use of CAM therapies becomes more commonplace in consumer health care, it is critical that health care providers are cognizant of available sources of high-quality CAM facts and knowledge and possess the ability to discuss this information with colleagues and consumers in the scientific and lay communities.
Homeopathy is a popular but implausible form of medicine. Contrary to many claims by homeopaths, there is no conclusive evidence that highly dilute homeopathic remedies are different from placebos. The benefits that many patients experience after homeopathic treatment are therefore most probably due to nonspecific treatment effects. Contrary to widespread belief, homeopathy is not entirely devoid of risk. Thus, the proven benefits of highly dilute homeopathic remedies, beyond the beneficial effects of placebos, do not outweigh the potential for harm that this approach can cause.
There are numerous ethical issues that one must consider when developing a research project; however, much discussion about ethics in health research has focused on experimental studies such as clinical trials. As a result, there remains some ambiguity as to the ethical issues that need to be considered in health-related social research. This paper outlines a number of important ethical issues that CAM researchers should be aware of when developing, running and writing up social research. Maintaining high ethical standards is extremely important in social research as it protects participants and researchers, improves the quality of the data retrieved and ensures that future researchers will have access to participants within the community.
Cancer is the second leading cause of death in Pakistan. There is increasing evidence that patients are using a range of (biomedical and nonbiomedical) therapeutic options for cancer treatment. To date there has been no sociologically informed research into the engagement of cancer patients in Pakistan with available modalities. In this article, the authors present findings from the first such study. They purposively sampled 46 cancer patients from four hospitals in Lahore and conducted semistructured interviews with them. They argue that individuals are actively mediating therapeutic possibilities by drawing on, and at times being constrained by, personal, social, and cultural resources. It is the authors' contention that this can be conceptualized by an appreciation of individuals' active engagement with three temporally and spatially specific dimensions: structural and practical constraint; pragmatic experimentation; and cultural and religious affiliation. The negotiation (and varying power) of these dimensions is crucial to the process.