Content uploaded by İlkay Çulha
Author content
All content in this area was uploaded by İlkay Çulha on Jun 22, 2017
Content may be subject to copyright.
Content uploaded by İlkay Çulha
Author content
All content in this area was uploaded by İlkay Çulha on Jun 22, 2017
Content may be subject to copyright.
International Journal of Caring Sciences May– August 2016 Volume 9 | Issue 2| Page 603
www.internationaljournalofcaringsciences.org
Original Article
Complementary and Alternative Medicine (Cam) Use Among Turkish
Surgical Patients
Ilkay Culha, MSc
Research Assistant, Eskisehir Osmangazi University, Faculty of Health Science, Eskisehir, Turkey
Nedime Kosgeroglu, PhD
Professor, Eskisehir Osmangazi University, Faculty of Health Science, Eskisehir, Turkey
Aysun Türe, MSc
Lecturer, Eskisehir Osmangazi University, Faculty of Health Science, Eskisehir, Turkey
Ozlem Kersu, MSc
Anesthesia Intensive Care Nurse, Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir,
Turkey
Ayse Ayvazcık, MSc
Neurosurgery Intensive Care Nurse, Eskisehir Osmangazi University, Faculty of Medicine,
Eskisehir, Turkey
Correspondence: Ilkay Culha, Research Assistant, Eskisehir Osmangazi University, Faculty of Health
Science, Eskisehir,Turkey, e-mail: ilkayc.ilkay@gmail.com
Abstract
Background: The use of complementary and alternative medicine (CAM) in both Turkey and throughout the
world is on the increase among the general population.
Objectives: To determine the factors affecting use of and frequency use of CAM among Turkish surgical
patients.
Methodology: The research was carried out at surgical clinics with 276 patients between 1 July 2015-1 August
2015. Data were collected with a questionnaire containing socio-demographic information and CAM usage and
were evaluated by Pearson's chi-square test and Fisher's exact test.
Results: 67% of patients have been using some kinds of CAM. Green tea / herbal tea (31.5%), garlic (19.6%)
and ginger (16.3%) were the most herbal products. Praying (39.9%), massage (34.8%) and thermal water / spa
(26.1%) were the most alternative therapies. Reasons for using CAM were pain 44.6%), stress (32.6%) and also
8.7% of patients have used these methods to cope with the problem that requires surgery. Surgical patients have
beliefs that CAM methods could support medical treatment (42.8%) and cause physically relaxing (33.3%).
Sources of information about CAM were relatives/neighbors (57.2%), friends (36.6%) and TV / radio (36.6%)
respectively. There was found significant relationship between gender, profession, income level and having
chronic disease (p = 0.001; p = 0.012; p = 0.030; p = 0.041 respectively).
Conlusions: More than half of the patients in the study use CAM, nearly half of them think CAM could support
the medical treatment. Most sources of information are people around them.
Key words: complementary and alternative medicine, supportive treatment, herbal medicine, surgery patient
Introduction
Alternative medicine is defined as all types of
health treatments which take the place of medical
treatments but not accepted by modern bio-
medicine or treatments, while complementary
medicine is the treatment and care system which
is applied together with and in addition to
medical treatments (Muslu & Ozturk 2008).
Background
The National Centre for Complementary and
Alternative Medicine (NCCAM) has classified
CAM methods in five groups, as alternative
medical system treatments (acupuncture,
ayurveda), treatments of the mind and body
(meditation, relaxation, prayer), practices with a
biological foundation (herbal remedies),
International Journal of Caring Sciences May– August 2016 Volume 9 | Issue 2| Page 604
www.internationaljournalofcaringsciences.org
manipulative applications – practices which take
the body as their basis (hydrotherapy,
reflexology) and energy treatments (reiki) (NIH
2012). The use of CAM in both Turkey and
throughout the world is on the increase among
the general population, and it is generally used in
problems related to such arthritis, allergies,
tiredness, headaches, neck and back pain,
hypertension, diabetes, insomnia, and lung and
digestion problems (Ozcakır & Aydın 2007).
According to the 2007 National Health Statistics
report, it was stated that 4 adults out of every 10
(38.3%) in the USA had resorted to CAM
applications, and that herbal and natural
medicines was the most frequently used method
(Barnes et al. 2008). In general, the most
important reason why patients resort to CAM was
determined as being increasing the quality of life
by ensuring the control of the symptoms, in
chronically ill patients (Pal 2002). The vast
majority of the studies concerning the use of
CAM in Turkey are comprised of cancer patients
and between the years of 2001-2007 among
cancer patients in Turkey, as being, on average,
46.2% (Kav et al. 2008). In a study where the use
of CAM applications by surgical patients was
evaluated, it was determined that 57.4% of the
patients used any one of the CAM applications
while the most frequently used CAM form of
treatment was prayer (25.2%) (Wang et al. 2003).
Even if it is considered that the use of CAM
methods is natural and harmless, the interaction
between CAM applications and the existing
medical treatment and unfavourable aspects are
also mentioned (Can 2013). CAM methods have
side effects such as delaying or leaving or
refusing modern treatments, material and
spiritual losses, and the development of feelings
of hopelessness, depression and failure (Muslu &
Ozturk, 2008). The use of herbal medicines can
lead to an increase in morbidity rates caused by
physiological changes in surgical patients and the
use of multiple types of medications, in the pre-
operative period. The use of herbal medication
may cause clotting disorders and interact with the
medication given prior to the operation, resulting
in various complications such as myocardial
infarction, stroke, bleeding, extended or
insufficient narcosis, and rejection by the body in
organ transplants (Adusumilli et al. 2004;
Skinner & Rangasami 2002). The immune-
suppressive effects of certain herbs may give rise
both to a predisposition to surgical infections and
an increase in infections of the site of the wound.
Together with the increase in the use of CAM,
where patients do not notify health workers that
they have been using herbal products, where
health workers fail to question this, and where
they are not sufficiently informed of the effects
of these products, this can lead to serious
problems during the surgical process (Cay &
Korkmaz 2015). It is recommended that clinical
practices guidelines are prepared in connection
with this matter (Kumar et al. 2005).
Methodology
Design, Setting and Sample
This was a descriptive study which was carried
out at surgical clinics in an university hospital in
Eskisehir between 1 July 2015-1 August 2015.
276 patients, aged over 18 and who have been
admitted to urology, neurosurgery, ENT,
orthopedics, general, plastic, cardiac, vascular,
gynecology clinics and who were willing to
attend were included in the study. Those
undergoing emergency surgical procedures and
patients with cognitive impairment were
excluded from the study.
Instruments
The questionnaire used in the study was prepared
based on a literature search for the aim of
determining the types of CAM methods (herbal
products and alternative teraphies) used in
Turkey and other countries in the world. The
questionnaire included questions including socio-
demographics (age, gender, surgical procedure,
level of education, level of income, occupational
status etc.), current use of CAM methods, types
of CAM methods, reasons for using CAM and
sources of CAM information.
Data collection and procedures
CAM was described to the patients by
researchers and then data were collected by
researchers using face to face interviews with
patients and each meeting took 5-10 minutes.
Ethical consideration
Data were collected by face- to- face interview
method after obtaining informed and written
informed consent of patients. The protocol was
approved by Hospital Ethical Review Committee.
Data analyses
Data were analyzed by IBM SPSS (v. 21.0)
statistics package programme Pearson’s chi-
square test and Fisher’s exact test were used for
comparisons between users and non-users of
International Journal of Caring Sciences May– August 2016 Volume 9 | Issue 2| Page 605
www.internationaljournalofcaringsciences.org
CAM. p < 0.05 was accepted as statistical
significance.
Results
The participants ranged from 18-91, mean
50.55±16.60. 129 of the patients (46.7%) were
female, 211 (76.4%) were married, 80 (29%)
were housewives, 98 (35.5%) had completed
only primary education, 200 (72.5%) were part of
a nuclear family, 172 (62.3%) stated “equal to
income” level and 118 (42.8%) of the patients
had at least one chronic illness hypertension
(23.2%), diabetes (15.2%), COPD, asthma and
lung cancer (4.7%) and heart failure (3.6%).
(Table 1).
The CAM use status of the surgical patients
who took part in the study, according to some of
their characteristics, is given in Table 1. There is
a significant difference between the genders,
occupations and income levels, and whether they
suffer from a chronic illness, and their use of
CAM (X2=12.06, p=0.001; X2=16.364, p=0.012;
X2=7.040, p=0.030; X2=4.187, p=0.041,
respectively) (Table 1).
Table 1. Some sociodemographic characteristics and use of CAM
n(%)* CAM use
n(%) X2 ;p value
Age
18-30 15(16.5) 32(17.3)
0.99; 0.911
31-43 14(15.4) 22(11.9)
44-56 25(27.5) 58(31.4)
57-69 27(29.7) 55(29.7)
>70 10(11.0) 18(9.7)
Gender
Woman 29(31.9) 100(54.1) 12.06; 0.001
Man 62(68.1) 85(45.9)
Marital status
Married 69(75.9) 142(76.8) 0.000; 0.983
Single 22(24.2) 43(23.2)
Education
Literate-illiterate 9(9.8) 29(15.7)
6.210;0.286
Primary school 31(34.1) 67(36.2)
Secondary school 15(16.5) 27(14.6)
High school 25(27.5) 53(28.6)
University 11(12.1) 9(4.9)
Profession
Student 9(9.9) 18(9.7)
16.364; 0.012
Working(Public
servant, employee)
23(25.2) 32(17.3)
Retired 33(36.3) 44(23.8)
Self-employement 8(8.8) 14(7.6)
Housewife 13(14.3) 67(36.2)
Other (teacher etc.) 5(5.5) 10(5.4)
Income Levels
Less than income 28(30.8) 58(31.4)
7.040; 0.030 Equal to income 52(57.1) 120(64.9)
More than income 11(12.1) 7(3.8)
Chronic disease
Yes 31(34.1) 87(47.0) 4.187; 0.041
No 60(65.9) 98(53.0)
*n refers to patients who don’t use CAM
International Journal of Caring Sciences May– August 2016 Volume 9 | Issue 2| Page 606
www.internationaljournalofcaringsciences.org
Figure 1.Prevalance of reasons for CAM use
32,6%
16,3%
28,6%
44,6%
8,7%
12,3%
27,5%
8,7%
19,9%
17,8%
0,0% 5,0% 10,0%15,0%20,0%25,0%30,0%35,0%40,0%45,0%50,0%
Stress
Psychological problems
Sleep related problems
Pain
Cope with situation requiring surgery
Chronic dieases
Tiredness
Nausea and vomiting
Cold sore
Advice
Table 2. Prevalance of CAM methods
Herbal products* Other alternative therapies*
n % n %
Herbal tea/green tea 87 31.5 Massage 96 34.8
Garlic 54 19.6 Aromatherapy 12 4.3
Ginger 45 16.3 Cupping 24 8.7
Stinger 32 11.6 Relaxing exercises 36 13.0
Olive oil/almond oil 29 10.5 Breathing exercises 33 12.0
Aloe vera 11 4.0 Meditation-yoga and
acupuncture 0 0.0
Others (parsley, lemon, onion
juice, linseed, henna, cumin,
henna)
13 4.7
Praying/religious practices
110 39.9
Leech 23 8.3
Music 35 12.7
Thermal/spas 72 26.1
* Marked multiple options
International Journal of Caring Sciences May– August 2016 Volume 9 | Issue 2| Page 607
www.internationaljournalofcaringsciences.org
Figure 2.Prevalance of CAM use with type of surgical procedure
CAM use
67% (185) of the surgical patients who took part
in the study, had used CAM methods other than
medicinal treatment, at any period of their lives.
When the methods which had been used are
examined in detail, 7.2% of the patients had only
used herbal products, 16.3% had only used other
alternative treatment methods, and 43.5% had
used both. The herbal products used most by the
patients were green tea / herbal tea (31.5%),
garlic (19.6%) and ginger (16.3%), respectively,
while the alternative treatments used most by the
patients were praying (39.9%), massage (34.8%)
and thermal spas (26.1%) respectively (Table 2).
On the other hand the reasons for the use of
CAM methods by the patients were mostly pain
(44.6%) and stress (32.6%), while 8.7% of the
patients had used them in order to be able to deal
with the problem which required surgery (Figure
1). The CAM positions of the patients according
to the surgical clinics are shown in figure 2, these
methods were used most by the patients in the
plastic surgery clinic (85.0%) (Figure 2).
When the thoughts of the surgical patients
concerning the use of CAM were evaluated,
42.8% of the patients who took part in the study
believed that the herbal products / alternative
treatments could support the medication /
medical treatment, 33.3% said that they gave
them physical comfort and 31.9% said they made
them feel psychologically more comfortable,
while 17.0% found there to be no benefit from
these methods.
When the resources from which the surgical
patients obtained information related to CAM
methods were evaluated, these were found to be
relatives and neighbours (57.2%), the television /
radio (36.6%), friends (36.6%), the internet
(24.3%), written sources (11.6%) and health
workers (10.5%).
Discussion
This study has been carried out with the purpose
of determining the use by surgical patients of
complementary and alternative treatment
methods (CAM), and the factors which influence
this.
The ratio of CAM use among the surgical
patients in the study is 67%. Both higher (Akıncı
et al. 2011; Efe et al. 2012) and lower (Aksu et
al. 2008; Akyol et al. 2011; Ceylan et al. 2009;
Güven et al. 2013; Tokem et al. 2011) rates of
CAM use have been determined in studies, which
posses a different sample, and which have been
carried out on individuals with different illnesses,
in our country. In a scan of the literature, where
16 studies on the use of CAM were examined, it
is stated that the frequency of CAM use ranges
from 24-98% (Bebis et al. 2014). On the other
hand, when we look at studies carried out abroad,
in the study conducted by Wang et al. (2003), the
rates of CAM use among surgical patients were
found to be lower (57.4%) than in our study.
The CAM use position of the patients who took
part in our study vary according to their gender,
occupation, whether they suffer from chronic
illnesses, and their income level. CAM use is
more widespread among female patients than
among male patients. This may be influenced by
the fact that the majority of the women in our
study were housewives, and that they spend more
time with their environments and sources of mass
communication. There are other studies within
75,9%
75,0%
68,0%
44,4%
45,0%
75,0%
55,6%
85,0%
45,8%
0,0% 10,0% 20,0% 30,0% 40,0% 50,0% 60,0% 70,0% 80,0% 90,0%
Neurosurgery
General surgery
Ophthalmic surgery
Gynecology
ENT
Cardiovascular surgery
Orthopedics
Plastic surgery
Urology
International Journal of Caring Sciences May– August 2016 Volume 9 | Issue 2| Page 608
www.internationaljournalofcaringsciences.org
the literature which also state that the use of
herbal products among women is higher than
among men (Guven et al. 2013; Grauer et al.
2004; Loya et al. 2009; Mahomoodally &
Roumysa 2013; Tindle et al. 2005). A significant
relationship may also have been determined
between CAM use and occupations in our study,
again due to the high number of retired women.
In the literature it is stated that a high percentage
of patients with chronic illnesses preferred
alternative treatments (Ottom et al. 2006; Bell et
al. 2006; Miller et al. 2008). In contrast to
expectations, in our study, CAM use among those
without chronic illnesses was higher. It can be
said that the fact that the CAM use rates of
patients directed at chronic illnesses or their
existing problems was low, also influenced this.
In the study, the highest percentage of CAM use
was found among patients who expressed their
income levels as “balanced income and
expenditure”. The fact that the number of patients
at this income level was higher than the number
of patients at other income levels may have
influenced this result.
In the studies concerning the use of CAM
methods within the literature, the usage status of
herbal products and other alternative treatments
by individuals was evaluated. When CAM
methods are examined in detail in the study, the
percentage of patients who used only herbal
products (7.2%) is lower than those who used
only other alternative methods of treatment
(16.3%). The percentage of patients who used
only herbal products was quite low, while almost
half of those who use CAM (43.5%), used both
methods. In the other studies conducted in our
country, higher rates of herbal product use have
been determined when compared to our results
(Cay et al. 2015; Efe et al. 2012; Erdogan et al.
2012; Güven et al. 2013; Kurt et al. 2013; Sagkal
et al. 2013). Akyol et al. (2011) and Grauer et al.
(2004), on the other hand, state a higher
percentage of use of herbal products than our
study, but one that is lower than the other studies
(16.8%). The rates of use of herbal products in
the studies conducted abroad are also
considerably higher than the results reached in
our study (Adusumuli et al. 2004; Wood et al.
2003). In a systematic compilation where 24
studies directed at CAM use were examined, it
was stated that the method most used among the
CAM methods was herbal product support
(Posadzki et al. 2013).
In terms of the other alternative methods of
treatment in our study, the most prevalent are
prayer / religious practices (39.9%). Similar
results have also been found in the other studies
conducted in our country (Araz et al. 2007;
Erdogan et al. 2012; Erdogan et al. 2013). The
patients which took part in the study have not
stated the use of methods such as acupuncture,
meditation and yoga. Similarly, Karacan et al.
(2012) also determined just one person each who
perform reiki and yoga, in his study. While the
use of other alternative treatments such as
acupuncture, hypnosis, homeopathy (Adusumuli
et al. 2004; Posadzki et al. 2013), yoga, tai-chi
(NIH 2012), reflexology and massage (Posadzki
et al. 2013) abroad is lower than the use of herbal
products, there are instances where these are
selected by patients. Matters such as cultural
differences between countries and regions,
differences in the income levels of individuals, a
lack of knowledge on these methods, and ease of
reach of the methods are able to influence the
extensiveness of these methods.
In the study the patients have mostly used more
than one herbal product. The most frequently
used herbal products by the patients are Herbal
tea/green tea (31.5%), garlic (19.6%) and ginger
(16.3%), respectively.
In the other studies conducted in our country, the
most frequently used herbal products can be
listed as follows: garlic (Akyol et al. 2011;
Erdogan et al. 2013; Zerrin et al. 2012); parsley
(Erdogan et al. 2012), linden / sage (Akyol et al.
2011), mint, nigella (Erdogan et al. 2013),
stinging nettle (Aksu et al. 2008, Karacan et al.
2012, Kurt et al. 2013, Zerrin et al. 2012), ginger
(Zerrin et al. 2012), thyme (Cay et al. 2015). On
the other hand, in the studies conducted abroad,
the most frequently used herbal products are
products such as aloe vera (Adusumuli et al.
2004; Grauer et al. 2004), ginseng (Adusumuli et
al. 2004; Grauer et al. 2004; Skinner &
Rangasami 2002), garlic (Adusumuli et al. 2004;
Grauer et al. 2004; Skinner & Rangasami 2002;
Wood et al. 2004), echinacea, (Adusumuli et al.
2004; Grauer et al. 2004; Hodges & Kam 2002;
Skinner & Rangasami 2002; Wood et al. 2004),
and it can be said that the use of different herbs is
widespread in different cultures.
The reasons why the surgical patients who took
part in the study used CAM were mostly pain
(44.6%), stress (32.6%), sleeping problems
International Journal of Caring Sciences May– August 2016 Volume 9 | Issue 2| Page 609
www.internationaljournalofcaringsciences.org
(28.6%), and tiredness (27.5%), while only 8.7%
of the patients use these methods in order to be
able to deal with problems which require surgery.
In contrast to our study, there are also studies
which state that these methods are used mostly
for the treatment of the illness (Adusumuli et al.
2004; Efe et al. 2012; Guven et al. 2013; Akyol
et al. 2011; Karacan et al. 2012; Cay et al. 2015;
Zerrin et al. 2012). Apart from these, cancer
patients use CAM methods for the purposes such
as the supporting of their treatment, directed at
the side effects of the treatments and for
strengthening the immune system (Mutlu et al.
2013; Ozcelik & Fadıloglu 2009). The results
support the notion that individuals use CAM
applications in order to be able to deal with their
existing illnesses. When the thoughts of the
patients concerning the use of CA methods is
within the study are evaluated, while 42.8% of
the patients who took part in the study believed
that the herbal products / alternative treatments
could support the medication / medical treatment,
33.3% said that they gave them physical comfort
and 31.9% said they made them feel
psychologically more comfortable, and 17.0%
found there to be no benefit from these methods.
In the other studies which have been conducted,
it was determined that patients found CAM
methods to be beneficial (Erdogan et al. 2012;
Erdogan et al. 2013; Mahomoodally & Roumysa
2013) and that they resulted in the patients
feeling better (Erdogan et al.2012; Erdoğan et al.
2013).
It can be seen that the surgical patients who took
part in the study mostly acquired information
concerning CAM methods from their
environment (relatives and neighbours) and
through the media. When the other studies
conducted in our country are evaluated, it can be
seen that the close environment of the patients
are in first place among the sources of
information, and that the media and the internet
are the other sources where a high level of
information is acquired (Bicen et al.2012; Cay et
al. 2015; Efe et al. 2012; Erdogan et al. 2012;
Guven et al. 2013; Ottom et al. 2008). The
studies conducted abroad have reached similar
results, determining that patients mostly used
their close environment and the social media as
sources of information (Adusumuli et al. 2004;
Wood et al. 2003). While the results support our
study, the accuracy of the information obtained
from these sources is thought provoking. In
contrast with our study, there are also studies
which show that the sources of information for
CAM are individuals who suffer from similar
illnesses (Akyol et al. 2011; Ucan et al. 2007).
Conclusion
It has been determined that more than half of the
patients who took part in the study used CAM
methods, close to half believed that these
methods can be a support to the medical
treatment, and that the sources of information
concerning these methods were mostly the people
in the environment of the patients. A significant
relationship was determined between the position
of CAM use according to gender, occupation,
whether the patient is suffering from a chronic
illness and income levels.
Relevance to clinical practice
For the reason that there could be interactions
with the current treatment, anesthesia,
intraoperative and postoperative process
especially when using herbal products it's
essential that surgical patients should be asked
about CAM usage by surgical staffs especially
nurses. Furthermore there could be planned
training programs about CAM use for surgical
staffs and also for patients.
References
Adusumilli P.S., Ben-Porat L., Pereira M., Roesler D.
& Leitman I.M. (2003) The prevalence and
predictors of herbal medicine use in surgical
patients. Journal of the American College of
Surgeons 198: 583-590.
Akinci A.C., Zengin N., Yildiz H., Sener E. &
Gunaydin B. (2011) The complementary and
alternative medicine use among asthma and
chronic obstructive pulmonary disease patients in
the southern region of Turkey. International
Journal Nursing Practice 17: 571-582.
Aksu M.G., Bozcuk H.S. & Korcum A.F. (2011)
Effect of complementary and alternative medicine
during radiotherapy on radiation toxicity. Support
Care Cancer 16: 415-419.
Akyol A.D., Yildirim Y., Toker E. & Yavuz B. (2011)
The use of complementary and alternative
medicine among chronic renal failure patients.
Journal of Clinical Nursing 20: 1035-1043.
Araz A., Harlak H. & Mese G. (2007) Health
behaviors and alternative medicine use. TAF Prev
Med Bull 6:112-122.
Barnes P.M., Bloom B. & Nahin R.L. (2008)
Complementary and alternative medicine use
among adults and children. National Health
Statistics Reports 12: 1-6. Avaliable from:
http://www.methodesurrender.org/docs/art_nhsr_2
007.pdf
International Journal of Caring Sciences May– August 2016 Volume 9 | Issue 2| Page 610
www.internationaljournalofcaringsciences.org
Bebis H., Akpunar D., Coskun S. & Ozdemır S.
(2014) Patients using complementary and
alternative treatment for breast cancer: Systematic
review, HEAD 11: 6-14.
Bell R.A., Suerken C.K., Grzywacz J.G., Lang W.,
Quandt S.A. & Arcury, T.A. (2006) CAM use
among older adults age 65 or older with
hypertension in the United States: general use and
disease treatment. Journal of Alternative &
Complementary Medicine 12: 903-909.
Bicen C., Erdem E., Kaya C., Karatas A., Elver O. &
Akpolat A. (2012) Herbal product use in patients
with chronic kidney disease. Turkish Nephrology,
Dialysis and Transplantation Journal 21: 136-140.
Can G. (2013) Complementary approaches in breast
cancer: Non- pharmacological approaches.
Saglıkla Nursing Journal 13: 54-55.
Cay O. & Korkmaz F.D. (2015) Herbal product usage
among cardiovascular surgery patients, Izmir
University Medical Journal. 1: 20-28.
Ceylan S., Azal O., Taslipinar A et al. Complementary
and alternative medicine use among Turkish
diabetes patients. Complementary Therapies in
Medicine. 17: 78-83.
Efe D., Akca N.K., Kiper S., Aydın G. & Gümüs K.
(2012) Supportive methods used by the individuals
with hypertension to decrease blood pressure.
Spatula DD 2: 207-212.
Erdogan Z., Cınar S. & Simsek S. (2013) The
relationship between hopelessness level and the
use of complementary medicine methods in
hemodialysis patients. Spatula DD 3: 107-112.
Erdogan Z., Oguz S.& Erol E. (2012) Use of
Complementary Therapies in the Patients with
Heart Disease. Spatula DD 2: 135-139.
Güven S.D., Muz G., Ertürk N.E.& Özcan A. (2013)
Hipertansiyonlu bireylerde tamamlayıcı ve
alternatif tedavi kullanma durumu. Balıkesir
Sağlık Bilimleri Dergisi 1:160-166.
Grauer R.P., Thomas R.D., Tronson M.D., Heard
G.C.& Diacon M. (2004) Preoperative use of
herbal medicines and vitamin supplements.
Anaesthesia and intensive care 32: 173.
Hodges P.J.& Kam P.C.A. (2002) The peri‐operative
implications of herbal medicines. Anaesthesia 57:
889-899.
Karacan Y., Akkuş Y., Akdemir N., Göker H., Aksu,
S., Sucak, G. A et al. (2012) The Use of
Complementary and Alternative Medicine by the
Stem Cell Transplantation Patients. Uludag
Medical Journal 38: 1-6.
Kav S., Hanoğlu Z., Algıer L. (2008) Use of
Complementary and Alternative Medicine by
Cancer Patients in Turkey: A Literature Review.
International Journal of Hematology and Oncology
18: 32-38.
Kumar N.B, Allen K. & Bell H. (2005) Perioperative
herbal supplement use in cancer patients: potential
implications and recommendations for presurgical
screening. Cancer control: Journal of the Moffitt
Cancer Center 12: 149-157.
Kurt H., Keskek S.O., Cil T. & Canataroglu A.(2013)
Complementary/alternative therapies in patients
with breast cancer. Turkish Journal Of Oncology
28: 10-15.
Loya A.M., González-Stuart A. & Rivera J.O. (2009)
Prevalence of polypharmacy, polyherbacy,
nutritional supplement use and potential product
interactions among older adults living on the
United States-Mexico border. Drugs & aging 26:
423-436.
Miller M.F., Bellizzi K.M., Sufian M., Ambs A.H.,
Goldstein M.S. & Ballard-Barbash R. (2008)
Dietary supplement use in individuals living with
cancer and other chronic conditions: a population-
based study. Journal of the American Dietetic
Association 108: 483-494.
Mahomoodally M.F. & Roumysa B. (2013)
Associations between the use of herbal therapy and
sociodemographic factors. Spatula DD-Peer
Reviewed Journal on Complementary Medicine
and Drug Discovery 3: 59-68.
Muslu K.G. & Oztürk C. (2008) Complementary and
alternative treatments and their practice in
children. Pediatric Health and Disease Journal 51:
62-67.
NIH. Complementary, Alternative, or Integrative
Health: What’s In a Name? (2012) Available from:
https://nccih.nih.gov/health/integrative-health
Mutlu H., Akca Z., Cihan Y.B., Aslan T., Erden A. &
Büyükcelik A. (2013) Alteration of
Complementary and Alternative Medicine Usage
in Patients with Cancer in Turkey. Medicine
Science 2: 757-759.
Otoom S.A., Al-Safi S.A., Kerem Z.K. & Alkofahi A.
(2006) The use of medicinal herbs by diabetic
Jordanian patients. Journal of herbal
pharmacotherapy 6: 31-41.
Ozcakir A. & Aydin S. (2007)
Complementary/alternative medicine use in
primary care. Research Journal of Medical
Sciences 1: 21-25.
Ozcelik H. & Fadıloglu C. (2009) Reasons for use of
complementary and alternative medicine in cancer
patients. Turkish Oncology Nursing 24: 48-52.
Pal S.K. (2002) Use of alternative cancer medicine in
India. The Lancet Oncology 3: 394-395.
Posadzki P., Watson L.K., Alotaibi A. & Ernst E.
(2013) Prevalence of use of complementary and
alternative medicine (CAM) by patients/consumers
in the UK: systematic review of surveys. Clinical
Medicine 13: 126-131.
Sagkal T., Demiral S., Odabas H., Altunok E. &
Tarihi K. (2013) Complementary and Alternative
Treatment Methods Among Elderly Individuals in
Living Rural Setting. Fırat University Health
Science Journal 27: 13-26.
International Journal of Caring Sciences May– August 2016 Volume 9 | Issue 2| Page 611
www.internationaljournalofcaringsciences.org
Skinner C.M. & Rangasami J. (2002) Preoperative use
of herbal medicines: a patient survey. British
Journal of Anaesthesia 89: 792-795.
Tindle H.A., Davis R.B., Phillips R.S. & Eisenberg
D.M. (2005) Trends in use of complementary and
alternative medicine by US adults: 1997-2002.
Alternative therapies in health and medicine 11:
42.
Tokem Y., Aytemur Z.A., Yildirim Y. & Fadiloglu C.
(2011) Investigation into the use of
complementary and alternative medicine and
affecting factors in Turkish asthmatic patients.
Journal of Clinical Nursing 21: 698-707.
Ucan O., Ovayolu N. & Pehlivan S. (2007)
Complementary and Alternative Medicine
Methods in Chronic Renal Failure. Health and
Society Journal 3: 56-60.
Wang S.M., Caldwell-Andrews A.A. & Kain Z.N.
(2003) The use complementary and alternative
medicines by surgical patients: a follow-up survey
study. Anesthesia & Analgesia 97: 1010-1015.
Wood M.J., Stewart R.L., Merry H., Johnstone D.E. &
Cox J.L. (2003) Use of complementary and
alternative medical therapies in patients with
cardiovascular disease. American heart journal
145: 806-312.
Zerrin G., Alev, Y. & Murat K. (2012) Using of herbal
product in patients. Journal of Clinical and
Analytical Medicine 3: 300-312.
Reproduced with permission of the copyright owner. Further reproduction prohibited without
permission.