ArticlePDF Available

Is a Biopsychosocial–Spiritual Approach Relevant to Cancer Treatment? A Study of Patients and Oncology Staff Members on Issues of Complementary Medicine and Spirituality

Authors:

Abstract and Figures

Complementary and alternative medicine (CAM) is increasingly being used by patients with cancer. Our aim is to compare the attitudes of cancer patients who use CAM to those of nonusers, on issues of CAM, biopsychosocial considerations, and spiritual needs. Questionnaires were administered to patients and medical care providers in a tertiary teaching hospital with a comprehensive cancer center. Forty-nine percent of the study patients reported integrating CAM into their conventional care. Health care providers considered psychological and spiritual needs as major reasons for CAM use, while patients considered the familial-social aspect to be more important. Cancer patients do not correlate CAM use with spiritual concerns but expect their physicians to attend to spiritual themes. Health care providers involved in oncology cancer care should emphasize spiritual as well as CAM themes. The integration of these themes into a biopsychosocial-spiritual approach may enrich the dialogue between patients and health providers.
Content may be subject to copyright.
Support Care Cancer (2006) 14: 147152
DOI 10.1007/s00520-005-0866-8
ORIGINAL ARTICLE
Eran Ben-Arye
Gil Bar-Sela
Moshe Frenkel
Abraham Kuten
Doron Hermoni
Received: 4 April 2005
Accepted: 29 June 2005
Published online: 16 August 2005
# Springer-Verlag 2005
Is a biopsychosocialspiritual approach
relevant to cancer treatment? A study
of patients and oncology staff members
on issues of complementary medicine
and spirituality
Abstract Background: Comple-
mentary and alternative medicine
(CAM) is increasingly being used by
patients with cancer. Objectives: Our
aim is to compare the attitudes of
cancer patients who use CAM to
those of nonusers, on issues of CAM,
biopsychosocial considerations, and
spiritual needs. Methods: Question-
naires were administered to patients
and medical care providers in a
tertiary teaching hospital with a
comprehensive cancer center.
Results: Forty-nine percent of the
study patients reported integrating
CAM into their conventional care.
Health care providers considered
psychological and spiritual needs as
major reasons for CAM use, while
patients considered the familialsocial
aspect to be more important.
Conclusions: Cancer patients do not
correlate CAM use with spiritual
concerns but expect their physicians
to attend to spiritual themes. Health
care providers involved in oncology
cancer care should emphasize spiri-
tual as well as CAM themes. The
integration of these themes into a
biopsychosocialspiritual approach
may enrich the dialogue between
patients and health providers.
Keywords Biopsychosocial model
.
Cancer
.
Complementary alternative
medicine (CAM)
.
Patientdoctor
relationship
.
Spiritual well-being
.
Spirituality
Background
Complementary and alternative medicine (CAM) is de-
fined by the Cochrane Complementary Medicine Field
Group as practices outside the domain of mainstream
medicine that complement it by contributing to a com-
mon whole, satisfying a demand not met by conventional
practices and diversifying the conceptual framework of
medicine [1].
CAM is increasingly being used by patients with cancer
in rates exceeding 30% and up to 83% [26]. CAM use for
cancer treatment is more prevalent among women and is
associated with younger age, higher education and socio-
economic status, advanced disease, active coping behavior,
and a change in life outlook and beliefs since the diagnosis
of cancer [3, 713]. Recent CAM use may as well be as-
sociated with greater psychosocial distress and a worse
quality of life [14]. In most cases, CAM users do not ex-
E. Ben-Arye
.
M. Frenkel
.
D. Hermoni
The Complementary and Traditional
Medicine Unit,
Department of Family Medicine,
Faculty of Medicine,
Technion-Israel Institute
of Technology,
Haifa, Israel
G. Bar-Sela
.
A. Kuten
Department of Oncology,
Rambam Medical Center and Faculty
of Medicine,
Technion-Israel Institute
of Technology,
Haifa, Israel
M. Frenkel
CAM Education Project,
Department of Family Medicine,
University of Texas,
Galveston, TX, USA
E. Ben-Arye (*)
Complementary and Traditional
Medicine Unit,
Department of Family Medicine,
Clalit Health Services,
6 Hasahaf Street,
Haifa, 35013, Israel
e-mail: eranben@netvision.net.il
Tel.: +972-52-8709282
Fax: +972-4-8513059
press disappointment or dissatisfaction with conventional
medicine but hope to do everything possible to regain
health, to gain more control in decision making, and to
improve the quality of life [3, 5, 7, 9, 12, 1517].
During the last two decades, cancer care has been chal-
lenged with a call for a more patient-centered and holistic
view, as suggested by the biopsychosocial model of Engel
[18] and themes of patient centeredness [19], mindfulness
[20], psychoneuroimmunology [21], and salutogenesis [22].
Cassileth and Vickers [23] proposed the term integrative
oncology, a synthesis of the best of cancer treatment and
evidence-based, supportive complementary modalities that
effectively relieve many of the physical and emotional
symptoms that cancer patients experience. Nowadays,
cancer treatment not only emphasizes biomedical aspects
but also relates to issues of quality of life and spirituality,
especially in palliative care [24]. Spiritual well-being, de-
fined by McClain et al. [25] as a sense of meaning and
purpose in life, faith, and comfort with existential con-
cerns, is increasingly being acknowledged as an important
element in assessing the quality of life of terminally ill
patients. Increased psychological and spiritual well-being
was found to be related to reduced feelings of anxiety and
hopelessness and increased coping with illness in patients
with advanced cancer [26].
The increased use of CAM treatments by patients with
cancer and the emerging acknowledgement of spirituality
in cancer management raise a number of questions: Is
CAM use for cancer treatment associated with a quest for
more holisticspiritual dimensions? Do patients and med-
ical practitioners share the same attitudes toward these
dimensions? How relevant is the biopsychosocialspiritual
model in communicating with patients with cancer?
In order to address these questions, we conducted a
study in the largest oncology center in northern Israel.
Study design and methods
Study site and participants
This study was conducted in a tertiary teaching hospital
with a comprehensive cancer center. The sampling frame
included patients older than 18 years of age who were ad-
mitted for chemotherapy or radiation treatment (group A)
and medical care providers (oncologists and nurses) from
the oncology department (group B). Patients and care pro-
viders were recruited between April 2002 and November
2003. The study protocol was approved by the local Hel-
sinki committee.
Study design
Participants from both groups were asked to complete a
questionnaire addressing issues of CAM use and cancer
management. The questionnaire was based on prior ques-
tionnaires developed by the Complementary and Tradi-
tional Medicine Unit for both patients and conventional
therapists [27].
CAM treatment is defined as therapy not offered by
conventional medicine and is one or more of the following
treatments: folk and traditional medicine, medicinal herbs,
Chinese medicine (including acupuncture), homeopathy,
nutritional therapy (nutritional supplements and diets specif-
ically designed for cancer treatment), mindbody techniques
(meditation, guided imagery, and relaxation), therapeutic
touch (massage, shiatsu, and reflexology), movement and
manipulation therapies (chiropractic, yoga, and Alexander and
Feldenkrais methods), and anthroposophical medicine.
Spirituality was defined in accordance with McClain et
al.s definition as a sense of meaning and purpose in life,
faith, and comfort with existential concerns. The authors
simplified this definition, adjusting it to local Israeli con-
text as Discuss spiritual aspects (meaning of disease, life,
and death and making a mindful decision in choosing
treatment).
Analysis
Data analysis was performed using the SPSS statistical
package. For sample size calculation, we assumed that the
cancer patients using CAM make up 40% (based on a pre-
vious unpublished survey). In order to estimate this pro-
portion with a 95% confidence interval and a 7% sampling
error, about 200 patients were required.
The relationships between CAM users and nonusers
and categorical variables, such as gender and ethnicity,
were examined using chi-square test. Statistical signifi-
cance was set at α=0.05. A comparison of continuous
variables between CAM users and nonusers was done
using t test.
Results
Questionnaires were offered to 220 patients and 60 staff
members of the Department of Oncology at the Rambam
Medical Center (Haifa, Israel). Data from 203 patients (group
A) and 48 health care providers (group B, 18 physicians and
30 nurses) were available for statistical analysis.
Of the 203 patients in group A, 138 (72%) were wo-
men and 53 (28%) were men (mean age 55.8 years [SD
13.2]). The mean number of years of education was 13.9
years (SD 2.8). Ninety-nine (49%) participants reported
current or past use of CAM for cancer treatment. The
most often practiced CAM modalities were nutritional
therapy (20.5%), medicinal herbs (19.5%), mindbody
techniques (13.8%), traditional Chinese medicine (11.3%),
homeopathy (10.3%), therapeutic touch (9.7%), and folk
and traditional medicine (8.2%).
148
A secondary analysis, which compared the attitudes of
CAM users (N=99) to those of nonusers (N=104), was
performed within group A. CAM users differed signifi-
cantly in age (mean age 53 years [SD 12.6] vs. 58 years
[SD 13.4]; t test, p=0.012) and sex (71 female users vs. 65
nonusers; chi-square test, p=0.043). No significant differ-
ence was noticed in educational level (p=0.268). When
asked why patients with cancer turn to CAM (Table 1),
significantly more users than nonusers desired to improve
quality of life (57 users [60% of responses] vs. 35 nonusers
[36.1%]; chi-square test, p=0.001) and to seek for a more
holistic treatment (37 users [38.9%] vs.. 21 nonusers
[21.6%]; chi-square test, p=0.009). No difference was
found in attributing disappointment with conventional
medicine as an important consideration (13.7 vs. 10.3% of
responses; chi-square test, p=0.472).
Table 2 illustrates participants attitudes toward the
relative importance of four components in cancer care:
biomedical (surgery, chemotherapy, and radiation), psycho-
logical, familialsocial (including occupational aspects), and
CAM. CAM users considered CAM as a relatively more
important component in cancer care than nonusers (mean
15.4% [SD 12.3] vs. 9.3% [SD 10.3]; t test, p<0.001).
More than nonusers, CAM users reported either in-
itiating a talk about CAM with their practitioners (49 users
[51%] vs. 22 nonusers [21.6%]; chi-square test, p<0.001)
or being asked about it (20 users [20.8%] vs. 6 nonusers
[5.9%]; chi-square test, p=0.002).
A second set of analyses was made in which attitudes of
participants in group A (patients) were compared to those
of group B (staff members). Table 1 shows that, more than
group A, group B attributed CAM use by cancer patients to
addressing psychological distress (37.5% of responses in
group B vs. 21.1% responses in group A; chi-square test,
p=0.018) and spiritual/religious aspects (20.8 vs. 4.1%;
chi-square test, p<0.001). Group B participants attributed
Table 1 Why do you think patients with cancer address CAM?
Statement Group A (patients)
(N=203; %)
Group B
(staff members)
(N=48; %)
CAM users (N=99) Nonusers (N=104) Both (N=203)
To do everything
to cure cancer
85 83 84 79
To improve quality
of life
60* 36 48 42
Consider CAM as safer and less toxic 26 30 28 35
To address
psychological
distress
22 19 21 37**
To address spiritual
or religious aspects
4 4 4 21*
Disappointed with conventional
medicine
13.7 10.3 12 48*
To look for a more holistic treatment 39* 21.6
*p<0.01
**p<0.05
Table 2 What is the relative importance of each of the four components in cancer treatment?
Component Group A (patients)
(N=203; %)
Group B
(staff members)
(N=48; %)
CAM users (N=99) Nonusers (N=104) Both (N=203)
Biomedical (surgery, chemotherapy, and
radiation)
55.8 57.3 56.5 47.3*
Psychological 19.7 21.7 20.6 23.8
Familialsocial
(including
occupational aspects)
9.8 11.7 10.7 17.2*
CAM 15.5* 9.3 12.5 13.5
*p<0.01
149
significantly more CAM use to disappointment with con-
ventional medicine (47.9 vs. 11 .9%; chi-square te st,
p<0.001). Table 2 shows that participants in group B con-
sidered addressing familysocial aspects in cancer care as
relatively more important than did group A (mean 17.2%
[SD 7.4] vs. 10.7% [SD 10.5]; t test, p<0.001) and bio-
medical components as relatively less so (mean 47.3% [SD
17.6] vs. 9.3% [SD 56.5]; t test, p=0.004).
Figure 1 illustrates the attitudes of participants from both
groups to the following question: During a 10-min phy-
sician consultation with a patient with cancer, what pro-
portion of time should be spent on each of the following
topics? Patients (group A) considered as relatively more
significant a discussion on spiritual aspects, such as the
meaning of disease, life, and death and a mindful decision
on choosing treatments (group A mean 18.2% [SD 13.3]
vs. group B mean 12% [SD 9.2]; t test, p=0.007). On the
other hand, staff members (group B) ascribed importance
to asking patients about their condition in general (group A
mean 23.6% [SD 14.9] vs. group B mean 30.3% [SD 16];
t test, p=0.011) and explaining the technical issues of
treatment (mean 22.4% [SD 13.1] vs. 27.7% [SD 11.3];
t test, p=0.017). No difference was found between the two
groups on the importance of addressing quality-of-life is-
sues and discussing laboratory and imaging results.
Discussion
In this study, the authors examined the patients attitudes
toward psychosocial aspects, spiritual beliefs, and CAM
use related to cancer care. It was hypothesized that CAM
and spiritual issues may share common features. Indeed,
certain CAM modalities refer to spirituality as part of a
holistic conceptualization of the individual [ 28]. Oriental
philosophies such as traditional Chinese, Tibetan, and
Ayurvedic (Indian) medicine perceive health as a harmo-
nious equilibrium between fundamental elements that
coresponds to physical, emotional, and spiritual mani-
festations in humans [29]. Western modalities such as
homeopathy and anthroposophical medicine extend the
biomedical paradigm and view health and disease as
related either to life force (vital force) [30]ortothe
complexity of body, mind, and soul [31].
In this report, a possible connection between CAM use
and spirituality was explored. The results of the study sup-
ported findings from previous studies showing that CAM
use is common among patients with cancer. The authors
compared the attitudes of patients who use CAM to those
of nonusers and found no direct association between CAM
use and a search for spiritual needs. When asked why a
patient with cancer seeks CAM, CAM users pointed to
more a holistic treatment and quality-of-life aspects. This
emphasis on holism does not necessarily mean that CAM
use better addresses spiritual needs, but it testifies to a
yearning for a broader context in healing.
A comparison of staff members and patients attitudes
showed that psychological and spiritual needs and disap-
pointment with conventional medicine were ranked higher
by the former as reasons for cancer patients to turn to CAM
(Table 1). Moreover, staff members ranked relatively high-
er the familialsocial aspect in cancer care and ranked rel-
atively lower the importance of biomedicine (Table 2).
These results indicated that staff members were highly
aware of psychosocial aspects in cancer care. However,
when their attitudes were compared to those of the patients
on the question of how time should be spent during a 10-
min consultation, staff members wished to spend less time
on spiritual issues than did patients (Fig. 1).
Fig. 1 During a 10-min physi-
cian consultation with a patient
with cancer, how much time
should be spent on each
of the following topics,
proportionally?
150
What is the meaning of these results? How can staff
members genera l awareness of psychoso cial themes be
settled with their tendency to assign relatively less time to
spiritual issues in a medical consultation? Future research
is warranted to examine the perceptions of staff members
when considering the importance of discussing spiritual
issues during a medical encounter. Further, they may be
asked who the preferred therapist is in relating to these
topicsneed it be a staff member (physician, nurse, or
social worker) or therapists outside the mainstream do-
main, such as CAM practitioners. Moreover, future studies
may illuminate patients expectations on relating to spir-
itual themes, comparing them to their oncologists aware-
ness or willingness to do so. Successive research may study
a possible role for CAM in allowing patients and medical
care providers to openly discuss themes of meaningfulness,
self-awareness, and spirituality.
This study has various limitations. It used data from
a combined group of physicians and nurses. It may be
claimed that patients attitudes should not be compared
to a unanimous oncology team but to physicians and
nurses separately. Studies in Norway and the USA il-
lustrated differences in the attitudes of oncologists and
oncology nurses toward CAM [32, 33]. However, our
understanding was that daily work in the oncology de-
partment is characterized by team work and that phy-
sicians and nurses alike are identified as therapists from
the patients point of view. This view is supported by a
study conducted in Israel, which found that patients with
cancer had high expectations of communication skills
from both oncologists and oncology nurses [34].
Another limitation is the small and nonhomogenous
sample of patients recruited to the study. The inclusion
criteria did not address issues of cancer type and stage of
disease. Demographics did not assess the type and depth of
religion or other spiritual domains. The association be-
tween CAM and spirituality was not thoroughly examined.
Attitudes of patients and staff members toward the meaning
of spirituality were not addressed in depth.
The authors hope that this study enables a preliminary
understanding of the issues of CAM use and the signif-
icance of acknowledging spiritual issues in cancer c are.
We believe that this study supports the need f or acquiring
a biopsychosocialspiritual attitude in cancer care that will
relate to the developing field of complementary medicine.
Conclusions
This study suggests that patients with cancer do not
correlate CAM use with spiritual concerns but expect their
physicians to attend to spiritual themes. Nonetheless, the
patients health providers view spiritual themes as an im-
portant reason for CAM use. The authors propose that
health care providers relate more to spiritual and CAM
issues during medical discussions. The integration of these
themes into a biopsychosocial spiritual approach may en-
rich the dialogue between patients and health providers.
Acknowledgements The authors thanks Ms. Yael Bruno for
conceptualizing the themes of spirituality and CAM and for editing
the text; Ms. Idit Lavi for statistical design and workup; and Mrs.
Myrna Perlmutter for her help in the preparation of this paper.
References
1. Ernst E, Resch K, Mills S et al (1995)
Complementary medicinea defini-
tion. Br J Gen Pract 45:506
2. Ernst E, Cassileth BR (1998) The
prevalence of complementary/alterna-
tive medicine in cancer. Cancer
83:777782
3. Fernandez CV, Stutzer CA,
MacWilliam L et al (1998) Alternative
and complementary use in pediatric
oncology patients in British Columbia:
prevalence and reasons for use and
nonuse. J Clin Oncol 16:12791286
4. Kao GD, Devine P (2000) Use of
complementary health practices by
prostate carcinoma patients undergoing
radiation therapy. Cancer 88:615619
5. Richardson MA, Sanders T, Palmer L
et al (2000) Complementary/alternative
medicine in a comprehensive cancer
center and the implications for oncol-
ogy. J Clin Oncol 18:25052514
6. Wyatt GK, Friedman LL, Given CW
et al (1999) Complementary therapy
use among older cancer therapy.
Cancer Pract 7:136144
7. Alferi SM, Antoni MH, Ironson G et al
(2001) Factors predicting the use of
complementary therapies in a multi-
ethnic sample of early-stage breast
cancer patients. J Am Med Womens
Assoc 56:120123, 126
8. Crocetti E, Crotti N, Feltrin A et al
(1998) The use of complementary
therapies by breast cancer patients
attending conventional treatments. Eur
J Cancer 34:324328
9. Edgar L, Remmer J, Rosberger Z et al
(2000) Resource use in women com-
pleting treatment for breast cancer.
Psychooncology 9:428438
10. Miller M, Boyer MJ, Butow PN et al
(1998) The use of unproven methods of
treatment by cancer patients. Frequen-
cy, expectations and cost. Support Care
Cancer 6:337347
11. Paltiel O, Avitzour M, Peretz T et al
(2001) Determinants of the use of
complementary therapies by patient
with cancer. J Clin Oncol 19:2439
2448
12. Rees RW, Feigel I, Vickers A et al
(2000) Prevalence of complementary
therapy use by women with breast-
cancer. A population-based survey. Eur
J Cancer 36:13591364
13. Sollner W, Maislinger S, DeVries A
et al (2000) Use of complementary
and alternative medicine by cancer
patients is not associated with per-
ceived distress or poor compliance
with standard treatment but active
coping behavior: a survey. Cancer
89:873880
14. Burstein HJ, Gelber S, Guadagnoli E,
Weeks JC (1999) Use of alternative
medicine by women with early-stage
breast cancer. N Engl J Med 340
(22):17331739
151
15. Kappauf H, Leykauf-Ammon D,
Bruntsch U et al (2000) Use of and
attitudes held towards unconventional
medicine by patients in a department of
internal medicine/oncology and hae-
matology. Support Care Cancer 8:314
322
16. Morant R, Jungi WF, Koehli C et al
(1991) Why do cancer patients use
alternative medicine? Schweiz Med
Wochenschr 121:10291034
17. Oneschuk D, Fennell L, Hanson J et al
(1998) The use of complementary
medications by cancer patients attend-
ing an outpatient pain and symptom
clinic. J Palliat Care 14:2126
18. Engel GL (1977) The need for a new
medical model: a challenge for bio-
medicine. Science 196:129136
19. Stewart M, Brown JB, Donner A et al
(2000) The impact of patient-centered
care on outcomes. J Fam Pract 49:796
804
20. Epstein RM (1999) Mindful practice.
JAMA 282:833839
21. Prolo P, Chiappelli F, Fiorucci A et al
(2002) Psychoneuroimmunology: new
avenues of research for the twenty-first
century. Ann N Y Acad Sci 966:400
408
22. Sagy S, Antonovsky H (2000) The
development of the sense of coherence:
a retrospective study of early life
experiences in the family. Int J Aging
Hum Dev 51:155166
23. Cassileth BR, Vickers AJ (2005) High
prevalence of complementary and al-
ternative medicine use among cancer
patients: implications for research and
clinical care. J Clin Oncol 23
(12):25902592
24. Rabow MW, Dibble SL, Pantilat SZ
et al (2004) The comprehensive care
team: a controlled trial of outpatient
palliative medicine consultation. Arch
Intern Med 164:8391
25. McClain CS, Rosenfeld B, Breitbart W
(2003) Effect of spiritual well-being on
end-of-life despair in terminally-ill
cancer patients. Lancet 361:16031607
26. Lin HR, Bauer-Wu SM (2003) Psycho-
spiritual well-being in patients with
advanced cancer: an integrative review
of the literature. J Adv Nurs 44:6980
27. Ben-Arye E, Ziv M, Frenkel M et al
(2003) Complementary medicine and
psoriasis: linking the patients outlook
with evidence-based medicine. Derma-
tology 207:302307
28. Moss D (2002) The circle of the soul:
the role of spirituality in health care.
Appl Psychophysiol Biofeedback
27:283297
29. Chan C, Ho PS, Chow E (2001) A
bodymindspirit model in health:
an Eastern approach. Soc Work Health
Care 34:261282
30. Bell IR, Lewis DA II, Lewis SE et al
(2004) Strength of vital force in
classical homeopathy: bio-psycho-
socialspiritual correlates within a
complex systems context. J Altern
Complement Med 10:123131
31. Cantor IS, Rosenzweig S (1997)
Anthroposophic perspectives in prima-
ry care. Prim Care 24:867887
32. Hann DM, Baker F, Denniston MM
(2003) Oncology professionals com-
munication with cancer patients about
complementary therapy: a survey.
Complement Ther Med 11:184190
33. Risberg T, Kolstad A, Bremnes Y et al
(2004) Knowledge of and attitudes
toward complementary and alternative
therapies: a national multicentre study
of oncology professionals in Norway.
Eur J Cancer 40:529535
34. Sapir R, Catane R, Kaufman B et al
(2000) Cancer patient expectations of
and communication with oncologists
and oncology nurses: the experience of
an integrated oncology and palliative
care service. Support Care Cancer
8:458463
152
... It is important to recognize that we cannot underestimate the value of spirituality to cancer patients. [21,22] In that regard, the first step is to welcome the demands of spiritual nature and, if they are not spontaneous, demonstrate an active and natural interest in the subject, as a manifestation of an active desire to familiarize with the patient. The physician interest in spirituality is one of the ways to try to meet the potential demands that can be associated with formal referrals to chaplaincy, specialists in spiritual support, support groups that work with spirituality, in addition to encouraging the patient to seek assistance or guidance in his religious community, if belonging to one. ...
Article
Full-text available
Spirituality is a dynamic and an intrinsic aspect of humanity and is usually intense in cancer for patients, families, and health care teams. Evidence on spirituality, health, and healing have increased over the last decades. This consensus is for those involved in cancer patient care, with concepts and possible strategies for addressing spirituality, with discussion on the relevance, impact, and challenges of spirituality care. The purpose and intent of the consensus are to highlight the need for spirituality inclusion in the complex and delicate trajectory of cancer patients.
... The relationships between quality of life, coping with disease and receiving spiritual support confirm that spirituality is an essential dimension of patient care (Vandenhoeck, 2013). The importance of spiritual care has been illustrated in diverse groups including: the elderly (Oz et al., 2021), disabled people (Kaye & Raghavan, 2002); as well as oncology (Ben-Arye et al., 2006), psychiatry (Galanter et al., 2011), cardiology (Ozdemir et al., 2021), thoracic (Chen et al., 2021) and HIV-positive patients (Chang et al., 2018;Dalmida et al., 2015). Furthermore, interest in spiritual competencies has also been expressed in the fields of teaching (Epstein, 2018;Harbinson & Bell, 2015), psychotherapy (Mutter et al., 2010;Ren, 2012) and in training for other healthcare professions such as nursing and midwifery (Deluga et al., 2021;McSherry et al., 2021). ...
Article
Full-text available
This study aimed to design, validate and standardize the Spiritual Supporter (SpSup) Scale, a tool designed to assess competency to provide spiritual care including knowledge, sensitivity to spiritual needs and spiritual support skills. This instrument can be used by all those engaged in or training for caregiving roles. The study was conducted in Poland in the Polish language. The SpSup Scale demonstrates high overall reliability (Cronbach’s α = 0.88), a satisfactory diagnostic accuracy (0.79), and a satisfactory discriminatory power of the items. Given the psychometric properties of SpSup Scale demonstrated here, the scale is recommended for the assessment of the competency to provide spiritual care in both clinical and research settings in Poland.
... 3 9 10 In palliative and oncology specialties, some have advocated an expansion of the 'biopsychosocial' framework in the formulation of clinical care for each patient to that of a more wholistic 'biopsychosocial-spiritual' model. [11][12][13] However, the incorporation of SR into residency training has not necessarily caught up with this clinical need, and at present, teaching in SR has not been consistently and appropriately integrated into the training curriculum. 14 15 Based on extant literature, the majority of patients wanted physicians to be aware of their SR and appropriately address issues related to SR. [16][17][18][19][20] However, physicians seldom incorporated discussion of these issues into their practice. ...
Article
Full-text available
Objectives With the increased emphasis on personalised, patient-centred care, there is now greater acceptance and expectation for the physician to address issues related to spirituality and religion (SR) during clinical consultations with patients. In light of the clinical need to improve SR-related training in residency, this review sought to examine the extant literature on the attitudes of residents regarding SR during residency training, impact on clinical care and psychological well-being of residents and SR-related curriculum implemented within various residency programmes. Design A scoping review was conducted on studies examining the topic of SR within residency training up until July 2020 on PubMed/Medline and Web of Science databases. Keywords for the literature search included: (Spirituality OR Religion) AND (Residen* OR “Postgraduate Medicine” OR “Post-graduate Medicine” OR “Graduate Medical Education”). Results Overall, 44 studies were included. The majority were conducted in North America (95.5%) predominantly within family medicine (29.5%), psychiatry (29.5%) and internal medicine (25%) residency programmes. While residents held positive attitudes about the role of SR and impact on patient care (such as better therapeutic relationship, treatment adherence and coping with illness), they often lacked the knowledge and skills to address these issues. Better spiritual well-being of residents was associated with greater sense of work accomplishment, overall self-rated health, decreased burnout and depressive symptoms. SR-related curricula varied from standalone workshops to continuous modules across the training years. Conclusions These findings suggest a need to better integrate appropriate SR-related education within residency training. Better engagement of the residents through different pedagogical strategies with supervision, feedback, reflective practice and ongoing faculty and peer support can enhance learning about SR in clinical care. Future studies should identify barriers to SR-related training and evaluate the outcomes of these SR-related curriculum including how they impact the well-being of patients and residents over time.
... Patients' desire for spiritual assessment has also received significant attention, especially in the context of serious illness and end-of-life care [11][12][13][14][15]. Spirituality in the setting of health care has been defined as the "aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred" [16]. ...
Article
Full-text available
Background Incorporation of patient religious and spiritual beliefs in medical care has been shown to improve the efficacy of medical interventions and health outcomes. While previous study has highlighted differences in patient desire for spiritual assessment based on patient religiosity, little is known about patient desire for spiritual assessment based on community type, particularly in urban compared to rural communities. We hypothesized that, given demographic trends which show a higher degree of religiosity in rural areas, patients in rural communities will be more likely to desire spiritual assessment. Methods In this cross-sectional study of 141 adult primary care patients in rural and urban Colorado at non-religiously affiliated clinics, we surveyed patient demographic information, measures of religiosity, patient desire for spiritual assessment, and frequency of spiritual assessment in practice. Univariate logistic regression analyses were used to compare the two populations. Results In both Denver County (urban) and Lincoln County (rural) over 90% of patients identified as religious, spiritual, or a combination of the two. Thirty eight percent (38.3%) of patients in Denver County and 49.1% of patients in Lincoln desired spiritual assessment. Over 97% of patients in both areas reported rarely or never being asked about their R/S within the past year. For patients who have had five or more clinic visits in the past year, more than 91% in both areas stated they have never or rarely been asked about their beliefs. Conclusions While the majority of patients in this study identify as religious or spiritual and many patients desire spiritual assessment, the majority of patients have never or rarely been asked about their spirituality within the past year. This demonstrates a significant gap between patient preference and provider practice of spiritual assessment in the primary care setting, which was similar in both rural and urban settings. This highlights the need for interdisciplinary focus on spiritual assessment and incorporation of patient R/S beliefs in medical care to provide holistic patient care and improve health outcomes.
... While physicians usually aim to transform the patient's situation into a clinical situation, here the circulating emotions triggered by symptom expression transform the clinical situation into a psychological situation, marked by anxiety-induced avoidance. Sometimes, patients use complementary treatments (Ben-Arye et al., 2006), as in this consultation, in which the intake of baking soda is discussed [363]. The patient hereby not only reveals her illness representations, she also demonstrates active coping (Weisman and Sobel, 1979), which has a (self-)reassuring function. ...
Article
Objectives: While patients' symptom experiences have been widely investigated, there is a lack of contextualized studies investigating how symptoms circulate in the medical consultation, how patients present them, what they convey, how physicians respond, and how patients and physicians negotiate with each other to find ways to address them. The aim of this study is to explore patients and physicians handling of symptoms throughout oncological consultations with a multiple case study approach. Methods: Five consultations, purposively selected from an existing dataset of audiotaped consultations with patients with advanced cancer, were analyzed by means of an inductive analytical approach based on a sensitive framework from the literature. Results: Patients' symptoms showed multiple dimensions such as medical, cognitive, emotional, psychological, interactional, symbolic, experiential, and existential. Significance of results: Different symptom dimensions remained unnoticed and unaddressed in the consultations. The physician-centered symptom approach that was observed leads to consumed time and missed opportunities for relationship building with the patient. Physicians showed a lack of sensitivity regarding the multiple dimensions of symptoms. Based on the findings, strategies for a more comprehensive symptom approach can be conceived.
... Traditional medicine is holistic in nature, often combining both ritualistic (spiritual) and drug-based (plant/animal based) healing practices (Franco and Narasimhan 2012). The emphasis on spiritual healing in traditional medicinal systems is an important feature that sets it apart from the formal science based 'conventional system of medicine' (Ben-Arye et al. 2006). Despite the seemingly diverging approaches employed in healing, these two systems play an important role in contemporary healthcare. ...
Article
Ethnopharmacological relevance In this study, we compare the traditional medicinal knowledge and associated spiritual practices of healers with that of non-healers, to understand the relevance of healers in contemporary times. Given that Brunei Darussalam is well-known for its forest cover, the study also aims to understand the number of species collected from the forests, compared to those from human influenced habitats. Materials and methods A total of six specialist healers from Belait, Tutong, Dusun and Iban communities, and seven non-healers who had personal experience in self-medication using medicinal plants participated in the study. We identified the specialist healers through purposive sampling, on the basis of their reputation in the locality, while the non-healers were those experienced in self-medication, recommended by the healers. Informants were interviewed at their residences, followed by collection trips to the plant habitats. We classified the total recorded ailments into 15 disease categories. We then compared the medicinal uses cited by healers to those mentioned by non-healers, as well as with prior published records from Brunei Darussalam. We also compare the habitats of species cited by both healers and non-healers to understand the dependency of the local pharmacopoeia on forests and human-influenced habitats. Results Our study records 175 medicinal plants belonging to 85 families, the majority of which (92) were exotic to Borneo. There were 110 species collected from disturbed, human influenced habitats such as roadsides, agricultural fields, secondary and degraded forests, and homestead lands, while 58 species were collected from the forests surrounding Kiudang. Majority of the plants used by both healers and non-healers were collected from human-influenced habitats, indicating that the local pharmacopoeia could be a disturbance one. Most of the medicinal plants recorded in this study were used to treat chronic, but non-life threatening conditions. Ailments affecting the digestive system were the most targeted group with 67 species used. All medicinal uses with more than one citation were recorded from healers. Medicinal uses cited by healers also had greater correspondence with prior published reports from Brunei Darussalam. Healers believe that combining medicinal plants can produce a synergistic effect. Our study found that traditional knowledge related to healing practices is mostly transmitted vertically from parents to children. We also show that a ritual gift (pikaras) and invocations characteristic of the beliefs of the healers play an important role in facilitating healing. Conclusion Our study adds further evidence to prior studies that the medicinal plants and healing practices in the Kiudang region could be considered as disturbance pharmacopoeia. Healers with their knowledge on both therapeutic and spiritual aspects of healing continue to play an important role in local healthcare.
... Menurut Crammer et al.,(2011) dalam studinya mengenai hubungan antara penggunaan CAM (Complementary and Alternative Medicine) dengan kesejahteraan spiritual menunjukkan bahwa di antara 4000 pasien kanker yang bertahan hidup di United State ditemukan bahwa keduanya memiliki hubungan secara bermakna. Harapan terhadap pemenuhan kebutuhan spiritual diungkapkan pula oleh Ben et al (2006), bahwa responden mengharapkan tenaga kesehatan dan dokter mampu menyediakan kebutuhan spiritual dan psikologis sebagai kebutuhan utama pasien dalam menggunakan CAM. ...
... The first of these was also significant in the RSCC study and elsewhere (Balboni et al., 2014;King et al., 2013). Patient attitudes toward spiritual care provision have not been as well-studied in the Middle East as in the United States, but the existing findings suggest that Middle Eastern patients (Ben-Arye et al., 2006), as with American patients (Ehman et al., 1999;McCord et al., 2004;Phelps et al., 2012), do indeed want spiritual care from their medical team. ...
Article
Objective When patients feel spiritually supported by staff, we find increased use of hospice and reduced use of aggressive treatments at end of life, yet substantial barriers to staff spiritual care provision still exist. We aimed to study these barriers in a new cultural context and analyzed a new subgroup with “unrealized potential” for improved spiritual care provision: those who are positively inclined toward spiritual care yet do not themselves provide it. Method We distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items included how often spiritual care should be provided, how often respondents themselves provide it, and perceived barriers to spiritual care provision. Result We had 770 respondents (40% physicians, 60% nurses) from 14 Middle Eastern countries. The results showed that 82% of respondents think staff should provide spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. In multivariable analysis of respondents who valued spiritual care yet did not themselves provide it to their most recent patients, predictors included low personal sense of being spiritual ( p < 0.001) and not having received training ( p = 0.02; only 22% received training). How “developed” a country is negatively predicted spiritual care provision ( p < 0.001). Self-perceived barriers were quite similar across cultures. Significance of results Despite relatively high levels of spiritual care provision, we see a gap between desirability and actual provision. Seeing oneself as not spiritual or only slightly spiritual is a key factor demonstrably associated with not providing spiritual care. Efforts to increase spiritual care provision should target those in favor of spiritual care provision, promoting training that helps participants consider their own spirituality and the role that it plays in their personal and professional lives.
... The first of these was also significant in the RSCC study and elsewhere (Balboni et al., 2014;King et al., 2013). Patient attitudes toward spiritual care provision have not been as well-studied in the Middle East as in the United States, but the existing findings suggest that Middle Eastern patients (Ben-Arye et al., 2006), as with American patients (Ehman et al., 1999;McCord et al., 2004;Phelps et al., 2012), do indeed want spiritual care from their medical team. ...
Article
Full-text available
Bar-Sela G1, Schultz MJ1, Elshamy K2, Rassouli M3, Ben-Arye E4, Doumit M5, Gafer N6, Albashayreh A7, Ghrayeb I8, Turker I9, Ozalp G9, Kav S10, Fahmi R11, Nestoros S12, Ghali H13, Mula-Hussain L14, Shazar I15, Obeidat R16, Punjwani R17, Khleif M18, Can G19, Tuncel G9, Charalambous H20, Faraj S13, Keoppi N21, Al-Jadiry M13, Postovsky S22, Al-Omari M23, Razzaq S13, Ayyash H24, Khader K25, Kebudi R26, Omran S27, Rasheed O28, Qadire M29, Ozet A30, Silbermann M31. OBJECTIVE: When patients feel spiritually supported by staff, we find increased use of hospice and reduced use of aggressive treatments at end of life, yet substantial barriers to staff spiritual care provision still exist. We aimed to study these barriers in a new cultural context and analyzed a new subgroup with "unrealized potential" for improved spiritual care provision: those who are positively inclined toward spiritual care yet do not themselves provide it. METHOD: We distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items included how often spiritual care should be provided, how often respondents themselves provide it, and perceived barriers to spiritual care provision.ResultWe had 770 respondents (40% physicians, 60% nurses) from 14 Middle Eastern countries. The results showed that 82% of respondents think staff should provide spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. In multivariable analysis of respondents who valued spiritual care yet did not themselves provide it to their most recent patients, predictors included low personal sense of being spiritual (p < 0.001) and not having received training (p = 0.02; only 22% received training). How "developed" a country is negatively predicted spiritual care provision (p < 0.001). Self-perceived barriers were quite similar across cultures.Significance of resultsDespite relatively high levels of spiritual care provision, we see a gap between desirability and actual provision. Seeing oneself as not spiritual or only slightly spiritual is a key factor demonstrably associated with not providing spiritual care. Efforts to increase spiritual care provision should target those in favor of spiritual care provision, promoting training that helps participants consider their own spirituality and the role that it plays in their personal and professional lives.
Article
Full-text available
2 ، ‫محمودی‬ ‫فاطمه‬ 3 ، ‫فانی‬ ‫صدیقه‬ 4 ‫چكيده‬ ‫و‬ ‫زمینه‬ ‫هدف‬ : ‫است‬ ‫شده‬ ‫متمرکز‬ ‫بعدی‬ ‫چهار‬ ‫الگویی‬ ‫بر‬ ‫اینک‬ ‫هم‬ ‫و‬ ‫یافته‬ ‫توسعه‬ ‫اخیرا‬ ‫ها‬ ‫نگاه‬ ‫تحول‬ ‫با‬ ‫سالمت‬ ‫ارزیابی‬. ‫ژدهوه‬ ‫هدد‬ ‫آماده‬ ‫حاضر‬ � ‫به‬ ‫و‬ ‫ژایایی‬ ،‫روایی‬ ‫بررسی‬ ‫و‬ ‫سازی‬ ‫ژرس‬ ‫عاملی‬ ‫ساختار‬ ‫آوردن‬ ‫دست‬ � ‫نامه‬ 4 ‫زیسدتی‬ ‫رویکرد‬ ‫اساس‬ ‫بر‬ ‫سالمت‬ ‫سنج‬ ‫بعدی‬˚‫روانی‬˚‫بود‬ ‫بعدی‬˚ ‫بعدی‬˚‫روانی‬ ‫بعدی‬˚‫روانی‬˚ ‫بعدی‬˚‫روانی‬˚‫بود‬ ‫معنوی‬ ‫و‬ ‫اجتماعی‬. ‫م‬ ‫روش‬ ‫و‬ ‫واد‬ ‫ها‬ : ‫شامل‬ ‫ژهوه‬ ‫نمونه‬ 133 ‫نمونده‬ ‫روش‬ ‫با‬ ‫که‬ ‫بود‬ ‫فرد‬ � ‫ل‬ ‫ا‬ ‫د‬ ‫س‬ ‫ر‬ ‫د‬ ‫ز‬ ‫ا‬ ‫ر‬ ‫ی‬ ‫د‬ ‫ش‬ ‫ر‬ ‫ه‬ ‫د‬ ‫ش‬ ‫ر‬ ‫د‬ ‫ل‬ ‫ت‬ ‫ف‬ ‫م‬ ‫خ‬ ‫م‬ ‫ا‬ ‫د‬ ‫ن‬ ‫م‬ ‫ز‬ ‫ا‬ ‫س‬ ‫ر‬ ‫ت‬ ‫د‬ ‫س‬ ‫د‬ ‫ر‬ ‫د‬ ‫ی‬ ‫ر‬ ‫د‬ ‫ی‬ ‫گ‬ 3133 ‫شدند‬ ‫انتفاب‬. ‫داده‬ ‫گردآوری‬ ‫برای‬ ‫ژرس‬ ‫از‬ ،‫ها‬ � ‫نامه‬ 4 ‫از‬ ‫که‬ ‫سالمت‬ ‫بعدی‬ 321 ‫اسداتید‬ ‫توسدت‬ ‫آن‬ ‫محتدوایی‬ ‫روایدی‬ ‫و‬ ‫تکدکیل‬ ‫ژرسد‬ ‫ت‬ ‫مورد‬ ‫برجسته‬ ‫أ‬ ‫بود‬ ‫گرفته‬ ‫قرار‬ ‫یید‬ ‫شد‬ ‫استفاده‬. ‫سازه‬ ‫روایی‬ ‫بررسی‬ ‫منظور‬ ‫به‬ ‫ژرس‬ ‫ای‬ � ‫گردید‬ ‫استفاده‬ ‫اکتکافی‬ ‫عاملی‬ ‫تحلیل‬ ‫از‬ ‫نامه‬. ‫یافته‬ ‫ها‬ : ‫عاملی‬ ‫تحلیل‬ 31 ‫حدود‬ ‫که‬ ‫کرد‬ ‫مکفص‬ ‫را‬ ‫عامل‬ 44 % ‫نمود‬ ‫تبیین‬ ‫را‬ ‫سالمت‬ ‫واریانس‬ ‫از‬. ‫نتیجه‬ ‫گیری‬ : ‫متنوع‬ ‫ابعاد‬ ‫بعدی‬ ‫چهار‬ ‫نگاه‬ ‫با‬ � ‫به‬ ‫توجه‬ ‫با‬ ‫که‬ ‫است‬ ‫مطرح‬ ‫سالمت‬ ‫از‬ ‫تری‬ ‫آ‬ ‫ن‬ ‫دقیخ‬ ‫نتایج‬ ‫توان‬ ‫می‬ � ‫آورد‬ ‫دست‬ ‫به‬ ‫تری‬. ‫توجه‬ ‫با‬ ‫ب‬ ‫قبول‬ ‫قابل‬ ‫اعتبار‬ ‫و‬ ‫روایی‬ ‫به‬ ‫ه‬ ‫ژرس‬ ‫از‬ ‫آمده‬ ‫دست‬ � ‫نامه‬ 4 ‫ژرس‬ ‫این‬ ‫از‬ ‫استفاده‬ ،‫سالمت‬ ‫ارزیابی‬ ‫بعدی‬ � ‫منظور‬ ‫به‬ ‫که‬ ‫مطالعاتی‬ ‫برای‬ ‫نامه‬ ‫می‬ ‫انجام‬ ‫سالمت‬ ‫سنج‬ ‫می‬ ‫ژیکنهاد‬ ‫گیرد‬ ‫شود‬ .
Article
Full-text available
Under the division of labor of Western medicine, the medical physician treats the body of patients, the social worker attends to their emotions and social relations, while the pastoral counselor provides spiritual guidance. Body, mind, cognition, emotion and spirituality are seen as discrete entities. In striking contrast, Eastern philosophies of Buddhism, Taoism and traditional Chinese medicine adopt a holistic conceptualization of an individual and his or her environment. In this view, health is perceived as a harmonious equilibrium that exists between the interplay of ‘yin’ and ‘yang’: the five internal elements (metal, wood, water, fire and earth), the six environmental conditions (dry, wet, hot, cold, wind and flame), other external sources of harm (physical injury, insect bites, poison, overeat and overwork), and the seven emotions (joy, sorrow, anger, worry, panic, anxiety and fear). The authors have adopted a body-mind-spirit integrated model of intervention to promote the health of their Chinese clients. Indeed, research results on these body-mind-spirit groups for cancer patients, bereaved wives and divorced women have shown very positive intervention outcomes. There are significant improvements in their physical health, mental health, sense of control and social support.
Article
Purpose: Oncologists are aware that their patients use complementary/alternative medicine (CAM). As cancer incidence rates and survival time increase, use of CAM will likely increase. This study assessed the prevalence and predictors of CAM use in a comprehensive cancer center. Subjects and methods: Subjects were English-speaking cancer patients at least 18 years of age, attending one of eight outpatient clinics at The University of Texas M.D. Anderson Cancer Center, Houston, TX, between December 1997 and June 1998. After giving written informed consent, participants completed a self-administered questionnaire. Differences between CAM users and nonusers were assessed by chi(2) and univariate logistic regression analysis. A multivariate logistic regression model identified the simultaneous impact of demographic, clinical, and treatment variables on CAM use; P values were two-sided. Results: Of the 453 participants (response rate, 51.4%), 99.3% had heard of CAM. Of those, 83.3% had used at least one CAM approach. Use was greatest for spiritual practices (80.5%), vitamins and herbs (62.6%), and movement and physical therapies (59.2%) and predicted (P <.001) by sex (female), younger age, indigent pay status, and surgery. After excluding spiritual practices and psychotherapy, 95.8% of participants were aware of CAM and 68.7% of those had used CAM. Use was predicted (P <.0001) by sex (female), education, and chemotherapy. Conclusion: In most categories, CAM use was common among outpatients. Given the number of patients combining vitamins and herbs with conventional treatments, the oncology community must improve patient-provider communication, offer reliable information to patients, and initiate research to determine possible drug-herb-vitamin interactions.
Article
160 patients (53.3%) replied to an anonymous questionnaire distributed to 300 consecutive patients of our Outpatient Oncology Clinic. 83 patients (53%) mentioned some experience of one or more alternative methods of cancer treatment. Most often cited were various herbal teas (35 instances), beetroot juice (16), Vogel plant extracts (15), laying on of hands (14), homeopathic medicine (13), the mistletoe extract Iscador (13), magnetopathy (12), various diets (10), acupuncture (10) and psychological methods (9). Resort to alternative methods of treatment correlated significantly with lower age (51.5 years vs 59.8 years, p = 0.001). The reasons for using alternative medicine were the desire to do everything possible to regain health (49), to use one's psychological forces as well (35), reports of successful cancer cures (28), desire for a holistic approach (23), hope of 'softer' medicine with less severe side effects (18) and, in 7 cases only, disappointment with conventional university medicine. The major source of information was relatives and friends, not the mass media. The physician should be aware of the locally available alternative medicine options and be able to advise his patients accordingly. He should also recognize and give due consideration to the patient's underlying desire for better control of his disease and a more holistic approach to care.
Article
This is an exploratory study of the relationship between three sociodemographic variables, four types of life experiences, and the development of the Sense of Coherence (SOC). The study was carried out using semi-structured life-history interviews of eighty-nine retirees whose SOC scores had been obtained in a previous study. The central research question was what kind of experiences within the family context during childhood are related to the development of the SOC. The interviews were scored on ten pre-coded variables derived from four types of life experiences which were hypothesized to shape the SOC: consistency, load balance, participation in shaping outcome, and emotional closeness. In addition, three sociodemographic variables, which were hypothesized to influence the family context by setting limits and offering opportunity for the kinds of interactions which might occur within the family, were measured: family education level, socioeconomic status, and gender. Results of the statistical analysis indicate that the most relevant childhood experience related to the adult SOC was participation in shaping outcomes. Both family education level and gender were related to SOC, directly and indirectly. Findings are discussed in terms of the salutogenic model and the historical and social context in which the interviewees grew up.
Article
BACKGROUND Complementary/alternative cancer treatments are believed to be prevalent. However, reliable prevalence rates do not exist. The aim of this review was to summarize the existing data on this topic.METHODSA series of computerized literature searches was performed to locate all published studies documenting the prevalence of complementary and/or alternative therapy (CAM) use among patients with cancer.RESULTSA total of 26 surveys from 13 countries, including 4 studies of pediatric patients, was retrieved. The use of CAM therapies in adult populations ranged from 7-64%. The average prevalence across all adult studies was 31.4%.CONCLUSIONS This large degree of variability most likely is due to different understandings of "complementary/alternative medicine" on the part of both investigators and patients. It is likely that the results of the current study reflect the primarily adjunctive use of CAM treatments. Future studies should use a standardized protocol to determine the true prevalence of these therapies more closely. Cancer 1998;83:777-782. © 1998 American Cancer Society.
Article
There is increasing evidence for the extensive use of complementary and alternative medicine (CAM) by patients with psoriasis. Clinical research in the arena of CAM and psoriasis treatment is evolving and includes some randomized controlled trials. To study CAM use among patients with psoriasis attending a dermatology clinic in a major university hospital in northern Israel. Prevalence, reasons for CAM use and its relevance to doctor-patient communication were emphasized. Semistructured interviews were conducted with psoriasis patients in a dermatology clinic. Consent was obtained for 78 patients. Post-visit questionnaires were given to 5 physicians. Seventy-eight patients with psoriasis were interviewed and 77 were studied. Sixty-two percent used CAM. Fifty-eight percent of users had seen a CAM practitioner. The study found a trend of CAM use among patients with psoriasis from Arab compared to Jewish descent (p=0.087). CAM users reported on average 2 different CAM modalities. Herbal medicine and nutritional treatments ranked first, followed by homeopathy, traditional Chinese medicine and nutritional supplements. The main reason for CAM use was stated to be to do everything to heal the disease, followed by a quest for improved quality of life. Others mentioned an interest in a less toxic treatment, disappointment with conventional treatment and stress reduction. Well over half of the study participants and their dermatologists did not initiate a discussion about CAM use. The dermatologists' ability to predict CAM use in their patients was relatively low. There is growing evidence of extensive CAM use among patients with psoriasis. Most patients use CAM as a complementary treatment, rather than an alternative to conventional treatment. Teaching CAM should be integrated into the dermatology residency curriculum. Dermatologists need to increase their awareness of CAM use by their patients in order to improve therapeutic communication.
Article
BACKGROUND Complementary/alternative cancer treatments are believed to be prevalent. However, reliable prevalence rates do not exist. The aim of this review was to summarize the existing data on this topic.METHODSA series of computerized literature searches was performed to locate all published studies documenting the prevalence of complementary and/or alternative therapy (CAM) use among patients with cancer.RESULTSA total of 26 surveys from 13 countries, including 4 studies of pediatric patients, was retrieved. The use of CAM therapies in adult populations ranged from 7-64%. The average prevalence across all adult studies was 31.4%.CONCLUSIONS This large degree of variability most likely is due to different understandings of "complementary/alternative medicine" on the part of both investigators and patients. It is likely that the results of the current study reflect the primarily adjunctive use of CAM treatments. Future studies should use a standardized protocol to determine the true prevalence of these therapies more closely. Cancer 1998;83:777-782. © 1998 American Cancer Society.
Article
Psychoneuroimmunology (PNI) investigates the relations between the psychophysiological and immunophysiological dimensions of living beings. PNI brings together researchers in a number of scientific and medical disciplines, including psychology, the neurosciences, immunology, physiology, pharmacology, psychiatry, behavioral medicine, infectious diseases, and rheumatology. All are scientists with profound interest in interactions between the nervous and immune systems, and the relation between behavior and health. Despite the variety in domains and approaches to research, the outcome common to all research endeavors is the discovery of new information, of uncovered facts, of novel evidence, which contributes to the continuing generation of knowledge. In this paper we discuss psychoneuroimmune aspects of some conditions that are not routinely immediately associated with immunity, such as the condition of being the caregiver of somebody suffering from dementia; the effect on the brain-body modulations of aluminum, a metal that is not a component of the human body; and insomnia, a fairly common but disturbing disease, that even today lacks an effectual treatment.
Article
Purpose: The purpose of this study was to assess the use of complementary therapies among older cancer patients, to report patterns of use, and to understand who is more likely to use complementary therapies. Description of study: A survey was conducted of 699 older cancer patients at 4 weeks and 6 weeks into cancer treatment. All participants were 64 years of age or older, had received a diagnosis of breast, colorectal, prostate, or lung cancer, and were recruited from community cancer treatment centers throughout Michigan. Measures of interest included self-reported physical symptoms, depressive symptomatology, optimism, spirituality, and use of conventional and complementary health services. Results: Approximately 33% of older cancer patients reported using complementary therapies. These individuals were more likely to be women, to be breast cancer patients, and to have a higher level of education. The three most frequently used therapies were exercise, herbal therapy, and spiritual healing. Complementary therapy users were significantly more optimistic than nonusers. Also, there were significant differences between users and nonusers on types of physical symptoms experienced, but no differences on reported depressive symptomatology or spirituality. Clinical implications: Oncology providers need to be aware that one third of their older patients are likely to supplement conventional care with complementary therapies. Therefore, providers should be knowledgeable about the safety and efficacy, in particular, of various exercise programs, herbal and vitamin therapies, and spiritual healing. It would be beneficial to develop a system within cancer centers by which patients could easily report on their use of complementary therapies, allowing providers to work in partnership with their patients.
Article
BACKGROUND Complementary and alternative medicine (CAM) is often used by cancer patients. Data on characteristics of users, concomitant psychologic disturbance, and compliance with standard treatment continue to be controversial. Use of and interest in CAM and their correlation with psychologic disturbance, ways of coping with illness, and compliance with standard treatment were examined in this study.METHODS The authors conducted a survey in a consecutive sample of 205 cancer patients undergoing radiotherapy, using a structured questionnaire to record use of and interest in CAM, the Hospital Anxiety and Depression Scale, the Hornheide Questionnaire to assess patient distress and social support, and the Freiburg Questionnaire of Coping with Illness.RESULTSOf the 172 participants, 24.4% (response rate, 83.9%) reported use of CAM, and 31.4% reported not having used but being interested in such methods. Logistic regression analysis including clinical, demographic, and psychologic characteristics as independent variables yielded 3 predictors of use of or interest in CAM: younger age (P = 0.004; odds ratio (OR), 0.96), progressive cancer (P = 0.064; OR, 1.47), and active coping behavior (P = 0.016; OR, 1.65). Patients interested in or using CAM did not show more psychologic disturbance, poorer social support, or less trust in medicine or compliance with radiotherapy than subjects without such interest.CONCLUSIONS Use of CAM by cancer patients is not associated with perceived distress or poor compliance with medical treatment but with active coping behavior. Patients seem to consider CAM as supplementary to standard medical methods and one way of avoiding passivity and of coping with feelings of hopelessness. Cancer 2000;89:873–80. © 2000 American Cancer Society.