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Issues in complementary therapies: how we got to where we are.

Consumer interest in and use of complementary/alternative therapies has increased exponentially in the past decades. Although many of the over 1800 therapies have not been used in the delivery of nursing care, a number of these therapies have a long tradition of use in nursing. Additionally, nurses have conducted research on selected complementary therapies. Nursing is in an excellent position to be a leader in integrating these therapies into the Western biomedical health model and in continuing the research that will provide a better scientific base for the use of complementary therapies.

Complementary Therapies↗

Critical review of complementary therapies for prostate cancer.

Despite its prominence as the most frequently diagnosed solid tumor among men in the United States, relatively little is known about the etiology of prostate cancer. Furthermore, research into treatment strategies for prostate cancer continues to lag behind research for the other most common cancers. At the same time, however, the popularity of complementary therapies among prostate cancer patients continues to grow. In this article, we provide a critical review of the most recent evidence for dietary modifications, food supplements, and herbs in prostate cancer prevention and treatment. Despite encouraging data for some of these interventions, even the strongest proponents of complementary therapy agree that only randomized controlled trials can provide sufficient evidence on which to create universal guidelines. However, such trials are highly complex and expensive, and they require lengthy follow-up. Until such trials are completed, an opportunity exists for health care professionals to improve their knowledge and understanding of the current evidence for or against complementary therapy in prostate cancer.

Antineoplastic Agents, Phytogenic↗

Prevalence of complementary therapy use by women with breast cancer. A population-based survey.

The study measured the prevalence and costs of complementary therapy use by women diagnosed with breast cancer in the South Thames NHS region. A postal questionnaire was sent to a sample of 1023 women from the Thames Cancer Registry who had been diagnosed with breast cancer in the previous 7 years. Just over a fifth (22.4%) had consulted a complementary practitioner in the previous 12 months. Almost one third (31.5%) had done so since diagnosis. Almost pound17000 had been spent on visits in the previous year. The women using complementary medicine after diagnosis were slightly younger, more educated and more likely to have used complementary medicine before their diagnosis than non-complementary medicine users. In conclusion, significant numbers of women are visiting complementary therapists for health reasons following a breast cancer diagnosis. The out of pocket costs per user, with notable exceptions, are modest. Use of practitioners of complementary therapies following diagnosis is a significant and possibly growing phenomenon.

Adolescent↗

Older rural women and the use of complementary therapies.

One hundred seventy-five rural women over the age of 70 participated in a study to assess their use of complementary therapies and practitioners. Data were collected via questionnaires and interviews. Findings suggest that these women used nontraditional health practices to treat a variety of symptoms, as well as to maintain their independence. However, very few of them informed their primary care providers that they used complementary therapies and practitioners. The majority were inadequately informed regarding the efficacy and safety of the therapies.

Aged↗

Integrating complementary therapies into community mental health practice: an exploration.

OBJECTIVES: To (1) describe the integration of massage and energy-based therapies with psychotherapy in a community mental health center, (2) to present qualitative feedback on the service, and (3) to present pilot data from a sample of long-term clients with persistent mental health concerns. DESIGN: A noncontrolled pilot study was conducted using interview data before and self-report instruments after completing a brief program of complementary therapy accompanying ongoing psychotherapy. SETTINGS/LOCATION: The program took place at a comprehensive community mental health center in southern Maine and in the private offices of massage therapists and energy healing practitioners who contracted with the program. SUBJECTS: Subjects were 20 women and 5 men, with mean age of 42 years and a mean history of 7.4 years of mental health treatment. All had histories that included trauma, 10 of which involved sexual abuse. The Diagnostic and Statistical Manual of Mental Disorders IV Axis I diagnoses were PTSD (10), major depression (nine), anxiety disorder (three), and dual diagnosis (three). INTERVENTIONS: Clients receiving ongoing psychotherapy were assigned to one modality of complementary therapy based on clinical judgment, availability of practitioners, and client interest. Modalities used were massage, acupuncture, Reiki, and Healing Touch. The mean number of sessions was five. OUTCOME MEASURES: Clients completed an investigator-generated instrument with Likert-scaled ratings of satisfaction and perceived changes in four dimensions of trauma recovery: perceived interpersonal safety, interpersonal boundary setting, bodily sensation, and bodily shame. RESULTS: Clients reported high levels of satisfaction with the service and significant levels of perceived (self-rated) change on each outcome measure. Qualitative results included enhanced psychotherapeutic outcomes reported by mental health clinicians. CONCLUSIONS: The integration of complementary therapies into community mental health practice may hold promise of enhancing mental health outcomes and improving quality of life for long-term users of mental health services.

Acupuncture Therapy↗

Surveys of complementary and alternative medicine: part III. Use of alternative and complementary therapies for HIV/AIDS.

A series of 16 independent studies of the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) community and their use of alternative and complementary therapies over the past 10 years helps document the changes that have occurred. The earlier studies are characterized by political activism, lack of confidence in conventional therapies, and widespread use of alternative pharmacological therapies and unapproved drug use. The improvement of conventional treatment since the mid-1990s has been accompanied by a greater emphasis on complementary therapies used in conjunction with conventional drug therapy. Mind-body or psycho-spiritual therapies that help the patient cope with stress and adjust to life-threatening illness are the most popular.

Acquired Immunodeficiency Syndrome↗

The experience of using a combination of complementary therapies: a journey of balance through self-healing.

Literature on complementary or alternative therapies from the perspective of personal experience is limited, and to date, there are no published studies using a qualitative approach to study the contextual effects of combined complementary therapies. Evaluating the use of combinations of complementary therapies from the perspective of those who experience them is important in understanding their beneficial and synergistic effects. This article is a report of the findings of a hermeneutic phenomenological study on the lived experience of 8 guests participating in a structured naturopathic program that used combinations of complementary/alternative therapies to promote healing in illness.

Adult↗

Shamanism as a healing paradigm for complementary therapy.

Any healing process--whether recovery from infection, physical trauma, or psychological distress--must entail the stimulation and direction of the body's own restorative functions. In former times these functions were called the vis mediatrix naturae. Arguably best articulated within traditional Chinese medicine (e.g. Reid 1993), many complementary therapies have identified this principle. The immune system is implicated in the operation of these healing processes, and immune system functions are modulated by both internal and external variables. External variables include the nature of the infection or trauma. Internal variables include the meaning of the illness to the patient or the patient's imagery surrounding the illness. It follows that any modulation of internal variables that increases immune function will therefore be highly beneficial in the healing process. Sometimes such modulation happens spontaneously, when it may be referred to as the placebo effect, or a good bedside manner, or spontaneous remission. Sometimes such modulation may be brought about intentionally either by the patient or by a therapist or healer. One body of technique for such modulation is shamanism, which pays particular attention to bridging the internal world of the patient to the external world where the problem originates. Shamanic practice is specifically focused on this healing task, and has its own toolkit of techniques for the modification of consciousness, the manipulation of imagery and meaning, and the generation of a healing milieu and therapeutic images from its mythic content. Early concerns about the mental health of shamanic practitioners are now thoroughly resolved (e.g. Stephen & Suryani 2000). Indeed, the relevance of shamanism to positive mental health is currently being explored (e.g. Money 1994, Singh 1999). Its relevance to social work (Voss et al. 1999) and to the near death experience (Green 1998) are also subjects of academic inquiry. The shamanic corpus exemplifies a healing paradigm that may also be used to understand the essential elements of healing, which underpin some established complementary therapies and some other healing modalities such as spiritual healing,'psychic' healing, spontaneous remission, and the placebo effect. The comparatively recent psychoneuroimmunological perspective appears to be congruent with and also to validate ancient shamanic healing technique. Both may share essential principles with complementary therapies and illuminate their essential healing processes.

Female↗

Legal issues in caring for patients with kidney disease by selectively integrating complementary therapies.

Clinical integration of complementary and alternative medical (CAM) therapies, such as acupuncture and traditional oriental medicine, chiropractic, herbal medicine, massage therapy, and "mind-body" therapies, into conventional health care raises important legal and risk management issues. Understanding which CAM therapies patients use is legally prudent, as conventional treatment advice may interact with patients' own efforts toward self-care. In addition, nephrologists may limit potential liability for medical malpractice by classifying any given therapy as follows: (1) the medical evidence supports both safety and efficacy--recommend; (2) the medical evidence supports safety, but evidence regarding efficacy is inconclusive-accept but monitor; (3) the medical evidence supports efficacy, but evidence regarding safety is inconclusive-accept but monitor; and (4) the medical evidence indicates either serious risk or inefficacy--avoid and discourage. Applying this framework whether a therapy is labeled "conventional" or "CAM" is consistent with the key recommendation of the recent report by the Institute of Medicine at the National Academy of Sciences on Complementary and Alternative Medicine, namely, to apply the same principles and standards of evidence of treatment effectiveness to all treatments. Liability risk management also includes going beyond legal and ethical informed consent requirements by engaging the patient in shared decision making concerning all material treatment options, including CAM therapies, if supported by evidence. Physicians further should familiarize themselves with documentation standards suggested by the Federation of State Medical Board Guidelines and whether these are applicable in their state or home institution. These steps aim to enable nephrologists to respond to patient interest in CAM therapies in a way that is clinically responsible, ethically appropriate, and legally defensible.

Complementary Therapies↗

Healing the heart: integrating complementary therapies and healing practices into the care of cardiovascular patients.

Complementary therapies and healing practices have been found to reduce stress, anxiety, and lifestyle patterns known to contribute to cardiovascular disease. Promising therapies include imagery and hypnosis, meditation, yoga, tai chi, prayer, music, exercise, diet, and use of dietary supplements. Many of these complementary approaches to healing have been within the domain of nursing for centuries and can readily be integrated into the care of patients with cardiovascular disease. While individual complimentary modalities hold considerable merit, it is critical that the philosophy underlying these therapies--caring, holism, and harmony--also be understood and honored.

Cardiovascular Diseases↗

Use of complementary therapies by individuals with 'arthritis'.

The popularity of complementary medicine is at an all-time high. Rheumatological patients are amongst its most frequent users. This survey was aimed at generating insight into this phenomenon. A self-selected convenience sample of 3384 individuals with 'arthritis' was sent a purpose-designed questionnaire. 1020 completed questionnaires were received (response rate = 30.1%). One third of respondents had received at least one treatment from a complementary practitioner. Orthodox therapies were generally perceived as more effective than complementary treatments. Therapeutic encounters with complementary practitioners were viewed as markedly more satisfying than those with GPs. Adverse effects reported in connection with orthodox treatments were more frequent and severe than those reported with complementary therapies. No firm conclusions can be drawn from these data. However, a hypothesis emerges that complementary medicine is well accepted by rheumatological patients and perceived to have certain advantages over mainstream medicine.

Adult↗

Some methodological problems in the assessment of complementary therapy.

The increased interest of the public and the medical profession in complementary forms of therapy introduces an urgent need for proper assessment of efficacy. This growth in popularity suggests that complementary therapies are effective in some circumstances, but without objective assessment neither the public nor the medical profession can be sure. Rigorous scientific assessment is required, but the nature of complementary therapy is such that double-blind randomized controlled trials, as usually conducted, are rarely applicable, and alternative approaches are needed. At its best, complementary therapy is designed individually for each patient, and few treatments can readily be applied 'blind'. These are the main problems in trial design but complementary therapists are also aware of the importance of body-mind interactions: they see the 'placebo effect' as an integral part of treatment which needs investigation, and they question the validity of clinical trials in which the patient's will is not fully engaged through lack of information, and of those not asking the patients if they feel better. The problems are examined and alternative approaches suggested. The paper raises the question of whether they are only problems for complementary medicine.

Clinical Trials as Topic↗

Complementary therapies: a patient's choice.

Judith Thwaite discusses the role of complementary therapy in her treatment for non-Hodgkins lymphoma. She was diagnosed with non-Hodgkins lymphoma in 1988 and since that time she has tried a number of therapies. A visit to the Bristol Cancer Help Centre changed her outlook on life and the Centre's policy of patient empowerment encouraged her to fulfil an ambition to write. She also visits the Royal Homoeopathic Hospital, London, regularly for massage, shiatsu, acupuncture, and reflexology and relates how these have helped her cope with the disease as well as her sessions of chemotherapy. Throughout her illness she has remained positive and optimistic, determined to use whatever methods that are available to help her.

Choice Behavior↗

Use of complementary therapies in a sexual health clinic setting.

This prospective cohort study examined the health-seeking behaviour of patients diagnosed with genital warts and vulvodynia who presented to Manly Sexual Health Service from March to June 2000. A self-administered questionnaire was used to assess patients' perceptions of their condition and their use of complementary therapies. Thirty-seven patients with genital warts and 26 patients with vulvodynia participated in the study. The use of at least one complementary health product or method was reported by 59% of patients with genital warts and 96% of vulvodynia patients (P < 0.001). Having received conflicting information and being worried about the condition was significantly associated with visits to complementary health providers. Acknowledgement of this search for complementary therapies and open discussion can help patients make informed decisions and to avoid drug interactions, and should ultimately lead to better patient care.

Adolescent↗

Complementary therapies: have they become accepted in general practice?

OBJECTIVES: To describe Victorian general practitioners' attitudes towards and use of a range of complementary therapies. DESIGN: A self-administered postal survey sent to a random sample of 800 general practitioners (GPs) in Victoria in July 1997. PARTICIPANTS: 488 GPs (response rate, 64%). MAIN OUTCOME MEASURES: GPs' knowledge; opinions about harmfulness and effectiveness; appropriateness for GPs to practise; perceived patient demand; need for undergraduate education; referral rates to complementary practitioners; and training in and practice of each therapy. RESULTS: Acupuncture, hypnosis and meditation are well accepted by the surveyed GPs, as over 80% have referred patients patients to practitioners of these therapies and nearly half have considered using them. General practitioners have trained in various therapies--meditation (34%), acupuncture (23%), vitamin and mineral therapy (23%), hypnosis (20%), herbal medicine (12%), chiropractic (8%), naturopathy (6%), homoeopathy (5%), spiritual healing (5%), osteopathy (4%), aroma-therapy (4%), and reflexology (2%). A quarter to a third were interested in training in chiropractic, herbal medicine, naturopathy and vitamin and mineral therapy. General practitioners appear to underestimate their patients' use of complementary therapies. CONCLUSIONS: There is evidence in Australia of widespread acceptance of acupuncture, meditation, hypnosis and chiropractic by GPs and lesser acceptance of the other therapies. These findings generate an urgent need for evidence of these therapies' effectiveness.

Acupuncture Therapy↗

High use of complementary therapies in a New South Wales rural community.

In this study a postal questionnaire was used to investigate the use of complementary therapies (CT) in a rural region of New South Wales (NSW). A total of 70.3% of respondents reported using one or more therapies with 62.7% having visited a complementary practitioner. Vitamin/mineral therapy (68.7%), chiropractic (26.1%) and massage therapy (25.1%) were the most frequently used therapies, with the most commonly visited practitioners being chiropractors (55.3%) and those trained in vitamin/mineral therapy (47.9%). Of the vitamins, vitamin C and multivitamins were used most often, with garlic and Echinacea being the most used herbal products. The main source of information were friends (64.5%) with most people indicating that CT could improve quality of life and provide relief of symptoms. Results suggest that CT use in rural communities is high and that, in light of these findings, there is a need for training in CT to be included in the undergraduate and continuing education of health professionals. Furthermore, these professionals should be alert to the potential for increased numbers of herb-drug interactions in rural communities.

Adolescent↗

The increasing use of reiki as a complementary therapy in specialist palliative care.

Palliative medicine and complementary therapies (CTs) have developed within the NHS as parallel philosophies of care. As a result, the last decade has seen an increase in the integration and usage of CTs, as adjunct therapies to conventional medical treatment. Documented benefits of relaxation, decreased perception of pain, reduced anxiety and improved sense of wellbeing have been shown to enable an enhanced quality of life, where curative treatment is no longer an option. Reiki is a more recent addition to the range of CTs available to cancer patients. As an energy-healing intervention it has gained in popularity as a non-invasive and non-pharmacological approach. Anecdotal evidence suggests that the profound relaxation effect has a positive impact on alleviating anxiety, stress, perception of pain and promotes a feeling of wellbeing particularly relating to the nature of psychospiritual wellbeing. However, there is very little evidence to support its application within clinical practice, and none within the specific field of specialist palliative care (SPC). This article will consider the position of reiki as an emerging CT within SPC. The function of the hospice movement, the role of CTs together with an understanding of energy healing will also be explored. Within this context, the rise in popularity of reiki and its potential benefits for SPC patients will be discussed. These considerations will then form the basis of the justification for further research in SPC.

Anecdotes as Topic↗

ED staff members' personal use of complementary therapies and their recommendations to ED patients: a southeastern US regional survey.

BACKGROUND: Use of complementary and alternative therapies has increased in the United States during the past 5 years. Little is known about the use of these therapies in emergency departments. METHODS: The Center for the Study of Complementary and Alternative Therapies, University of Virginia, surveyed staff in 10 emergency departments in the southeast region of the United States with the purpose of exploring ED practitioners' personal use of complementary therapies and recommendations of these therapies to patients. RESULTS: ED staff reported back rub or massage, music, and prayer or spiritual practices as the 3 most frequently used complementary therapies for personal well-being. Back rub or massage and spiritual practices including prayer and group support were most frequently recommended to patients. Clinicians expressed interest in acquiring additional knowledge of complementary therapies and support for integration of these therapies in emergency departments. CONCLUSIONS: Use of complementary therapies for personal well-being and for patient care by ED staff in the southeast region of the United States is limited. Most ED staff are not familiar with these therapies, but a majority of staff (70%) want to learn more about them. Findings suggest that ED nurses would like additional training in, and better referral patterns to, complementary therapies.

Adult↗