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Surveys of complementary and alternative medicine: part IV. Use of alternative and complementary therapies for rheumatologic and other diseases.

This fourth review in the series covers eight recent U.S. surveys on complementary and alternative medicine (CAM) use by patients with rheumatologic and other autoimmune conditions, and summarizes seven studies of other disease categories. Regarding the previous reviews, the acronym CAM is used unless it is possible to refine the concepts. This reflects the problem that most survey questionnaires do not differentiate between adjunct or complementary therapies and alternative approaches to treatment.

Attitude to Health↗

Physicians' attitudes towards the use of complementary therapies (CTs) by cancer patients in Finland.

This study describes physicians' attitudes towards the use of complementary therapies (CTs) by cancer patients in Finland. Responses to 33 Likert-type statements were received from 234 physicians; the response rate was 50.6%. The questionnaire items were analysed separately and using five sum variables. Data analysis was based on descriptive statistics, chi-square and t-tests and analysis of variance. Attitudes among physicians and oncologists in particular were quite critical. Over four-fifths of the physicians (86%) were doubtful whether CTs should be used at all, given the scarcity of solid research evidence on their benefits. Three quarters (75%) referred to unknown risk factors, half (51%) were of the opinion that CTs should not be used in cancer care at all. On the other hand 58% believed that CTs could help to relieve stress and anxiety among cancer patients, and 79% wanted to see scientific testing to establish the effects of CTs. The most positive attitude towards CTs was shown by general practitioners and non-specialized physicians. Positive attitudes were associated with personal CT use, with recommending CTs to patients and with a high level of interest to participate in CT training. The physicians did not believe the specific CTs singled out for investigation would help patients to recover from cancer. They thought that the use of CTs by cancer patients was motivated by future hope, a determination to do everything possible to cure the cancer and the perception of CTs as a last resort. The result that professional attitudes towards CTs are quite critical in Finland presents a very special challenge to the relationship between physicians and patients: it is crucial that physicians know enough about CTs so that they can discuss the issue with patients and provide relevant advice and guidance on their use.

Adult↗

Reasons for complementary therapies and characteristics of users among HIV-infected people.

The aim of this study was to analyse in a large sample of HIV-infected subjects the expectations toward complementary therapies (CT) and the characteristics of users. Self-administered anonymous questionnaires were distributed in seven European countries among HIV-infected subjects consecutively attending the offices of AIDS organizations. Among 632 ever CT users, nutritional supplements (124 subjects) and psycho-physiological approaches (116 subjects) were the most frequent CT used: 61.4% used CT to improve energy. Half the CT users wanted to prevent or alleviate the highly active antiretroviral therapy (HAART) side effects. General malaise and neuropathy were the most common HAART side effects, where CT users found improvement (62.0% and 54.7%, respectively). Acupuncture improved neuropathy in a high proportion of subjects (87.5%); whereas for others CT were considered less effective (range 20.0-36.4%). The most common expectations from CT were to improve energy and to prevent or alleviate the HAART side effects. This suggests that HIV-infected people expect not so much specific help as general support from CT.

Adult↗

Complementary therapies. Therapeutic touch: a nursing function.

Therapeutic touch has been practised for some time, but like most complementary therapies, it carries images of being 'unscientific' for many sceptical practitioners. The author defines the therapy, then summarises some of the research which measured its effectiveness. Therapeutic touch, she believes, helps patients to get themselves into the best state for self-healing to occur.

Complementary Therapies↗

Complementary therapies education in midwifery.

Midwives and their clients are becoming increasingly interested in the use of complementary and alternative therapies which offer a variety of different strategies for dealing with the effects of pregnancy and childbirth. This paper explores the current provision of complementary therapy education for midwives, and suggests the establishment of a new clinical specialism of complementary therapies in midwifery.

Complementary Therapies↗

New therapy complementary to transcatheter arterial embolization for hepatocellular carcinoma.

A new therapy complementary to transcatheter arterial embolization (TAE) in which anticancer agents are percutaneously injected into the tumor under ultrasound guidance (percutaneous injection chemotherapy combined with TAE; TAE-PICT) has been developed and found to be effective. A total of 68 hepatocellular carcinoma (HCC) nodules in 50 patients were treated with TAE-PICT, and the complications were evaluated. Among those with solitary HCC nodules < or = 5 cm in diameter, 17 were treated with TAE-PICT and 24 with only TAE in a prospective comparative study. No major complications were seen, and the anticancer drugs could still be found in the tumor 3 months after injection. A significantly higher cumulative survival rate (p= 0.03961) and significantly higher cumulative recurrence-free survival rate (p = 0.00647) were achieved in patients treated with TAE-PICT than in those treated with TAE alone.

Aged↗

Complementary therapies in long-stay neurology in-patient settings.

Complementary therapies have been embraced by many nurses, but the effectiveness of such regimes on the wellbeing of patients has never been researched successfully. This article describes a pilot study which evaluated their effects on long-stay neurology patients.

Aged↗

Long-term breast cancer survivors' use of complementary therapies: perceived impact on recovery and prevention of recurrence.

OBJECTIVE: Many cancer survivors use some form of complementary therapy (CT); this is particularly true for women with breast cancer. The majority of reports on CT use in women with breast cancer have focused on CT use during cancer treatment or within a year or two of treatment completion. The purpose of this study was to evaluate longer-term breast cancer survivors' (average, 8.7 years) frequency of CT use and their beliefs about the role of CT in cancer recovery and the prevention of cancer recurrence, as well as the relationship of CT use with current life satisfaction. METHODS: A mail survey was completed by 608 breast cancer survivors a minimum of 2 years after their most recent cancer diagnosis. Participants were contacted through the American Cancer Society Reach to Recovery program in Florida. The self-report questionnaire inquired about the use of various CTs, beliefs about CT, current life satisfaction, demographic characteristics, and cancer treatment history. RESULTS: Most of the respondents were older than 50, were Caucasian, were married, had attended or completed college, and were at least 5 years after breast cancer treatment. The most commonly used CTs included exercise, vitamins, prayer/spiritual practice, support groups, humor, self-help books, and relaxation. These survivors used CT therapies because they wanted to play a more active role in their cancer recovery, to manage stress, and to maintain hope. A majority of them reported that they used CT to reduce the risk of cancer recurrence. Use of CT was not correlated with life satisfaction. CONCLUSIONS: Most of the breast cancer survivors in this study had used some form of CT since the time of their most recent cancer diagnosis and believed that such therapies could be of significant benefit, despite a lack of correlation between CT use and current life satisfaction. Many believed that use of CT may prevent cancer recurrence. It is important, therefore, to investigate the efficacy of various CTs among longer-term cancer survivors, especially with regard to their potential in preventing cancer recurrence.

Adult↗

Complementary therapy use among older rural adults.

OBJECTIVE: Explore use, cost, and satisfaction with the quality and effectiveness of complementary therapy among older rural adults. DESIGN: Descriptive survey. SAMPLE: A random sample of 325 older adults from rural communities throughout Montana and North Dakota. MEASUREMENTS: Participants were interviewed by telephone. RESULTS: Only 57 participants (17.5%) had used complementary providers and most sought this care for chronic problems, heard about providers through word-of-mouth information, and were satisfied with the care. A total of 35.7% (116) used self-directed complementary practices and most used these practices for health promotion, heard about them through informal sources, and found them to be at least somewhat helpful. Of the 325 participants, 45.2% (147) used some form of complementary care, e.g., providers, self-directed practices, or both. Participants used as much complementary care as is found in national studies. Most spent relatively little out-of-pocket for complementary care. CONCLUSIONS: Understanding the health care choices that older rural residents make, including complementary health care, is paramount for a comprehensive approach to meeting their health care needs.

Aged↗

Relatives' lived experiences of complementary therapies in a critical care department--a phenomenological study.

This phenomenological study examined relatives' lived experiences of complementary therapies in the Department of Critical Care Medicine at Royal Hobart Hospital. Participants in the study, 20 relatives of critically ill patients, were involved in a non-structured, audiotaped interview. Subsequently, transcripts were analysed using a phenomenological transformative process to identify common themes in the text. Study findings suggested four emerging conceptual categories, which with further analysis uncovered the essence of the phenomenon as extending and enriching a caring atmosphere.

Adolescent↗

An analysis of paper-based sources of information on complementary therapies.

This study involved an investigation into the availability of paper-based publications containing information on complementary therapies (CTs) within a single cancer centre in the North West. The publications were collected during a 1-week period in July 2003 from the four most likely locations in the site that a patient would visit, to ensure that the research related to data that was readily available. An evaluation grid was developed, and the quantity and quality of the data presented about CTs were analysed. A total of 80 publications were collected. Forty-five (56.3%) related to breast cancer specifically, of which only six (20.7%) made reference to CTs. Thirty-five (43.8%) related to cancer in general, of which only 16 (45.7%) made reference to CTs. The type of information relating to CTs was of very limited value to assist in reaching any decisions as to their use. As a result, it was recommended that the healthcare service prepare and publish a leaflet, specifically relating to the use of CTs in the treatment of cancer, to be freely available within the site for the use of its breast cancer patients.

Bibliometrics↗

Developing a tool to measure holistic practice: a missing dimension in outcomes measurement within complementary therapies.

Despite the wide and continuing debate over the relevance of particular research methods to evaluate complementary therapies, less attention has been given to what outcome criteria and measures to use and/or whether these have a sufficient breadth in perspective. While complementary and alternative medicine researchers have paid heed to the importance of measuring the subjective experience of therapy users, they have left unmeasured the notion of holism, in particular, the measurement of the effect of the interaction between therapist and therapy user, and its underlying philosophy of health and healing. This paper reports on an exploratory, qualitative study aimed at developing a measure of holism and holistic practice. It draws out some key features requiring measurement and provides insight into the emerging measure. Further development work is needed before the measure can be used within research or routine practice.

Complementary Therapies↗

Complementary therapies and their role in nursing care.

This article aims to develop the nurse's knowledge of the range of complementary therapies available and how they can benefit patients. It relates to UKCC Professional Development categories Care enhancement and Patient, family, client and colleague support.

Complementary Therapies↗

Complementary therapies for diabetes: the case for chromium, magnesium, and antioxidants.

A growing body of interest on the possible beneficial role of chromium, magnesium, and antioxidant supplements in the treatment of diabetes has contributed to debate about their value for reaching metabolic control and to prevent chronic complications in diabetic subjects. In this article we use a systematic approach focused on clinically based evidence from clinical trials regarding the benefits of chromium, magnesium, and antioxidant supplements as complementary therapies in type 2 diabetes. Chromium, magnesium, and antioxidants are essential elements involved in the action of insulin and energetic metabolism, without serious adverse effects. However, at present there is insufficient clinically based evidence and its routine use in the treatment of type 2 diabetes is still controversial. Because the most frequent origin of deficiencies in micronutrients is an inadequate diet, health care providers should invest more effort on nutrition counseling rather than focusing on micronutrient supplementation in order to reach metabolic control of their patients. Results from long-term trials are needed in order to assess the safety and beneficial role of chromium, magnesium, and antioxidant supplements as complementary therapies in the management of type 2 diabetes.

Animals↗

How oncologists discuss complementary therapy use with their patients: an audio-tape audit.

Understanding the dynamics of oncologist-patient communication regarding complementary therapy (CT) use is essential for the development of much-needed clinical guidelines. Discussions of CT use in 314 audio-taped initial consultations between cancer patients and their oncologists were identified and coded. Patients' anxiety levels and coping styles were also assessed. Reference to CT use was found in 91 consultations (29%). Patients and kin initiated most CT discussions, commonly during discussions of patients' medical history, treatment options or prognosis. In half of these discussions, patients volunteered that they were currently using a CT or were considering its use. Discussion of CT use was more likely to occur in consultations with patients who were younger, were better educated, spoke poorer English, had metastatic disease or limited life expectancy and expressed higher levels of fighting spirit and anxious preoccupation and lower levels of fatalism. The most commonly discussed CTs were: changes in diet; use of multivitamins, vitamin C or antioxidants; and having a positive attitude or fighting spirit. The doctor's overall response to CTs was most frequently coded as "encouraging", although 35% of attempts to initiate discussion were ignored by the oncologist. Doctors were more likely to make encouraging statements about CTs typically perceived to be potentially helpful versus potentially harmful. The current findings point to a need for practical consensus on how to communicate with cancer patients on the subject of CT use so that patients can receive the support and guidance that they are seeking from their oncologists.

Adaptation, Psychological↗

Determinants of the use of complementary therapies by patients with cancer.

PURPOSE: We performed a survey of Israeli oncology patients to examine the extent of their use of complementary therapies (CT) and to compare sociodemographic, psychologic, and medical characteristics, attitudes, and quality of life of users and nonusers of CT. PATIENTS AND METHODS: Questionnaires were administered to 1,027 patients attending ambulatory and inpatient hematology or oncology facilities at three hospitals. Medical information was extracted from charts. Univariate and multivariate comparisons of users and nonusers of CT were performed. RESULTS: A total of 526 participants (51.2%) had used CT since their diagnosis, and 357 patients (34.9%) had used CT recently (in the past 3 months). Factors that multivariate analysis found to be significantly associated (P <.05) with recent CT use were as follows: female sex; age 35 to 59 years; more education; coming to the hospital by private car; advanced disease status; having a close friend or a relative with cancer; and attending support groups or individual counseling. After controlling for these factors, individually examined psychosocial variables associated with recent CT use included the following (odds ratios [OR] with 95% confidence intervals [CI]): needs unmet by conventional medicine (OR, 2.76; 95% CI, 1.95 to 3.89); helplessness (OR, 1.39; 95% CI, 1.0 to 1.91); incomplete trust in the doctor (OR, 1.49; 95% CI, 1.08 to 2.06); and changed outlook or beliefs since the diagnosis of cancer (OR, 1.47; 95% CI, 1.07 to 2.02). Functional quality of life (including physical, emotional, social, and role function) and symptom (fatigue and diarrhea) scores were significantly worse for recent CT users compared with nonusers, controlling for age, sex, and current disease status. CONCLUSION: Characteristics associated with CT use include age, sex, education, and advanced disease. Significant associations between CT use and attending supportive psychotherapy, unmet needs, helplessness, and worse emotional and social function indicate considerable distress, suggesting that increased attention to psychosocial needs within oncologic settings is warranted.

Adolescent↗

[Complementary therapies in palliative cancer care].

The use of complementary and alternative medicine (CAM) has grown in popularity both among the general population and among the cancer patients. Cancer patients often use CAM, which is a treatment that is not commonly used in the conventional setting. However, the prevalence of CAM use appears to vary substantially, with reported frequency of use of at least one CAM therapy ranging from 20% to 83.3%. Complementary medicine has become an important aspect of palliative cancer care. Acupuncture, aromatherapy, homeopathy, hypnotherapy, massage, reflexology, relaxation techniques, and spiritual healing are frequently used forms of treatment. The purpose of this article is to provide information about some complementary therapies that are commonly used by cancer patients in the palliative care.

Complementary Therapies↗

Current issues in the delivery of complementary therapies in cancer care--policy, perceptions and expectations: an overview.

This review discusses the current policies, perceptions and expectations around the use of complementary therapies (CTs) in cancer care. Whilst the last two decades have seen a marked increase in the demand for and provision of CTs amongst cancer patients, this has not been matched with an increase in the understanding of their effectiveness or their benefits to cancer patients. The issues discussed highlight the need to understand more fully the benefits of integrated services. Important questions raised here relate to what patients perceive as being the primary benefits/expected outcomes of CTs and how, if at all, they see their relationship with CT practitioners as different from that with "orthodox" clinicians. The challenge is clearly to find a common ground between "orthodox" professionals, CT practitioners and patients.

Attitude of Health Personnel↗