The problematic nature of conflating use and advocacy in CAM integration: Complexity and differentiation in UK cancer patients’ views
Philip Tovey
School of Healthcare, University of Leeds, Leeds, United Kingdom
Alex Broom
School of Social Science, University of Queensland, St Lucia QLD, Australia
PP: 384 - 395
Abstract
The integration of complementary and alternative medicine into cancer care is widely debated. Advocates of integration frequently cite the popularity of such therapies amongst patients in support of their case. However, little specific empirical attention has been given to how integration is actually regarded by these patients.
Based on semi structured interviews with 80 cancer patients in the UK, this article examines the assumption of a link between use and support for integration. On the basis of this study we argue that:
- A characterisation of unequivocal cancer patients' support for integration (even amongst those who use CAM) is an over-simplification and distortion of the situation
- It is inappropriate to conflate ‘use' with ‘advocacy'
- Patients' engagement with the idea of integration is complex and multi-layered; and
- This complexity can be explicated by looking at key dimensions of an integrative process: evidence and risk, cost, and provider legitimacy.
Keywords
complementary and alternative medicine, cancer, integration, UK, sociology
Article Text
Calls for the integration of complementary and alternative medicine (CAM) into cancer care are ubiquitous. The notion of ‘integrative medicine' has been hotly debated in the medical literature over the last decade (eg Caspi et al 2000; Ernst 2005a). However, there still exists little or no consensus on what integration actually means in oncology contexts, or indeed, the most effective means of achieving ‘an integrative approach' to cancer care. Much of the debate about integration in cancer care has centred on evidence production and the degree to which CAM therapies can be justified in a UK policy context espousing evidence-based practice (Ernst 2005a). Regardless of such debates, pockets of grassroots integration are becoming more evident in the UK, particularly in the context of palliative and hospice care (Broom & Tovey 2007). However, little empirical attention has been given to how attempts at integration are actually regarded by cancer patients.
The work which has been done in the area of CAM and cancer has focused on what cancer clinicians and other biomedical stakeholders think of actual or potential integration (eg Hewson et al 2006). As a consequence, a tendency to conflate use of CAM services with support for the process of integration into state funded services has emerged. It is regularly assumed that the majority of cancer patients' view CAM integration as prima facie good (eg Frenkel & Borkan 2003). However, this assumption has little empirical evidence to back it up. While high levels of personal usage amongst cancer patients (see Cassileth & Vickers 2005) may translate into widespread support for integration into public service delivery, this cannot be treated as inevitable. To date, we know little about cancer patients' views of: the benefits and limitations of integration; the relative importance of evidence in driving integration; the relationship between financial cost versus physiological (and psychological) benefit; and finally, the importance of the context of delivery (ie location/provider type) on experiences of integrative care.
The aim of this article is to examine empirically this assumption of cancer patients' support for CAM integration. In so doing we argue that:
- A characterisation of unequivocal cancer patients' support for integration (even amongst those who use CAM) is an over-simplification and distortion of the situation
- It is inappropriate to conflate ‘use' with ‘advocacy'
- Patients' engagement with the idea of integration is complex and multi-layered; and
- This complexity can be explicated by looking at key dimensions of an integrative process: evidence and risk, cost, and provider legitimacy.
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References
Baum M (2006) Use of ‘alternative' medicine in the NHS, The Times May 23.
Berman B (2003) Integrative approaches to pain management: How to get the best of both worlds, British Medical Journal 326: 1320-1321.
Broom A and Tovey P (2007) Therapeutic pluralism? Evidence, power and legitimacy in UK cancer services, Sociology of Health and Illness 29(3): 551-569.
Canter P, Thompson-Coon J and Ernst E (2005) Cost effectiveness of complementary treatments in the United Kingdom: Systematic review, British Medical Journal 331: 880-881.
Caspi O, Bell I, Rychener D, Gaudet T and Weil A (2000) The tower of Babel: Communication and medicine. An essay on medical education and complementary/alternative medicine, Archives of Internal Medicine 160: 3193-3195.
Cassileth B and Vickers A (2005) High prevalence of complementary and alternative medicine use among cancer patients: Implications for research and clinical care, Journal of Clinical Oncology 23(12): 2590-2592.
Chong O (2006) An integrative approach to addressing clinical issues in complementary and alternative medicine in an outpatient oncology center, Clinical Journal of Oncology Nursing 10(1): 83-88.
Ernst E (2002) The risk-benefit profile of commonly used herbal therapies: Ginkgo, St John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava, Annals of Internal Medicine 1: 136(1): 42-53.
Ernst E (2005) Is homeopathy a clinically valuable approach? Trends in Pharmacological Sciences 26(11): 547-548.
Ernst E (2005a) Second thoughts on integrative medicine, Journal of Family Practice 54(2): 154-155.
Frisch N (2001) Standards for holistic nursing practice: A way to think about our care that includes complementary and alternative modalities, Online Journal of Issues in Nursing 6(2) Available at http://www.nursingworld.org/ojin/topic15/tpc15_4.htm.
Horrigan B (2003) Michael Lerner, PhD, MD, mindbody medicine, Alternative Therapies 8(6): 91-99.
Pittler MH and Ernst E (2003) Systematic review: Hepatotoxic events associated with herbal medicinal products, Alimentary Pharmacology and Therapeutics 18(5): 451-471.
Foundation for Integrated Medicine (2006) Integrated healthcare: A way forward for the next five years? Foundation for Integrated Medicine.
Frenkel M and Borkan J (2003) An approach for integrating complementary-alternative medicine into primary care, Family Practice 20: 324-332.
Hewson M, Copeland H, Mascha E, Arrigain S, Topol E and Fox J (2006) Integrative medicine: Implementation and evaluation of a professional development program using experiential learning and conceptual change teaching approaches, Patient Education and Counseling 62(1): 5-12.
Lafferty W, Bellas A, Corage-Baden A, Tyree P, Standish L and Patterson R (2004) The use of complementary and alternative medical providers by insured cancer patients in Washington State, Cancer 100(7): 1522-1530.
Lengacher C, Bennett M, Kip K, Gonzalez L, Jacobsen P and Cox C (2006) Relief of symptoms, side effects, and psychological distress through use of complementary and alternative medicine in women with breast cancer, Oncology Nursing Forum 33(1): 97-104.
McClean S (2005) ‘The illness is part of the person': Discourses of blame, individual responsibility and individuation at a centre for spiritual healing in the north of England, Sociology of Health and Illness 27(5): 628-648.
Milligan M, Fanning M, Hunter S, Tadjali M and Stevens E (2002) Reflexology audit: Patient satisfaction, impact on quality of life and availability in Scottish hospices, International Journal of Palliative Nursing 8(10): 489-496.
Pham B, Klassen T, Lawson M and Moher D (2005) Language of publication restrictions in systematic reviews gave different results depending on whether the intervention was conventional or complementary, Journal of Clinical Epidemiology 58(8): 769-776.
Weiger W, Smith M, Boon H, Richardson M, Kaptchuk T and Eisenberg D (2002) Advising patients who seek complementary and alternative medical therapies for cancer, Annals of Internal Medicine 137: 889-903.
Vickers A (2000) Recent advances: Complementary medicine, British Medical Journal 321: 683-686.
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