Oncologists’ and specialist cancer nurses’ approaches to complementary and alternative medicine and their impact on patient action
Introduction
The dynamics between complementary and alternative medicine (CAM) and biomedicine have been regularly examined within the sociological literature (e.g. Hirschkorn & Bourgeau, 2005; Mizrachi, Shuval, & Gross, 2005). Such analyses have focused on the management of professional boundaries and the centrality of notions of evidence, efficacy and professionalism in shaping inter-professional dynamics. However, little is known about how inter- and intra-professional dynamics are manifested at a grassroots level in clinical contexts, and importantly, how patients make sense of these and how they may impact on patient action. This paucity of research is particularly evident in cancer care, where ironically, CAM use seems to be most prolific (e.g. Ernst & Cassileth, 1998; Lewith, Broomfield, & Prescott, 2002; Rees et al., 2000). In this specific disease context the responses of biomedical clinicians to patients’ treatment preferences are of particular importance given the level of emotion and anxiety reported in treatment decision-making processes (see Arora, 2003; Hack, Degnera, & Parker, 2005). Moreover, effective communication about CAM has been reported by both cancer patients and clinicians to enhance the patient/practitioner relationship (Roberts et al., 2005).
Such patient-practitioner exchanges do not exist in a vacuum. Indeed, drawing on work from other areas of health research, the actual extent to which biomedical clinicians are actually pivotal to contemporary patient action on CAM is open to question. A plurality of information sources, such as the Internet (Broom, 2005), the influence of friends and family (Maly, Umezawa, Ratliff, & Leake, 2006), and the ‘plurality of experts’ (Giddens, 2001), evident in the CAM field are all characteristic of a multi-dimensional decision-making environment. In this context the impact and influence of those at the apex of formal legitimate authority (cancer specialists and, to a different extent, cancer nurses) requires fresh empirical examination. This paper presents the findings from a Department of Health-funded study with cancer patients in the UK. It addresses their interpretation of key processes (see Methods section). Specifically, the paper considers: (1) patient experience with cancer specialists and specialist cancer nurses about non-biomedical treatment options at this time of potential or actual ‘integration’; (2) the impact of the attitudes and approach of biomedical practitioners on patient engagement with CAM; (3) how processes are played out between oncologists and specialist nurses and how this impacts on patients.
Section snippets
Background
The inter-professional dynamics between CAM and biomedicine have received significant attention from health sociologists over the last two decades. Key concerns have been the occupational dominance of biomedicine and the ongoing peripherisation of many CAM modalities in the context of primary care (see Hirschkorn & Bourgeau, 2005). To a certain degree we have seen a gradual encroachment by CAM modalities such as acupuncture, chiropractic and osteopathy on biomedical territory for specific
Methods
After ethics approval was secured, we approached three NHS teaching hospitals and one partially NHS-funded hospice involved in cancer and palliative care services in the north of England. This project was a 30-month qualitative study utilising in-depth interviews. Patients were recruited via posters placed in oncology wards and patient information and support centres. The final sample included 80 cancer patients with a good distribution of ages from 20 to 87 and representation from all major
Results
Patients reported three distinct responses from their medical specialists regarding their CAM use or interest in using CAM—responses which had very specific impacts on patient action. These were: (a) explicit negativity; (b) supportive ambivalence; and, (c) pragmatic acceptance. We identify broad patterns of correspondence between specialists’ responses to CAM usage and patient action. Despite the theoretical possibility of a plurality of influences on patient action, oncologists’ reactions to
Discussion
The aim of this study was to examine cancer patients’ accounts of their clinicians’ attitudes towards CAM and the ways in which dialogue within the patient/practitioner encounter shapes their perceptions of and usage of CAM. Specifically, we were interested in the range of oncologists’ views encountered by patients; their apparent impact on action; and, the role of specialist cancer nurses as a further source of professional input for patients. As with all research, our methods clearly impacted
Acknowledgements
We would like to thank the anonymous referees for their helpful comments on an earlier draft of this paper. This work was funded by the UK Department of Health. Award no.: 09/02.
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