Understanding cancer survivors' information needs and information-seeking behaviors for complementary and alternative medicine from short- to long-term survival: a mixed-methods study

Education about complementary and alternative medicine in cancer self-help groups by trained peers

PURPOSE

On average, about 50% of cancer patients use complementary and alternative medicine (CAM) in addition to conventional cancer treatment. Since there is a high need for information, patients often search for information about CAM and share experiences with peers, especially in self-help groups. In this study, we tested and evaluated an educational concept developed for group leaders of cancer self-help groups on how to approach the topic of CAM in their peer groups.

METHODS

The educational concept has been developed and piloted with health care professionals and representatives from different self-help organizations in Germany. It aims to inform and discuss the possibilities and limitations of CAM in terms of scientific evidence, to reflect user behavior, and to provide a guide on how to find and evaluate reliable and evidence-based information sources. First, self-help group leaders took part in an on-site training where they were educated on various CAM topics with the goal of being able to conduct the educational concept in their respective self-help groups. Then, the educated group leaders performed this concept in their groups. The educational concept was evaluated by both the group leaders and participants with respect to acceptance, usefulness, and satisfaction using paper-pencil questionnaires. The study was conducted in Germany based on an observational study design with a six-month follow-up. For the analyses, descriptive and univariate statistics for dependent samples were used.

RESULTS

A total of n = 50 interested group leaders conducted the educational program in their groups. The most common implementation barriers were organizational or structural problems, as well as the feeling of being overwhelmed with managing the program in their groups. A total of n = 423 participants were educated with this program by their respective group leaders. The majority felt satisfied with the educational program and improved their knowledge about CAM. At the six months follow-up (T2), significantly more participants had consulted their physicians to inform themselves about CAM and felt more confident in finding reliable information about CAM.

CONCLUSIONS

In this observational study, we have managed to successfully implement an educational concept with respect to the topic of CAM in cancer self-help groups. Based on the results, the concept approach will be modified to include both a CAM- professional and group leader to train the self-help groups. In the future, the effects of the program should be tested by a randomized trial.

Health information needs and feedback of users in the online TCM community

To improve the information service quality of the online Traditional Chinese Medicine (TCM) community, this study investigated users' information needs, feedback and the relationship between them. Using qualitative content analysis, the basic characteristics of users' needs were obtained. Logistic regression was used to explore the impact of different need characteristics of feedback. The main findings are as follows: 1) Disease consultation, health preservation, professional discussion, knowledge sharing and experience description are the major 5 types of information needs in the online TCM community; 2) Some users provided TCM-related information, such as the tongue image and the TCM four diagnosis; 3) A total of 78.8% of the posts received effective feedback, and the main types of feedback were answering, discussing, inquiring and emotional supporting; 4) Providing enough information can significantly and positively affect whether needs receive effective feedback, suggesting that users can present information about their condition in as many different formats as possible when articulating their needs.

Communication Between Cancer Patients and Physicians About Complementary and Alternative Medicine: A Systematic Review

Objectives: Complementary and alternative medicine (CAM) has become increasingly popular among cancer patients and is often used concomitantly with standard cancer therapies. Nonetheless, disclosure of CAM utilization by cancer patients to physicians, along with the provision of information on CAM therapies by physicians, is poor. This review explores the literature to synthesize existing information on communication about CAM usage, reasons for nondisclosure, and the clinical implications thereof. Methods: A search of medical literature published between December 1, 2009, and October 1, 2021 (last searched on April 18, 2022), on communications between physicians and cancer patients about CAM treatments was conducted through MEDLINE and EMBASE. Results were screened for inclusion, dually reviewed, and assessed using the QualSyst quality appraisal instrument. Findings were categorized and synthesized for review. Results: A total of 30 articles were located (n = 8721 total participants), which discussed elements related to patient disclosure of CAM use (n = 16), provider experiences or perceptions related to communication about CAM (n = 3), patterns of this communication (n = 6), and recommendations for effectively discussing CAM with cancer patients (n = 5). Reports indicate that nondisclosure is common throughout the cancer care spectrum. Factors influencing nondisclosure range from patient beliefs and attitudes about their provider, demographic characteristics, disease progression, physician-patient relationship, physician noninquiry, and type of CAM used; ultimately creating a gap in care that may have serious medical implications. Discussion: Many of the studies identified are small and confined to a single-center, hospital-network, or geographic setting, thereby limiting the applicability of findings and recommendations. Nonetheless, improving patient-physician communication is essential in delivering evidence-informed, patient-centered care and crucial for achieving patient satisfaction and positive health outcomes. The lack of adequate CAM dialogue about CAM use increases the risk of adverse interactions with conventional cancer treatments and results in missed opportunities for providers and patients to engage in vital information exchange. Future research and education are necessary to further identify barriers surrounding patient-provider communication about CAM treatments.

Who Knows? Information Received, and Knowledge about, Cancer, Treatment and Late Effects in a National Cohort of Long-Term Childhood, Adolescent and Young Adult Cancer Survivors

Simple Summary

With the growing population of cancer survivors, survivorship management has become central for both medical professionals and patients. This entails, among other factors, empowering survivors with the necessary knowledge about their medical history and their risk for late effects, because informed patients make better lifestyle and health choices. Although a lack of information and low satisfaction with information received are fairly well-documented phenomena among childhood cancer survivors, less is known about survivors of young adult cancer and populations of long-term survivors no longer engaged in follow-up care. This paper aims to fill this gap by investigating information provision in childhood, adolescent and young adult cancer survivors.

Abstract

Background: Knowledge of medical history and late effects is central in modern survivorship management, especially for long-term childhood, adolescent and young adult cancer survivors’ (CAYACS) with long life expectancy rates and high risks of late effects. Identifying information and knowledge gaps is, therefore, important. As part of the population-based NOR-CAYACS study, we investigated the following: (1) written information received about their disease and treatment, and any information about late effects; (2) satisfaction with this information and associated factors; (3) knowledge about late effects and factors associated with low knowledge of specific late effects. Material and methods: A questionnaire-based survey (Nor-CAYACS) was mailed to 5361 CAYACS (childhood cancers, breast and colorectal cancer, acute lymphatic leukemia, non-Hodgkin lymphoma and malignant melanoma) identified by the Cancer Registry of Norway (CRN). Of these, 2018 answered questions about disease and late effects information and knowledge. Exposure variables were extracted from the questionnaire and CRN. Unfortunately, it was not possible to stratify by treatment in the analyses. We ran descriptive statistics for comparisons and logistic regressions to identify factors associated with outcomes of interest. Results: Overall, 50% to 60% of survivors reported not having received written information about their disease and treatment, or any information about late effects. There was a large variation in reported knowledge across 17 late effects. Lower levels of knowledge were associated with male sex, lower education and poorer health literacy in multivariable regression models. Conclusions: Knowledge of cancer history and risks of late effects is essential for effective self-management, yet significant information and knowledge gaps were reported in this population-based sample of long-term CAYACS. Systematic approaches to making (up-to-date) information available to long-term survivors are needed to ensure that information does not get lost in medical and life transitions.

Patients´ perception of the quality of community pharmacy services using the critical incident technique

Background/Aim. The Critical Incident Technique (CIT) is a qualitative research method for measuring consumer satisfaction by collecting and analyzing information on participants and their activities. This method allows participants to present their detailed experiences related to a particular service in the way they perceive them. The aim of this study was to examine patients' perceptions of an incident that occurred in community pharmacies using CIT and determine recommendations for improving the quality of pharmacy services. Methods. A qualitative study using an interview based on the CIT was conducted in three pharmacies in Serbia, on the territory of Krusevac city. The entire course of the interviews was audio-recorded, which provided detailed research. Results. A total of 68 critical incidents were collected and divided into two groups: positive (37) and negative (31), depending on the (dis)satisfaction of patients with the services of pharmacists in community pharmacies. The following thematic clusters of pharmacy services were covered: accessibility of community-based pharmaceutical services, pharmacist behavior, patient counseling, dispensing drugs and/or medical devices, compounding, and pharmacy sales/commercial practice. Conclusion. The results show that the CIT is a useful tool for evaluating and improving pharmaceutical services. Based on the data collected, various aspects of community pharmacy services can be improved, and further research should be carried out.

Implementation of Acupuncture in Routine Oncology Care: A Comparison of Physicians’, Nurses’, Physiotherapists’ and Acupuncturists’ Practice and Beliefs

Background:

It is important to investigate beliefs in acupuncture in professionals because professionals’ expectations may affect treatment outcomes.

Aim:

To document the type, number, and education of professionals practicing acupuncture. Further, to compare beliefs about the effectiveness of acupuncture for common cancer related symptoms in the different types of professionals.

Methods:

This cross-sectional study employed a questionnaire on practice and beliefs regarding acupuncture effects for symptoms that commonly occur in patients treated within oncology care settings. The respondents (n = 555) consisted of oncology professionals that is, physicians (n = 133), nurses (n = 172), and physiotherapists (n = 117). Additional respondents consisted of acupuncturists (n = 133), working outside approved health care.

Results:

Of the respondents, acupuncture was practiced by 4% of the physicians, 6% of the nurses, 58% of the physiotherapists, and 90% of the acupuncturists. The professionals believed acupuncture to be effective for pain (of the physicians, nurses, physiotherapists, and acupuncturists, 94%, 98%, 89%, and 99% respectively believed in the effectiveness), chemotherapy-induced nausea (corresponding figures: 74%, 89%, 89%, and 93%), and vasomotor symptoms (corresponding figures: 71%, 81%, 80%, and 97%). The physicians believed acupuncture to be effective in a mean of 5 symptoms, nurses in 6 symptoms, physiotherapists in 6 symptoms, and acupuncturists in 10 symptoms ( P < .001).

Conclusions:

Since the professionals varied substantially regarding practice, education and beliefs in acupuncture, oncology clinics may consider delivering patient preferred acupuncture according to evidence-informed guidelines rather than on varying preferences among the professionals, since professionals’ treatment expectations may modify treatment outcomes.

Identifying gaps in consumer health library collections: a retrospective review

Background:

The objective of this study was to determine if search request forms, which are used when a patron's request for information cannot be fulfilled at the time of contact with the library team, can be used to identify gaps in consumer health library collections.

Case Presentation:

Search request forms were collected from 2013 to 2020 and analyzed independently by two reviewers. Search request forms were included if they were complete and contained a record of how the request was fulfilled. Descriptive statistics were used to summarize patron characteristics. Search request forms were iteratively coded to identify themes in the data and determine if resources provided to patrons could be found within the library collection. The study team subsequently reviewed search request forms to determine reasons for identified gaps. Two hundred and forty-nine search request forms were analyzed. Six main content themes were identified: 1) understanding the cancer diagnosis, 2) cancer treatments, 3) understanding disease prognosis, 4) support during and after treatment, 5) natural health products and therapeutic effects in oncology, and 6) research literature. The majority of patrons were patients (53%). Over half (60%) of the submitted search request forms reflected collection gaps, and many (16%) contained queries for information about rare cancer diagnoses. The main reason that queries could not be satisfied was that there was limited consumer health information on the requested topics (53%).

Conclusions:

Search request forms are a useful resource for assessing gaps in consumer health library collections.

Alternative Medicine-Seeking Behavior among Cancer Patients at The Indonesian Cancer Foundation

Background: A large proportion of cancer deaths are caused by patient delay in accessing hospital treatment. One of the causes of such delays is the use of alternative medicine. Purpose: This research is conducted to determine the characteristics and factors related to the behavior of seeking treatment in the form of alternative medicine among cancer patients at the Indonesian Cancer Foundation (Yayasan Kanker Indonesia). Methods: This research is a quantitative descriptive research with a cross-sectional study design. The target of the research is all patients who temporarily stayed at the Yayasan Kanker Indonesia from February–April 2020, a total of 45 patients aged ≥ 17 years who had been diagnosed with cancer. The data was obtained via questionnaires and interviews. The variables examined are the predisposition factors (sex, age, education, occupation, stage of cancer, time ranges for accessing health services after symptom onset, prior illness, family history), enabling factors (distance to health services, income, health insurance), and reinforcing factors (family support and information resources). Analysis of research data was conducted using frequency tables and Chi-Square or Fisher's Exact test. Results: The factors related to the behavior of seeking treatment via alternative medicine in cancer patients at Yayasan Kanker Indonesia are the stage of cancer (p=0.04), the time span between symptom onset and checking into health services (p=0.02), and length of illness (p=0.03). Conclusion: Alternative treatment search behavior is influenced by several factors, namely the stage of cancer, the time span between symptom onset and checking into health services, and the length of illness.

"It's natural so it shouldn't hurt me": Chemotherapy patients' perspectives, experiences, and sources of information of complementary and alternative medicines

BACKGROUND AND PURPOSE

Minimal evidence regarding the safety and efficacy of complementary and alternative medicine (CAM) use during chemotherapy is accompanied with a high prevalence of use and nondisclosure to health professionals. This study aimed to explore patients' perspectives, experiences, support needs, and sources of information regarding CAM use during chemotherapy.

MATERIALS AND METHODS

Semi-structured interviews with ten adult participants who recently completed chemotherapy treatment at a large hospital in Australia were transcribed verbatim. Three investigators thematically analysed the interviews.

RESULTS

These participants receiving chemotherapy valued CAMs as a natural complement to chemotherapy to improve wellbeing, with their use most strongly influenced by past experiences rather than expert advice.

CONCLUSION

Health professionals would benefit from education on how to best inform patients of the potential risks, harms and lack of efficacy for CAM use during chemotherapy in a way that does not lead to patient non-disclosure of CAM use.

Needs, preferences, and experiences of adult cancer survivors in accessing dietary information post-treatment: A scoping review

INTRODUCTION

To support provision of healthy lifestyle information tailored to patients' needs and preferences, this review maps adult cancer survivors' self-reported needs, preferences, and experiences accessing dietary information post-treatment.

METHODS

A scoping review of research published within the past decade conducted using PRISMA-ScR guidelines. Seven databases were searched in June 2020.

RESULTS

Of 15,973 articles identified, 57 met eligibility criteria. Studies most frequently included survivors of breast cancer (49%), persons aged 40+ years (95%), ≤5 years post-diagnosis (54%), and residing in North America (44%). Cancer survivors commonly identified needing information regarding healthy eating, particularly practical skills, and support in changing dietary behaviours. Preferences included specific recommendations, direct communication with healthcare professionals, and peer support from other cancer survivors. In practice, survivors frequently reported receiving generic advice from healthcare professionals, limited dietary follow-up, and lack of referral to support. Unmet needs in healthcare settings led to dietary information-seeking elsewhere; however, survivors indicated difficulty identifying credible sources. Personal beliefs and desire for involvement in care motivated dietary information-seeking post-treatment.

CONCLUSION

Cancer survivors' experiences accessing dietary information post-treatment do not align with needs and preferences. Less is known about survivors who are young adults, >5 years post-diagnosis, and living in rural areas.

Potential factors that influence usage of complementary and alternative medicine worldwide: a systematic review

OBJECTIVES

To determine similarities and differences in the reasons for using or not using complementary and alternative medicine (CAM) amongst general and condition-specific populations, and amongst populations in each region of the globe.

METHODS

A literature search was performed on Pubmed, ScienceDirect and EMBASE.

KEYWORDS

'herbal medicine' OR 'herbal and dietary supplement' OR 'complementary and alternative medicine' AND 'reason' OR 'attitude'. Quantitative or qualitative original articles in English, published between 2003 and 2018 were reviewed. Conference proceedings, pilot studies, protocols, letters, and reviews were excluded. Papers were appraised using valid tools and a 'risk of bias' assessment was also performed. Thematic analysis was conducted. Reasons were coded in each paper, then codes were grouped into categories. If several categories reported similar reasons, these were combined into a theme. Themes were then analysed using χ2 tests to identify the main factors related to reasons for CAM usage.

RESULTS

231 publications were included. Reasons for CAM use amongst general and condition-specific populations were similar. The top three reasons for CAM use were: (1) having an expectation of benefits of CAM (84% of publications), (2) dissatisfaction with conventional medicine (37%) and (3) the perceived safety of CAM (37%). Internal health locus of control as an influencing factor was more likely to be reported in Western populations, whereas the social networks was a common factor amongst Asian populations (p < 0.05). Affordability, easy access to CAM and tradition were significant factors amongst African populations (p < 0.05). Negative attitudes towards CAM and satisfaction with conventional medicine (CM) were the main reasons for non-use (p < 0.05).

CONCLUSIONS

Dissatisfaction with CM and positive attitudes toward CAM, motivate people to use CAM. In contrast, satisfaction with CM and negative attitudes towards CAM are the main reasons for non-use.

Open dialogue about complementary and alternative medicine (CAM) integrated in conventional oncology care, characteristics and impact. A systematic review

OBJECTIVE

To systematically review evidence on the characteristics, experiences and impact of an open dialogue about complementary and alternative medicine (CAM) integrated in oncology care.

METHODS

We searched MEDLINE, EMBASE, AMED, Scopus, ProQuest Dissertations and Thesis, Cochrane Central Register, clinicaltrials.gov, forskningsdatabase.dk and PROSPERO. Two reviewers screened title, abstract and full-text articles. Each study was appraised using the Critical Appraisal Skills Programme (CASP) and synthesized narratively. PROSPERO registration CRD42019112242.

RESULTS

We retrieved 4736 articles and included 5; 3 received 9 ½, 1 received 9, and 1 received 5 points on the CASP score. Predominately, the open dialogue was one or two individual, patient-centered, face-to-face consultations led by oncology physicians. In one study, it was a tele-phone consultation and in another it was structured counseling led by pharmacists. Integrated information and recommendations about CAM contributed to high level of satisfaction and improvement in concerns, quality of life and well-being.

CONCLUSION

Integration of open dialogue about CAM in oncology care including acknowledging patients' preferences, values, wishes and knowledge, and providing information about CAM expands the opportunities for improving patients' health, quality of life and well-being.

PRACTICE IMPLICATIONS

Open dialogue about CAM has potentials, but research on how it specifically helps patients, is needed.

Optimizing Community and Hospital Services Using the Cancer Support Source Program

Background:

The Cancer Support Community developed the Cancer Support Source (CSS) to assess the needs of cancer patients with distress. Each item on this self-administered questionnaire represents an area of concern which the patient rates and indicates their need for action with a “staff person,” but no details about the category of staff is given.

Objective:

To examine the factor structure of the CSS and to increase its utility to triage patients for referral to services based on a needs assessment.

Methods:

Data from 690 patients who completed the CSS over a 1-year period were analyzed. In study 1, an exploratory principal component analysis was conducted. In study 2, the fit of this proposed model was evaluated with confirmatory factor analysis (CFA).

Results:

Three factors were retained in the final CFA: emotional distress, physical health concerns, and resource needs. This model demonstrated adequate fit, Root Mean Square Error of Approximation (RMSEA)= 0.056, Comparitive Fit Index (CFI) = .907, Standardized Root Mean Square Residual (SRMR) = 0.050.

Conclusions:

Three factors are proposed as CSS subscales to guide referral and coordinate services: Emotional Distress/Patient and Family Counselor, Physical Health Concerns/Medical Care Provider, and Resource Needs/Case Management-Clinical Social Worker. The clinical utility of these referral subscales should be established with additional research.

Health and Psychosocial Self-Care Needs in Off-Therapy Childhood Cancer: Hybrid Model Concept Analysis

PURPOSE

The self-care concept is a complicated and multi-dimensional phenomenon. There are different opinions about self-care needs; therefore, this study was conducted to clarify the self-care needs of the off-therapy childhood cancer survivors based on the hybrid model.

PATIENTS AND METHODS

There are three phases in the hybrid model including literature review, fieldwork, and final analysis. At the theoretical phase, 119 articles in databases were evaluated without time limits up to August 2019. At the fieldwork phase, 19 participants were selected with purposive sampling and interviewed through unstructured interviews. Then, the data were analyzed by qualitative content analysis approach. In the final phase, the overall analysis of the two previous phases was carried out and the ultimate definition of self-care needs was presented with the integration of the results of two previous phases.

RESULTS

Theoretical results showed that self-care needs are those that need to be performed by off therapy childhood cancer in everyday life in order to maintain health and well-being through the practice of healthy behaviors and activities. Also, fieldwork results indicated that self-care needs are increased due to the physical, mental, and social vulnerability of the disease. Following that, the need for protective self-care behaviors to prevent against physical and psychosocial side effects arises. If the patients are unable to implement protective behaviors, the need for support from others is created. Therefore, by synthesizing the findings of literature review and fieldwork, self-care needs are two-dimensional concept: (1) need for changing in behavior to protect themselves against physical and psychosocial distress and (2) need for supporting to implement care.

CONCLUSION

Taking into account the self-care needs, healthcare providers can support childhood cancer survivors in gaining and maintaining independency in self-care. On the other hand, the results of this study by creating a basic knowledge in the field of self-care needs can be used in the development of policy and standards of care to meet the needs of this group.

Digital divide and Internet health information seeking among cancer survivors: A trend analysis from 2011 to 2017

OBJECTIVE

The current study aims to explore the trend of Internet health information seeking (IHIS) in cancer survivors and the relationship between four dimensions of digital divide (eg, mental access, material access, skills access, and usage access) and IHIS.

METHODS

Data from three iterations (2011, 2013, and 2017) of Health Information National Trends Survey were analyzed. Only cancer survivors (2011: n=563; 2013: n=459; 2017: n=504) were included. ANOVA and multivariate regressions were performed.

RESULTS

The rate of IHIS among cancer survivors has increased from 53.5% in 2011 to 69.2% in 2017. Also, across the three survey years, material access (eg, physical Internet access), usage access (eg, eHealth activities), and mental access (eg, trust in online health information) have remained in a significant and positive relationship with IHIS. Skills access (eg, health information seeking skills) and the other mental access factor, self-efficacy in health information seeking, were not significantly associated with IHIS over time.

CONCLUSIONS

This research revealed a rising trend of IHIS adoption in cancer survivors, and demonstrated significant relationships between digital divide and IHIS. We call for targeted interventions to reduce the digital divide barriers for cancer survivors.

From parallel to partnership

PURPOSE

In the USA, there has recently been an unprecedented convergence of complementary/alternative medicine (CAM) with mainstream biomedical care. This confluence may lead to a deeply rooted philosophical conflict. This qualitative study works to identify factors that health-care leaders can use, which will build a pathway to greater integrative practice between medical doctors and CAM practitioners - from parallel existence to partnership - by examining the tensions between biomedical medicine and naturopathic medicine. The purpose of this study is to offer short-term suggestions for partnership and long-term recommendations for better understanding.

DESIGN/METHODOLOGY/APPROACH

An original qualitative study using semi-structured with CAM practitioners and biomedical practitioners.

FINDINGS

Areas of conflict that are preventing synergy are identified and a pathway for health-care leaders to follow to create greater integration and partnerships is suggested.

RESEARCH LIMITATIONS/IMPLICATIONS

This is a qualitative and exploratory study that has significant limitations on generalizability.

PRACTICAL IMPLICATIONS

This study suggest steps that both types of health-care practitioners can take to increase their success at working together on an individual level, a group level, an organizational level and on an industry-wide basis, as well as provide a specific pathway to create greater integrative practice for health-care leaders.

SOCIAL IMPLICATIONS

The results indicate that stronger partnerships between different types of medical practitioners increase patient choice, patient satisfaction and outcomes.

ORIGINALITY/VALUE

Increasing interested in CAM modalities is driving more contact between CAM practitioners and biomedical practitioners. This contact is best established in partnership between practitioners rather than in parallel. This original research outlines the sources of conflict and provides recommendations for encouraging greater synergy.

The Critical Incident Technique: Method or Methodology?

The critical incident technique (CIT) is a qualitative research tool that is frequently used in health services research to explore what helps or hinders in providing good quality care or achieving satisfaction with care provision. However, confusion currently exists on the nature of the CIT: Is it a method for data collection and analysis or a methodology? In this article, I explain why this distinction is important and I argue that the CIT is a methodology (and not a method) for the following reasons: Key methodological dimensions are described for the CIT; it has a clear focus; studies that apply this technique make use of various methods for data collection and analysis; it describes, explains, evaluates, and justifies the use of a specific format for those methods; it implies philosophical and practical assumptions; and studies that use the CIT cannot easily make use of additional methodologies simultaneously.