Integrating complementary and alternative medicine (CAM) into standard hospice and palliative care

In the United States, there are 629 million visits to complementary and alternative medicine (CAM) providers each year. Many adults appear to value both conventional and CAM approaches. Because of this public interest and promising evidence that CAM relieves suffering and improves quality of life, we established a program of CAM, known as Integrative Palliative Care (IPC), in a US hospice. This paper outlines our strategy of collaborative relationships with community schools of traditional Chinese medicine (TCM), massage, and harp therapy. It also describes the use of volunteers and small grants and donations to develop and maintain a program of CAM in the hospice setting. The difficulties of research design, problems with tracking outcomes, and the shortcomings of providing therapies with this model are discussed.     

The role of complementary and alternative medicine (CAM) in Germany – A focus group study of GPs

Background  

There has been a marked increase in the use of complementary and alternative medicine (CAM) in recent years worldwide. In Germany, apart from 'Heilpraktiker' (= state-licensed, non-medical CAM practitioners), some general practitioners (GPs) provide CAM in their practices. This paper aims to explore the attitudes of GPs about the role of CAM in Germany, in relation to the healthcare system, quality of care, medical education and research. Furthermore, experiences of GPs integrating CAM in their daily practice were explored.     

Breast cancer survivors' perceptions of complementary/alternative medicine (CAM): making the decision to use or not to use

The study described in this article explored breast cancer survivors' perceptions and experiences as they decided whether to use a variety of complementary/alternative therapies. Six focus groups were conducted composed of women who had been diagnosed with breast cancer. Each 2-hour session was audiotaped and transcribed verbatim. In this article, the process by which the participants made the decision to use or not to use complementary/alternative therapies, including their discovery and investigation of complementary/alternative medicine (CAM) and their experiences using or not using CAM, are described. Barriers to using CAM included cost, access, and time. Family and friends generally supported the decision to use CAM; however, the participants described health care practitioners' reactions as mixed.     

Complementary and alternative medicine (CAM) use among children with current asthma

Objective

To estimate the prevalence of complementary and alternative medicine (CAM) use among children with current asthma.

Design

We analyzed data from the Asthma Call Back Survey (ACBS) 2006-2008. ACBS is a follow-up to the state-based Behavioral Risk Factor Surveillance System (BRFSS) survey that collects information on asthma and related factors including CAM use for asthma. The survey is administered to the parents who report in a subset of BRFSS states that their children have asthma. 5435 children had current asthma and were included in this analysis.

Results

Overall, 26.7% (95% confidence interval [CI] = 24.5-29.0) of children with current asthma reported CAM use in the previous 12 months. Among them, the three most commonly used therapies were breathing techniques (58.5%; 95% CI = 53.6-63.5), vitamins (27.3%; 95% CI = 23.0-31.5), and herbal products (12.8%; 95% CI = 9.2-16.4). Multivariate analysis of CAM use revealed higher adjusted odds ratios (aOR) among children who experienced cost barriers to conventional health care compared with children with no cost barrier (aOR = 1.8; 95% CI = 1.2-2.8). Children with poorly controlled asthma were most likely to use all types of CAM when compared to their counterpart with well-controlled asthma: aOR = 2.3 (95% CI = 1.6-3.3) for any CAM; aOR = 1.7 (95% CI = 1.2-2.6) for self-care based CAM; and aOR = 4.4 (95% CI = 1.6-9.3) for practitioner-based CAM.

Conclusions

Children with poorly controlled asthma are more likely to use CAM; this likelihood persists after controlling for other factors (including parent's education, barriers to conventional health care, and controller medication use). CAM is also more commonly used by children who experienced cost barriers to conventional asthma care. CAM use could be a marker to identify patients who need patient/family education and support thus facilitate improved asthma control.     

Pregnancy,risk perception and use of complementary and alternative medicine

Pregnancy and childbirth are events of major significance in women’s lives. In western countries women are increasingly using complementary and alternative medicine during this time. However, there is little research exploring the factors that are influential in women’s motivations to use complementary and alternative medicine during pregnancy and childbirth. This article draws on data from a narrative-based study designed to explore women’s experiences of complementary and alternative medicine use during pregnancy and childbirth. The study involved 14 women living in the South-west of England, who had used complementary and alternative medicine during pregnancy and childbirth. We elicited narratives by interviewing women two to three times. The women in our study used complementary and alternative medicine both as a response to the uncertainty of pregnancy and childbirth and as a defence against manufactured risk, and in doing so indicated their desire to transform an unpredictable and unmanageable future into one which is more predictable and manageable. It was a means of dealing with the stress and anxiety associated with uncertainty which has to be dealt with. Their consciousness of the risks of biomedicine developed though the practice of complementary and alternative medicine, and their high educational status and relative affluence facilitated their choices. There was a tension evident in their narratives between a need to ‘be in control’ versus a desire for a natural childbirth without medical intervention. Women in the study showed their autonomy by actively pursuing complementary and alternative medicine while at the same time selectively using expert medical knowledge.     

Acculturation and the use of complementary and alternative medicine

The use of complementary and alternative medicine (CAM) has been growing substantially in the US in recent years. Such a growth in CAM use coincides with an ongoing increase in the proportion of the foreign-born population in the US. The main objective of this study is to examine the relation between acculturation and the use of CAM therapies among immigrants. Data from a CAM supplement to the 2002 National Health Interview Survey were analyzed to estimate the effects of acculturation on the likelihood of using different CAM therapies over the past 12 months prior to the survey. The results suggest that the level of acculturation-as measured by nativity/length of stay in the US and language of interview-is strongly associated with CAM use. As immigrants stay longer in the US or as their use of English becomes more proficient, the likelihood that they use CAM therapies increases as well, and it gradually approaches the level of CAM use by native-born Americans. Moreover, this relation between acculturation and CAM use generally persists even after the effects of socioeconomic status, health insurance coverage, self-reported health status, and other demographic variables have all been taken into consideration. The substantially lower rates of CAM use by recent immigrants and its possible causes warrant further research.     

Ethnic differences in use of complementary and alternative medicine at midlife: longitudinal results from SWAN participants

OBJECTIVES: We estimated the prevalence and longitudinal correlates of use of complementary and alternative medicine (CAM) at midlife among participants of the Study of Women's Health Across the Nation (SWAN). METHODS: Multiple logistic regression was used to evaluate the relationship between baseline survey-reported symptoms and use of herbal, spiritual, and physical manipulation therapies 1 year later. RESULTS: Almost half of all women had used CAM in the past year. Baseline psychological symptoms were associated with subsequent use of spiritual therapies among White and Chinese women. Baseline CAM use was a major predictor of subsequent use in White, Japanese, and Chinese women. CONCLUSIONS: Baseline CAM use, rather than presence of symptoms, was the major predictor of subsequent CAM use. Premenopausal health behaviors are important determinants of choice of therapy during midlife.     

Effectiveness of pertussis vaccination in New South Wales,Australia, 1996-1998

Pertussis notifications have increased over the past decade in Australia and other industrialised countries. This study estimates the effectiveness of pertussis vaccination in one Australian State (New South Wales, NSW) among children aged less than 14 years, during a period when an Australian whole-cell pertussis vaccine was in routine use. Cases notified with pertussis between 1996 and 1998 and pertussis vaccine coverage estimates from the Australian Childhood Immunisation Register were used. Vaccine effectiveness (VE) was calculated using the screening method, with adjustment for age group, year of disease onset and area of residence. VE was highest (91%) in the youngest age group (8–23 months) and lowest (78%) in the oldest age group (9–13 years). Pertussis vaccination is highly effective at preventing pertussis in NSW children, as measured by notified cases. Ongoing monitoring will be important to evaluate VE following Australia's change to an acellular vaccine based program.     

Trends in complementary/alternative medicine use by breast cancer survivors: Comparing survey data from 1998 and 2005

Background  

Use of complementary and alternative medicine (CAM) by women with breast cancer is often said to be increasing, yet few data exist to confirm this commonly held belief.     

Race/ethnicity and women's use of complementary and alternative medicine in the United States: results of a national survey

Objectives. We studied the use of complementary and alternative medicine (CAM) among women in 4 racial/ethnic groups: non-Hispanic Whites, African Americans, Mexican Americans, and Chinese Americans.

Methods. We obtained a nationally representative sample of women aged 18 years and older living in the United States in 2001. Oversampling obtained 800 interviews in each group, resulting in a sample of 3068 women.

Results. Between one third and one half of the members of all groups reported using at least 1 CAM modality in the year preceding the survey. In bivariate analyses, overall CAM use among Whites surpassed that of other groups; however, when CAM use was adjusted for socioeconomic factors, use by Whites and Mexican Americans were equivalent. Despite the socioeconomic disadvantage of African American women, socioeconomic factors did not account for differences in CAM use between Whites and African Americans.

Conclusions. CAM use among racial/ethnic groups is complex and nuanced. Patterns of CAM use domains differ among groups, and multivariate models of CAM use indicate that ethnicity plays an independent role in the use of CAM modalities, the use of CAM practitioners, and the health problems for which CAM is used.

     

Trends in the use of complementary and alternative medicine in the United States: 2002-2007

In this study we seek to assess recent trends in complementary and alternative medicine (CAM) use based on a comparative analysis of data from the 2002 and 2007 National Health Interview Survey (NHIS). The findings suggest that CAM use, in particular the use of provider-based CAM therapies such as chiropractic care, massage, and acupuncture, have grown significantly in the U.S. This growth was more pronounced among non-Hispanic Whites than among racial and ethnic minorities, increasing an already existing White-minority gap in CAM use. Findings from this study also reveal that CAM use becomes more likely when access to conventional care has been restricted. In both 2002 and 2007, having unmet needs in medical care or having delayed care due to cost were associated with a higher chance of CAM use.     

A public health agenda for traditional,complementary, and alternative medicine

Traditional medicine (a term used here to denote the indigenous health traditions of the world) and complementary and alternative medicine (T/CAM) have, in the past 10 years, claimed an increasing share of the public's awareness and the agenda of medical researchers. Studies have documented that about half the population of many industrialized countries now use T/CAM, and the proportion is as high as 80% in many developing countries. Most research has focused on clinical and experimental medicine (safety, efficacy, and mechanism of action) and regulatory issues, to the general neglect of public health dimensions. Public health research must consider social, cultural, political, and economic contexts to maximize the contribution of T/CAM to health care systems globally.     

Sociocultural barriers to the use of complementary and alternative medicine for HIV

The author investigated sociocultural barriers that constrain use of complementary and alternative medicine (CAM) in the lives of people with HIV. Qualitative interviews with 62 persons with HIV revealed that 73% (n = 45) of interviewees were classified as potential users of CAM. These included both users and nonusers who expressed interests in using CAM or specific modalities but did not use. The demand for CAM was constrained to the extent that participants were unable to incorporate CAM into their health strategies. Three main CAM constraints dealt with obstacles stemming from the Culture of Medicine, the Social Organization of Alternative Medicine, and Everyday Life. From these constraints, the author drew conclusions about sociocultural factors that slow the diffusion of CAM into mainstream health practices.