Alternative,complementary, and conventional medicine: is integration upon us?

In attempts to improve their health and/or combat illness, approximately 4 in 10 Americans will use a complementary and alternative medicine (CAM) therapy this year. CAM therapies vary widely, with acupuncture, chiropractic, herbal medicine, and homeopathy among the more prominent modalities. CAM therapies are used in addition to and/or instead of the more conventional forms of medical care available in U.S. hospitals or licensed physicians' offices. A rapidly increasing interest in CAM has led to a nascent movement aimed at integrating various CAM therapies with the conventional health care system. In Washington State, for example, health insurance coverage for CAM therapies has been mandated, and a number of "integrated" delivery systems have been born. Although the political and economic forces leading to adoption and integration of CAM therapies vary widely by geographic locale, it is likely that some degree of integration will occur throughout much of the United States. Similar processes are occurring in Canada, Europe, and Australia, and indeed within middle and upper level socioeconomic strata worldwide. This paper identifies potential barriers and facilitators to potential integration, of medical disciplines and argues for an accessible, multidisciplinary and evidence-based, yet humanistic and patient-oriented approach.     

Complementary and alternative methods of treatment of neck pain

The enthusiasm for complementary and alternative medicine (CAM) is worldwide and is based on the public perception that these approaches are safe and effective. In reality, however, this attitude is based more on cultural and anecdotal experiences than on stringent scientific trials. Because neck pain is a common and disabling symptom that frustrates both patients and physicians, this article reviews the applicability of several CAM therapies for the treatment of neck pain. Despite the long history of CAM, more systematic and better designed, randomized, placebo-controlled trials are needed to determine which approaches have merit. This article recognizes the shortcomings of conventional therapies and encourages clinicians to explore additional treatment options. It is hoped that in the future greater acceptance and integration of CAM can be based on sound scientific results.     

Thai nurses’ perspectives on the use of complementary and alternative medicine among Thai breast cancer survivors in northern Thailand

Breast cancer survivors are more likely to seek complementary and alternative medicine (CAM) for their health and well‐being than other cancer patients. The purpose of the study was to describe how Thai nurses perceive the use of CAM in Thai breast cancer survivors. An ethno‐nursing research method was used. Fifteen Thai nurses who had experience in taking care of Thai breast cancer survivors who used CAM from a tertiary care referral and resource centre in the lower northern part of Thailand were interviewed. Two major themes emerged from this study: Meaning of care practices in CAM was seen as: (i) an additional beneficial choice for health; and (ii) emotional and psychological healing. Nurses should be concerned about CAM use in Thai breast cancer survivors. Open communication about CAM helps ensure that safe and holistic care is provided. Further research to enhance integration of CAM into health care is needed.     

General practitioners, complementary therapies and evidence-based medicine: the defence of clinical autonomy

Amidst the substantial change currently gripping primary health care are two developments central to contemporary debate regarding the very nature, territory and identity of general practice - the integration of complementary and alternative medicine (CAM) and the rise of evidence-based medicine (EBM).This paper reports findings from a study based upon 25 in-depth interviews with general practitioners (GPs) personally practising complementary therapies alongside more conventional medicine to treat their NHS patients. The paper outlines the GPs' perceptions of EBM, its relationship to their personal development of CAM, and their notions of good clinical practice more generally. Analysis of the GPs' accounts demonstrates how CAM can be seen as a useful resource with which some GPs defend their clinical autonomy from what they perceive to be the threat of EBM.     

Using complementary and alternative therapies wisely

Growing numbers of consumers are using complementary and alternative medicine (CAM). Many of these therapies offer effective approaches to the management of chronic conditions and the promotion of health. However, they are not without risks. This article discusses the risks associated with common CAM therapies and offers practical suggestions to promote the safe integration of CAM with conventional care.     

Blending the boundaries: steps toward an integration of complementary and alternative medicine into mainstream practice

Complementary and alternative medicine (CAM) is growing in popularity among patients traditionally seen in an allopathic setting. A literature review and information search was conducted to determine the trend in demand for and the availability of CAM in the United States. The results of major surveys show that there is an increase in the use of CAM in the United States. The best predictor of CAM use is higher level of education. In addition, findings reveal that the field of CAM is poorly researched. Many studies in CAM therapies have flaws, such as insufficient statistical power, poor controls, inconsistent treatment, and lack of comparisons. The National Center for Complementary and Alternative Medicine of the National Institutes of Health, has declared their top strategic priority to be investing in research. Currently, more than 70 medical schools offer some type of training in alternative medicine, although there are few guidelines for curriculum and there is considerable heterogeneity in content, format, and requirements among CAM courses. As patients have greater access to information, their needs and values change. They become more involved in their overall health care and are taking a more natural and holistic approach to achieving well-being. Health care practitioners, both allopathic and alternative, must be well informed. There is an imperative to make CAM research a high priority. Valid and reliable empirical data must document the clinical efficacy and safety of CAM practices. In order to integrate CAM into the mainstream, there must be a coordinated effort among all the entities involved. Physicians need to be familiar with proven CAM therapies in order to advise patients about these modalities and the potential benefits and limitations. CAM practitioners should be licensed and regulated in scope of practice to provide a high standard of care, and be sufficiently educated in conventional medical science(s) in order to recognize how, where, and why their respective complementary practice is most effective for integration.     

Communicating facts and knowledge in cancer complementary and alternative medicine

OBJECTIVES: To review written resources disclosing reliable facts and knowledge in cancer complementary and alternative medicine (CAM). DATA SOURCES: Conventional and biomedical and complementary and alternative medicine journals, electronic media, full text databases, electronic resources, and newsletters. CONCLUSION: Sources of CAM information are numerous. The inherent quality of this information fluctuates. High-quality sources of cancer CAM information are available and accessible for health care providers. IMPLICATIONS FOR NURSING PRACTICE: As the use of CAM therapies becomes more commonplace in consumer health care, it is critical that health care providers are cognizant of available sources of high-quality CAM facts and knowledge and possess the ability to discuss this information with colleagues and consumers in the scientific and lay communities.     

The spectrum of therapeutic influences and integrative health care: classifying health care practices by mode of therapeutic action

The growing popularity of complementary and alternative medicine (CAM) and integrative medicine (IM) highlight the need for a clinically relevant system for classifying health care practices. All systems, modalities, and techniques of health care (conventional, complementary, alternative, and traditional) can be organized in categories of "primary mode of therapeutic action." This results in six categories: biochemical; biomechanical; mind-body; energy; psychological (symbolic); and nonlocal. In each category, there are subdivisions. Organizing health care by primary mode of therapeutic action has numerous benefits: (1) conventional and CAM practitioners, and the public, can readily see some of the general similarities and differences among practices; (2) health care educators gain a common foundation and shared language for explaining CAM and IM; (3) professionals and the public, wishing to combine dissimilar practices, gain a common framework for evaluating the meaning of integration; and (4) the crossover problem can be understood as a natural occurrence in health care, not a confusing intellectual dilemma. The National Center for Complementary and Alternative Medicine (NCCAM) system of categories for CAM is briefly critiqued.     

Nurse Practitioners’ Role in Complementary and Alternative Medicine: Active or Passive?

Complementary and alternative medical (CAM) therapies are emerging as a significant force that is shaping the delivery of health care in the United States. The physician-scientists of conventional medicine are slowly easing into the process of evaluating and integrating CAM therapies. After all factors are considered, should the role of NPs in this process be active or passive? This article explores reasons why NPs should or should not take an active role in evaluating and integrating CAM therapies. It proposes a role that NPs could have in determining the influence of complementary and alternative medicine on their clinical practice. Key words: Alternative medicine, complementary medicine, nurse practitioners     

Complementary approaches to palliative oncological care

The popularity of complementary and alternative medicine (CAM) has increased tremendously in recent years. Thus, it is imperative to distinguish between alternative therapies that can be dangerous and complementary therapies that are primarily palliative and augment conventional treatment. Memorial Sloan-Kettering Cancer Center's Integrative Medicine Service offers complementary therapies to patients in an attempt to improve quality of life and provide symptom management. In addition to clinical services, it also provides education to health care professionals and the public and performs clinical and laboratory research on complementary modalities and the antitumor properties of botanicals. If CAM is to be accepted by mainstream medicine, research must be done usingstandard research methodologies.     

Challenges and Future Directions for Integrative Medicine in Clinical Practice

The best medical practice involves the integration of the therapies taken from the full range of available healthcare options, applied after considering the circumstances of each individual patient. This requires a knowledge of both conventional and non-conventional therapies along with a consideration of the personal preferences of both the practitioner and the patient in the context of informed consent, the strength of the available scientific evidence, the range of possible alternatives, the associated costs and risks versus the potential benefits of treatment, as well as the availability, accessibility and immediacy of treatment. Effective integration is often difficult to achieve as there are many obstacles to the implementation of complementary and alternative medicine (CAM) in mainstream practice. These include the credentialing and regulation of complementary therapists, the development of appropriate funding models for supporting the delivery of CAM services within the mainstream health system, along with obstacles around the production, dissemination and use of evidence about CAM, as the hurdles for producing and evaluating evidence are often placed considerably higher for CAM than for conventional medicine. A further obstacle to integration relates to interdisciplinary collaboration that is hampered by differences in philosophy and nomenclature between disciplines, few interdisciplinary associations or forums where interdisciplinary issues can be discussed, along with competition for clients and unequal status and access to public funding. Despite these obstacles, progress is being made. The research base for CAM is continually expanding, there is a growing recognition of the need for cross-training of conventional and complementary practitioners, and complementary therapies such as yoga, massage, meditation and hypnosis appear to be widely accepted in mainstream general practice. However, this acceptance may be based on the perception that these therapies are relatively safe and do not threaten to usurp the role of the general practitioner rather than scientific evidence of their efficacy and safety. Collaboration requires an environment of shared understanding, mutual respect and trust. The fostering of interdisciplinary collaboration therefore requires open communication between patients, conventional medical practitioners and complementary therapists along with appropriate education and training programmes. As the practice of medicine is also intricately linked with the socio-political and cultural environment, the successful implementation of integrative medicine will also require a cultural shift across the public and private sector that creates an imperative for all health professionals to work together for the benefit of their patients and the wider community.     

Complementary and alternative therapies in occupational health. Part II--Specific therapies.

Dossey (2001) says, "The nurse serves as a facilitator and helps assist the patient and his or her significant others to be in the best state for healing to take place. Nurses are in a unique position to be instruments of healing at all times." According to Fitch (1999), "A fundamental goal of nursing is to comfort." Complementary and alternative therapies offer many self care and comforting remedies help employees prevent disease and promote healing. Occupational health nurses have the ability to educate employees and offer guidance about CAM therapies; encourage self care management of minor complaints; and encourage employees, when appropriate, to seek health care. As employees' use of CAM continues to increase, occupational health nurses need to monitor use of CAM therapies among employees. Nurses should inform the employer, case managers, and insurance companies involved about the potential increase in CAM use to promote changes in the health care system and integrate conventional and CAM therapies as needed. Further research related to CAM therapies continues as the health care system warrants safe, effective, and cost effective ways to promote health and prevent or manage illness.     

Integrating Complementary and Alternative Therapies in an Outpatient University Hospital Setting

Introduction

As the use of complementary and alternative medicine (CAM) therapies increases, the integration of these therapies requires collaboration with conventional medicine and healthcare disciplines. The purpose of this article was to characterise the profile of patients seeking CAM therapies at the University of Colorado Hospital’s outpatient Center for Integrative Medicine.

Methods

Data were collected on demographic and disease characteristics, methods of payment and referral sources to assess comparison with previous studies.

Results

A total of 853 patients were seen for integrative therapies in a 23-month time period. Patients ranged in age from 14 to 89 years old and were predominately female (75%). Thirty-two percent of patients were referred by a hospital-based clinic. The majority of patients sought care for symptoms related to pain disorders, with musculoskeletal diagnoses comprising the majority of cases. Cancer patients most often sought treatment in the form of acupuncture/traditional Chinese medicine and massage therapy.

Discussion/conclusion

An integrative medicine programme can exist in a hospital-based setting and provide meaningful cross-disciplinary treatment and dialogue. Although there are differences among populations, locations and treatment centres as to the types of conditions for which CAM therapies are sought, the forecast for continued integration of CAM services in a university hospital is promising.     

Developing the complementary and alternative medicine education infrastructure: baccalaureate programs in the United States

OBJECTIVES: Efforts to build a complementary and alternative medicine (CAM) education and research infrastructure have been productive. Development has focused largely on graduate, postgraduate, and professional level training. This paper examines baccalaureate programs, looking at the prevalence and characteristics of CAM and holistic health training in the United States. DESIGN: A comprehensive literature and web site search was conducted to find educational institutions offering baccalaureate programs in CAM or holistic health. Search criteria included accredited undergraduate programs terminating in a minor, an AA, or a BA/BS degree. RESULTS: A search of health and education databases produced marginal results. Internet searches, by contrast, were very productive in locating CAM or holistic health-related programs generally and baccalaureate programs specifically. The most effective search strings included terms such as "holistic health," "minor," "certificate," and "undergraduate." Using these terms, 5 programs were found in the United States that met the inclusion criteria: Arizona State University East, Bastyr University, San Francisco State University, Metropolitan State College of Denver, and Georgian Court College. CONCLUSIONS: Preparing tomorrow's scholars and clinicians to contribute meaningfully to this emerging healthcare paradigm will require a plan that integrates all elements of higher education. The creation of a truly effective workforce of CAM-competent M.D.s, nurses, health educators, pharmacists, and other allied health professionals will increasingly necessitate baccalaureate preparation. Curriculum discussions at the campus, state, and national levels are needed.     

An integrative approach to addressing clinical issues in complementary and alternative medicine in an outpatient oncology center

Complementary and alternative medicine (CAM) is popular among patients with cancer and often is used in conjunction with conventional medicine, mostly without the knowledge or guidance of healthcare professionals. The popularity of CAM has brought into sharp focus clinical issues such as the lack of disclosure and concern about interactions among dietary supplements, prescribed medications, and diseases. Those clinical issues underscore the need for a coordinated approach to integrate CAM therapies safely into conventional medicine. This article describes how an integrative CAM program in an outpatient oncology center addresses some of the clinical issues. The CAM program uses a nurse specialist to interface between CAM and conventional medicine. An interesting aspect of the CAM program is the provision of patient consultation and the creation of an individualized complementary therapies plan.     

Complementary and alternative medicine in pediatric oncology

OBJECTIVES: To summarize research in complementary and alternative medicine (CAM) therapies used for children with cancer and to explore issues and directions for measuring outcomes of CAM therapies in children. DATA SOURCES: Scientific and research articles, internet for active research studies. CONCLUSION: CAM is increasingly used as adjunctive cancer therapies in pediatrics. Mind-body and touch therapies have the greatest evidencefor effectiveness in reducing psychological and physical stressors. Supplements and herbal therapies receive the greatest interest, however, and more research is needed to determine efficacy in improving symptoms or outcomes in children with cancer. IMPLICATIONS FOR NURSING PRACTICE: Mind-body and touch therapies can be used by nurses to reduce symptoms and anxiety in children. Potential risks and benefits should be determined for therapies that have no evidence.     

Complementary and alternative medicine in mainstream public health: a role for research in fostering integration

In light of the increased utilization of complementary and alternative medicine (CAM) in recent years, there is an increased possibility that CAM approaches could prove to be important factors in public health, particularly if used within an integrative framework together with mainstream medicine. There exists a defined need for research to explore the integration of conventional health care and CAM approaches, as well as define mechanisms of CAM-based therapies to facilitate such integration. Essential to these goals is the accumulation of a database derived from outcomes-based clinical and basic science investigations. We posit that that CAM clinicians need to be more thoroughly trained as researchers, skilled in developing and recording results of pragmatic studies that could provide credible evidence for the use of CAM in the public sector health care. It is proposed that this may be best achieved through a three-tiered system in which (1) clinician-scientists of both mainstream and alternative disciplines recognize the value of research designed to foster such integration; (2) educational and health care institutions must develop academic and clinical training programs that examine and delineate each disciplines' respective strengths and weaknesses; and (3) such programs are attractive to, and receive continued extramural subsidy. In the broadest sense, such a paradigmatic approach to CAM integration could create a common basis for scientific dialogue, encourage exchanges between medical communities, and establish policies for the development of a true multidisciplinary health care cooperative that is consistent with the current public health model.     

Complementary and alternative medicine for older adults with venous leg ulcer pain

Chronic pain management is an important, and often under-addressed, component in the care of older adults with venous leg ulcers (VLUs). Clinicians caring for older adults with VLUs must consider and address both the physiological and psychosocial aspects of chronic pain. Traditional pharmacological approaches to pain management are only part of the solution. One strategy is to adopt a more holistic approach to chronic pain management that includes complementary and alternative medicine (CAM) therapies. Unfortunately, there is a paucity of CAM research that focuses on the pain management of older adults with VLUs. Despite these limitations, pain management that includes discussion of relevant CAM modalities must be a priority for clinicians caring for older adults living with VLUs.