Use and comprehension of complementary and alternative medicine in breast cancer patients: Results from cognitive interviews

Introduction

Studies about the use of complementary and alternative medicine (CAM) show that oncological patients and, among these, most often women, frequently use CAM. However, prevalence of CAM use differs greatly between different studies. The patients’ understanding of CAM (e.g. what exactly constitutes homeopathy) is rarely investigated.

Materials and methods

This study involves 2 steps: (1) surveying female breast cancer patients in a neoadjuvant, adjuvant or palliative treatment situation. A total of 172 patients returned the questionnaire concerning their CAM use plus EORTC-QLQ; (2) cognitive interviews were performed with 17 patients within the framework of validating the questionnaire. By using the think aloud technique, difficulties in understanding the questionnaire were examined, and the comprehension of CAM methods was explicitly probed. Qualitative content analysis was applied to the data and more themes emerged from the cognitive interviews besides validation issues. These results will be presented here.

Results

Patients use CAM for both cancer-specific (e.g. prevention of relapse) and non-specific reasons (e.g. general well-being). Some patients reported preferring conventional medicine for the cancer-specific therapy, but integrated CAM as a means of general support. Comprehension of CAM modalities was often vague, e.g. the term “homeopathy” was repeatedly used as a generic term for CAM. Most interviews demonstrated that the allocation of different CAM modalities was unclear. In some cases we evidenced considerable contradictions, e.g. an extensive adjustment of nutrition that was not described as keeping a specific diet.

Discussion

A significant lack in patients’ comprehension as to what exactly is a feature of which CAM modality might be a cause of the variability of CAM use seen in different studies. The fact that many patients are not well informed about CAM methods often prescribed by different therapists demonstrates the risk of interactions between CAM modalities among themselves and with conventional medicine.

Conclusion

Regarding the integration of CAM and conventional medicine many patients wish for and implement themselves, their comprehension of CAM modalities and modes of action plays an important role. Being aware of this is crucial in order to ensure a patient-centred treatment.

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