Early integration of person-oriented dialogue about complementary alternative medicine in conventional oncology treatment and care: Impact and lived experiences. A multi-method study

Research output: ThesisPh.D. thesis

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Abstract

Introduction: An increasing number of patients initiate or increase the use of complementary alternative medicine (CAM) when diagnosed with cancer or at the beginning of the oncology treatment. CAM (vitamins, acupuncture, etc.) is most frequently used as a supplement and seldom as an alternative to conventional oncology treatment and care. Used as a supplement CAM has shown to improve patients' health, quality of life and well-being, but it may also be harmful and constraining. Therefore, open dialogue between health professionals and patients about CAM (OD-CAM) including person-oriented and professional guidance in safe and health promoting use should be integrated early in the oncology treatment.

Dialogue about CAM is random and limited in the context of oncology treatment, as patients as well as health professionals are reluctant to discuss its benefits and risks. Knowledge on the integration of safe and health promoting OD-CAM early in oncology treatment is sparse and research on the subject is needed.


Purpose: The overall purpose of this PhD study was to explore the lived experiences and impact of OD-CAM integrated early in oncology treatment on patients’ health, quality of life and well-being. The essential elements of the OD-CAM and their potential impact were also investigated. The study was designed to increase our knowledge on the conduct of safe and health promoting OD-CAM and its integration into conventional oncology treatment and care. 


Methods: Existential phenomenological philosophy framed the study and the multimethod component design was applied. Methodologically different studies were conducted; 1) A systematic review (paper I) of available evidence on the characteristics, essential elements and impact and experiences of OD-CAM integrated in conventional oncology treatment and care. 2) A phase II, parallel group, randomized trial investigating whether early integration of OD-CAM in oncology treatment is superior to standard care in improving patients’ health, quality of life and well-being (Paper II). 3) A qualitative interview study that aimed to obtain an in-depth understanding of the impact of OD-CAM integrated early in oncology treatment on the lived experiences of health, quality of life and well-being of patients with cancer (paper III). The results of the three studies aspired the initiation of the fourth study; A phase III, parallel group, randomized trial investigating the effect of OD-CAM compared to standard care specifically on patients’ emotional and existential quality of life and well-being, uncertainty regarding oncology treatment, and survival (Paper IV). The results of each study were compared, interpreted and discussed and constitute the main results of the PhD study.


Main results: The study represents a total of 3,272 patients undergoing palliative or curative oncology treatment. OD-CAM, including provision of balanced and individualized guidance on how to live a safe and health promoting life alleviates patients' experience of guilt, reduces anxiety, and enhances hope, life courage and harmony with oneself. Lack of balanced and individualized guidance increases the risk of experiencing guilt and vulnerability. Guidance in how to alleviate symptoms and side effects from oncology treatment and strengthen the body helps patients reduce nausea, depression, anxiety and psychological distress and improves their physical functioning and emotional quality of life. Altogether, this enhances the hope of the patients and improves their probability of living a habitual and meaningful life. Especially patients with severe concerns benefit from the early integrated dialogue. OD-CAM may also improve survival.

The non-judgmental, non-supercilious, receptive, authentic presence, respecting and empathic approach of the health professional together with knowledge about CAM and oncology treatment and care are crucial elements of effective and beneficial OD-CAM integrated early in oncology treatment.


Conclusion and perspectives: This PhD study has shown that OD-CAM integrated early in oncology treatment provided systematically in one or two sessions in a caring, person-oriented and integrative way is a feasible, clinically meaningful and promising intervention in improving the health, quality of life and well-being of patients with cancer.

Today, OD-CAM sessions are offered to all patients undergoing oncology treatment at Lillebaelt Hospital. To promote and integrate open dialouge about CAM in general in daily oncology practice, a research project inspired by participatory design will eventually be initiated in 2023. 
Original languageEnglish
Awarding Institution
  • University of Southern Denmark
Supervisors/Advisors
  • Jensen, Lars Henrik, Principal supervisor
  • Nørgaard, Birgitte, Co-supervisor
  • Delmar, Charlotte, Co-supervisor, External person
Publisher
DOIs
Publication statusPublished - 17. Mar 2023

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