Andrea Mulkins

Supporting the Transformative Process: Experiences of Cancer Patients Receiving Integrative Care

Purpose . The purpose of this study is to describe the essential features of the transformative experience among people living with cancer who are seeking integrative care and to identify factors supporting this process. It is hoped that after establishing the nature and meaning of this change or shift, one will better understand what is most meaningful in terms of providing appropriate care and support to patients seeking integrative care. Study Design . An interpretational, qualitative approach guided sampling, data collection, and analysis with 11 individuals. A purposeful sample was drawn from selected integrative care facilities according to sociodemographics and type of cancer. Due to the complexity of this subject, second interviews were conducted with 5 participants to enhance the richness and validity of the data. Results . The experience of transformation is a dynamic 4-stage process in which participants learned about themselves and became more aware of who they are and how they relate to the world. Participants found that 4 dimensions of integrative medicine played a fundamental role in supporting this process. These dimensions include (1) having access to a range of appropriate therapies to support individual journeys, (2) care that focuses on one’s overall well-being, (3) control over cancer management, and (4) developing healing relationships with care providers. Conclusion . Although practitioners may not be able to create transformative experiences for patients, they may be able to establish and maintain conditions that support this process.

Assessing the role of evidence in patients' evaluation of complementary therapies: a quality study.

Background: Making the decision to use complementary and alternative medicine (CAM) for cancer treatment is difficult in light of the limited available evidence for these treatments. It is unclear how patients use evidence to make these decisions. Objectives: (1) Describe the type of information about CAM that cancer patients use in their decision making; (2) understand why certain types of information about CAM are accepted as evidence by cancer patients; and (3) explore the role of scientific evidence in treatment decision making. Methods: A qualitative study design using in-depth semistructured interviews with cancer patients attending 4 conventional and integrative health care institutions in Alberta and British Columbia, Canada, was used. Results: Twenty-seven patients were interviewed. Patients sought CAM information from a range of sources, including the Internet, health care providers, friends, relatives, and newspapers. Many expressed frustration about the overwhelming amount of available information and found it difficult to identify reliable information. Information was described as reliable if it supported them in arriving at a decision about CAM. Types of information participants identified included anecdotes, expert opinion, gut feeling, popular literature, scientific evidence, testimonials, advertising and trial and error. Profound differences were found between new CAM users, experienced CAM users, and users with late-stage cancer in type of information sought, the role of scientific evidence in decision making, and overall information needs. Conclusion: Although this was a relatively small qualitative study, the results suggest that (1) many patients do not value scientific evidence as highly as conventional providers and (2) it is important for clinicians and other information providers to be aware of the different types of information that patients seek out and access when making choices and decisions regarding CAM treatments and why they seek out these sources.

Evaluating a yogic breathing and meditation intervention for individuals living with HIV/AIDS.

Purpose. To assess the effectiveness of a group program aimed at improving well-being among individuals living with HIV/AIDS. Methods. A randomized controlled trial was used to evaluate a residential program designed to teach breathing, movement, and meditation techniques. Sixty-two participants were recruited from community HIV/AIDS organizations. Fifteen withdrawals from the study left 47 study participants. Standardized measures used were the Mental Health Index (MHI), the MOS-HIV Health Survey (MOS), and the Daily Stress Inventory (DSI), along with qualitative interviews. Results. A repeated-measures analysis of variance indicated positive changes in well-being on the MHI and the MOS, where the effect was primarily seen immediately following the program and disappeared at later data points. The DSI indicated an increase in experience and impact of stress over time for the intervention group postprogram. Alternatively, the qualitative interviews described positive changes in how participants were living their day-to-day lives. Conclusion. In order to capture the outcomes of this program properly, both qualitative and quantitative measures are needed.

Evaluation of the Tzu Chi Institute for Complementary and Alternative Medicine's Integrative Care Program

OBJECTIVE There are an increasing number of clinics providing integrative health care using new and innovative delivery models. The purpose of this study was to quantitatively and qualitatively evaluate the Integrative Care Program offered at the Tzu Chi Institute for Complementary and Alternative Medicine, Vancouver, British Columbia, Canada. DESIGN At enrollment, data are collected on demographics, health history, current health concerns and diagnoses, quality of life/health status (SF-36) and patient satisfaction. The measures are repeated 6 months into the program. Descriptive analysis was used to summarize the data. Focus groups were also included as part of the study design. RESULTS Patients seeking integrative care are a highly complex population living with numerous comorbid chronic conditions. Although their baseline scores on the SF-36 are lower than Canadian population norms across all subscales, significant improvement occurred from baseline to 6 months. Qualitative data support that patients were pleased with the clinical care they received and aligned with the philosophical underpinnings of the program. DISCUSSION This is one of the first studies to evaluate integrative health care. Studies like this are needed to develop appropriate methods to assess models of integrative health care delivery.

From the conventional to the alternative: exploring patients' pathways of cancer treatment and care.

Abstract Background: Complementary and alternative medicine (CAM) use is widespread and on the increase among cancer patients. Most research to date has involved a cross-sectional snapshot of CAM use rather than an exploration into the longitudinal, nonlinear treatment trajectories that cancer patients develop. Our aim is to explore and describe different treatment and decision-making pathways that individuals develop after receipt of a diagnosis of either breast, colorectal, or prostate cancer. Methods: The study was part of a larger mixed-methods pilot project to explore the feasibility of conducting a five-year international study to assess cancer patients’ treatment pathways, including health care use and the perceived impact of different patterns of use on health outcomes over the course of one year. The results presented in this paper are based on the analysis of personal interviews that were conducted over the course of 12 months with 30 participants. Results: Five pathways emerged from the data: passive conventional, self-directed conventional, cautious integrative, aggressive integrative, and aggressive alternative. Factors that shaped each pathway included health beliefs, decision-making role, illness characteristics, and the patient–practitioner relationship. Conclusions: The results of this examination of the longitudinal treatment and decision-making trajectory provide important information to support health care professionals in their quest for individualized, targeted support at each stage of the patient pathway.

An Assessment of the Tzu Chi Institute for Complementary and Alternative Medicine as an Optimal Healing Environment

AbstractBackground: Integrative medicine appears to have come closest to meeting the criteria of an optimal healing environment (OHE). However, to date, we have little insight as to how OHEs can be designed or promoted. Objectives: The purpose of this study was to explore which aspects of integrative healthcare delivery at the Tzu Chi Institute facilitated and which were barriers to achieving an OHE. Design: The study is a descriptive analysis of a wide range of data collected between October 1998 and January 2003. Data were collected on demographics, health history, clinic utilisation, goal attainment and six standardised outcomes measures that include the Short Form Health Status Survey, General Perceived Self-Efficacy Scale, Multidimensional Health Locus of Control Scale and MOS (Medical Outcomes Study) Social Support Survey. Results: Several variables were identified as having the potential to influence individuals’ experiences in an integrative care programme. These included participation in the mind/body programme, number of clinic visits, degree of social support, sense of control over health and specific disease conditions. Discussion: This study has generated important findings that will be useful in the further development of OHEs.

The Living Well Lab: a community-based HIV/AIDS research initiative

Abstract Background: Complementary and Alternative Medicine (CAM) is becoming a pillar in the rehabilitative efforts for many living with HIV/AIDS. A community-based research program called the Living Well Lab (LWL) was established in 2007, operating out of Friends For Life (FFL), a non-profit wellness center in Vancouver, Canada offering free CAM therapies to people living with HIV/AIDS. Therapies range from naturopathy to yoga. The LWL partnered with academic and community organizations to evaluate CAM use and changes in health and quality of life outcomes of FFL’s HIV+ members. Methods: A longitudinal, combined methods approach assessed the health- and quality-of-life-related outcomes and experiences of CAM users. Participants completed outcome packages (5 time points) over 18 months, which focused on changes in physical and emotional states, satisfaction with services and social support. Interviews were conducted at baseline, 9- and 18-month time points. Quantitative analyses were descriptive while content analysis and thematic coding were used in the qualitative analysis. Results: Two hundred and seven members enrolled in the LWL. Quantitative data demonstrated improvement in mental and physical wellbeing, social support and patient satisfaction specifically: SF-12, Arizona Integrative Outcomes Scale and three visual analog scales (stress, pain and energy). Participants felt several factors contributed to these changes such as managing anxiety, accepting their illness, learning to relax, an increased capacity for self-care and social support. Conclusions: CAM use may be associated with changes to physical, social and mental wellbeing. Issues throughout the study provided important lessons for future research.

P05.19. Outcomes in breast cancer treatment decision-making

Methods This case-control study involved telephone interviews at baseline, and completion of spirituality, self-efficacy, and control over treatment DM questionnaires at baseline, 6 months, and 1 year. Forty cases and 40 controls with stage 0-III breast cancer were matched by age, stage of illness, and province. Differences between pairs at each time point, adjusted for the time since diagnosis, were estimated using GEE linear regression models.