Judith M. Fouladbakhsh

Gender, Symptom Experience, and Use of Complementary and Alternative Medicine Practices Among Cancer Survivors in the U.S. Cancer Population

PURPOSE/OBJECTIVES To identify relationships among gender, physical and psychological symptoms (pain, insomnia, fatigue, and depression), and use of specific complementary and alternative medicine (CAM) practices among survivors in the U.S. cancer population. DESIGN Secondary analysis of the 2002 National Health Interview Survey (NHIS). The CAM Healthcare Model, an extension of the Behavioral Model for Health Services Use, guided the study. SETTING United States. SAMPLE 2,262 adults (aged 18 years and older) diagnosed with cancer representing more than 14.3 million cancer survivors in the United States . METHODS NHIS interview data on use of CAM practices (diet, yoga, tai chi, qigong, meditation, guided imagery, relaxation, and deep breathing) were examined in relationship to gender and symptoms. Analysis was conducted using Stata 9.2 software for population estimation. Binary logistic regression, the primary statistical model employed in the analysis, focused on between-subject differences in practice use. MAIN RESEARCH VARIABLES Dichotomous outcome variables included use of at least one CAM practice and use of specific individual CAM practices. Independent variables included gender, age, education, race, provider contact, cancer diagnosis, pain, insomnia, fatigue, depression, and health status. FINDINGS CAM practice use was more prevalent among female, middle-aged, Caucasian, and well-educated subjects. Pain, depression, and insomnia were strong predictors of practice use, with differences noted by gender and practice type. CONCLUSIONS CAM practices are widely used in the U.S. cancer population, especially among women. Symptom experience influences likelihood of use, with increased odds when men report symptoms. IMPLICATIONS FOR NURSING Study findings inform oncology nurses on the benefits of integrating self-care CAM practices in relationship to gender into the symptom management care plan for cancer survivors. Findings reported in this study will help guide future CAM practice intervention studies.

Predictors of use of complementary and alternative therapies among patients with cancer.

PURPOSE/OBJECTIVES To determine predictors of use of complementary and alternative medicine (CAM) therapies among patients with cancer. DESIGN Secondary analysis of two federally funded panel studies. SETTING Urban and rural communities in the midwestern United States. SAMPLE Patients with lung, breast, colon, or prostate cancer (N = 968) were interviewed at two points in time. 97% received conventional cancer treatment, and 30% used CAM. The sample was divided evenly between men and women, who ranged in age from 28-98; the majority was older than 60. METHODS Data from a patient self-administered questionnaire were used to determine CAM users. Responses indicated use of herbs and vitamins, spiritual healing, relaxation, massage, acupuncture, energy healing, hypnosis, therapeutic spas, lifestyle diets, audio or videotapes, medication wraps, and osteopathic, homeopathic, and chiropractic treatment. MAIN RESEARCH VARIABLES Dependent variable for analysis was use or nonuse of any of the identified CAM therapies at time of interviews. Independent variables fell into the following categories: (a) predisposing (e.g., gender, age, race, education, marital status), (b) enabling (e.g., income, health insurance status, caregiver presence, geographic location), and (c) need (e.g., cancer stage, site, symptoms, treatment, perceived health need). FINDINGS Significant predictors of CAM use were gender, marital status, cancer stage, cancer treatment, and number of severe symptoms experienced. CONCLUSIONS Patients with cancer are using CAM while undergoing conventional cancer treatment. IMPLICATIONS FOR NURSING Nurses need to assess for CAM use, advocate for protocols and guidelines for routine assessment, increase knowledge of CAM, and examine coordination of services between conventional medicine and CAM to maximize positive patient outcomes.

Using the behavioral model for complementary and alternative medicine: The CAM healthcare model

Complementary and alternative medicine (CAM) therapies, products and practices are increasingly being used across the United States and worldwide by individuals who are healthy, as well as by those who are ill (Barnes, Powell-Griner, McFann & Nahin et al., 2004; Burstein, Gelber, Guadagnoli, & Weeks, 1999; Eisenberg, et al., 1998; Ernst & Cassileth, 1998; Kessler, et al., 2001; Richardson & Straus, 2002). This trend, which is anticipated to continue, reflects changing health care behavior. Individuals, who are experiencing illness, use CAM for treatment, management of illness related symptoms and to enhance quality of life. Those who are well also use CAM to promote health, and prevent disease. This increasing prevalence of CAM has created a need to identify patterns and predictors of use among the diverse populations of users. Concurrently, this trend evokes questions about the effect of CAM on the utilization of conventional health services and providers, health outcomes and quality of life. This paper presents an emerging conceptual framework, referred to as the CAM Healthcare Model. This model aims to identify factors associated with the use of CAM providers, therapies, products and practices within a health services framework, thereby providing a guide for CAM research and practice. The CAM Healthcare Model is a modification of Andersens Behavioral Model for Health Service Use, a framework that has guided research on conventional health services for more than three decades (Andersen, 1969, 1995). The CAM Healthcare Model identifies factors influencing the use of CAM health services and resources that are provider-directed, and CAM use as a self-directed health care activity and/or practice. The authors propose that CAM use, with or without a provider, has the potential to affect utilization of conventional health services as it offers more choices to healthcare consumers. These choices ultimately affect healthcare outcomes, research, health service delivery and policy, hence the importance of this work Understanding the trends and implications of CAM use further emphasizes the need for a model to study CAM within a health service/resource context.

The Use of Complementary/Alternative Medicine Therapies for the Self-Treatment of Pain Among Residents of Urban, Suburban, and Rural Communities

The use of complementary/alternative medicine (CAM) therapies has increased dramatically in the past decade.1,2 Frequently, these therapies are used to seek relief from pain, one of the most common health problems today. In the United States, 42% of adults experience pain daily, and 89% experience pain monthly.3 Many people frequently rely on self-treatment of their pain, often utilizing CAM therapies in addition to traditional medications without informing their health care practitioners.3–5 As the number of medications and herbal products/supplements an individual takes increases, so does the likelihood of experiencing drug interactions.6 This brief report describes the occurrence of pain among community residents and identifies the CAM therapies used for self-treatment of pain. Similarities and differences found in urban, suburban, and rural communities are described.

Comparative analysis of CAM use in the U.S. cancer and noncancer populations

Background: Complementary and alternative medicine (CAM) therapies are often used with conventional medical treatments, hence it is important for healthcare providers to understand factors influencing use and implications for patient care. Method: This study compared patterns and predictors of use of CAM providers, practices, and products among the U.S. cancer and noncancer population. Predisposing, enabling, and need factors in the CAM Healthcare Model were examined for ability to predict CAM use from a health service utilization perspective. A secondary analysis of the 2002 National Health Interview Survey was conducted for population estimation using STATA 9.2 software. The analysis compared CAM use by cancer survivors (N=2,262; estimated cancer population=14.3 million) and individuals without cancer (N=28,734; estimated population=191.5 million). Multinomial Logistic Regression identified between-subject differences and allowed for population comparison. Results: Data suggest that cancer survivors and noncancer populations differ in their CAM use patterns, with cancer survivors more likely to use CAM. Conclusion: While these patterns may have begun during the initial period of cancer diagnosis and treatment, they continue among long-term survivors. Predisposing, enabling, and need factors were strong predictors of CAM use in both populations.

Inner Correspondence and Peacefulness with Practices among Participants in Eurythmy Therapy and Yoga: A Validation Study

Several mind body medicine interventions require an active participation of the practitioners. We intended to develop a questionnaire to operationalize and measure the “inner correspondence” of individuals practicing Yoga or Eurythmy Therapy. In an anonymous cross-sectional study we enrolled 501 individuals (61% yoga). Exploratory factor analysis (study 1) of the 12-item instrument (Cronbachs alpha = .84) pointed to a 3-factor solution, with one major scale and good internal consistency (alpha = .83) and two minor scales with weak internal consistency. To improve the quality of the main scale, we added 8 new items which were tested in a sample of 135 individuals (study 2: 71% Yoga). Factor analysis confirmed a 12-item single factor (alpha = .95), that is, Inner Correspondence/Peaceful Harmony with Practices (ICPH). The scale correlated strongly with mindfulness (FMI; r > .50), moderately with life and patient satisfaction (BMLSS; r between .32 and .43), and weakly negative with symptom score (VAS; r = −.23). In conclusion, the scale ICPH was confirmed as a relevant tool to measure the inner correspondence and feelings of peacefulness with practices. It can be used in clinical studies to assess the efficacy of mind-body practices involving physical movements.

Self-Treatment of Pain Among Adolescents in an Urban Community

Pain occurrence among adolescents, whether acute or chronic, persistent or intermittent, remains high, with potentially serious effects on quality of life, physical and emotional functioning, and psychosocial adjustment. The prevalence of pain in adolescents varies widely, and although discussed in the literature for more than two decades, data on adolescent knowledge and pain self-treatment is scarce. This descriptive-correlational study identified pain prevalence and intensity and pain self-treatment choices among adolescents in a diverse urban community. Almost 90% (n = 253) of high school students reported pain in the preceding 2 weeks and completed a series of study questionnaires (demographic data form, Brief Pain Inventory-Short Form, Adolescent Self-Treatment Survey). Respondents ranged in age from 14 to 19 years (mean 16) and were predominantly female (70%) and caucasian (75%). The sample was representative of all high school grades, and the majority (86%) reported participation in sports, dance, and physical activities. Mean pain scores ranged from 3.0 (current pain) to 6.5 (worst pain), with significantly higher scores among girls. A gender-related effect was also noted for pain interference in activities, mood, and sleep among the adolescent girls compared with the boys. Gender also predicted use of self-treatment methods, with girls more likely to use over-the-counter medications and nonpharmacologic therapies. Number of pain sites was also a strong predictor of use of self-treatment methods among adolescents. Knowledge of the pain experience during adolescence will help guide community-based nursing initiatives aimed at increasing awareness, promoting knowledge about pain and its treatment, and ensuring safety and positive outcomes related to self-treatment.

A Pilot Study of the Feasibility and Outcomes of Yoga for Lung Cancer Survivors

PURPOSE/OBJECTIVES To determine the feasibility of a standardized yoga intervention for survivors of non-small cell lung cancer (NSCLC) and, effects on sleep, mood, salivary cortisol levels, and quality of life (QOL). DESIGN This 14-week, one-group, repeated-measures study included a three-week preintervention phase, eight weeks of yoga classes (40 minutes once per week) and home practice, and a three-week postintervention phase. Follow-up occurred at three and six months poststudy. SETTING A community-based cancer support center in the midwestern United States. SAMPLE 7 adults who had completed initial treatment for stages I-IIIa NSCLC. METHODS A standardized yoga protocol was developed prior to the study by experts in the field. Breathing ease was monitored before, during, and after classes to assess feasibility of movement without compromising respiratory status while doing yoga. Data analysis included descriptive statistics, repeated-measures analysis of variance, and salivary cortisol analysis. MAIN RESEARCH VARIABLES Sleep quality, mood, salivary cortisol, and QOL were assessed using the Pittsburgh Sleep Quality Index, Profile of Mood States-Brief, a cortisol measurement, and the Medical Outcomes Survey SF-36®, respectively. Breathing ease was assessed using a dyspnea numeric rating scale as well as observation of participants. FINDINGS Participants with varying stages of disease and length of survivorship were able to perform yoga without respiratory distress. Class attendance exceeded 95%, and all practiced at home. Mood, sleep efficiency, and QOL significantly improved; salivary cortisol levels decreased over time. CONCLUSIONS Yoga was feasible for NSCLC survivors without further compromising breathing with movement. Potential benefits were identified, supporting the need for future clinical trials with larger samples stratified by cancer stage, treatment, and length of survivorship. IMPLICATIONS FOR NURSING Nurses and healthcare providers should consider yoga as a mind-body practice to manage stress, improve mood and sleep, and potentially enhance QOL for NSCLC survivors.

Nondrug Therapies for Pain Management Among Rural Older Adults

This quasiexperimental two-group pilot study tested an intervention aimed at educating older adults in rural communities about the appropriate use of nondrug treatments for pain. Earlier data reveal that older adults use significantly less nonpharmacologic modalities than their younger counterparts, and that pain self-treatment is prevalent in rural areas. Individuals aged ≥60 years who experienced pain in the preceding 2 weeks were recruited from rural Midwestern communities through the use of flyers and information sessions at hospitals, churches, and community organizations. Upon enrollment, participants selected a date for an educational session, which was randomized to the experimental or control condition. All participants (n = 53) completed a series of questionnaires (Brief Pain Inventory, Symptom Distress Scale, Perceived Control Scale) at the initial educational session (T1) and at a two-week follow-up session (T2). Participants in the control and experimental groups attended a 30-minute educational session on safe use of over-the-counter medications; the experimental group also received an additional 30-minute session on safe and effective use of heat, cold, and relaxation breathing. Hot and cold packs and relaxation breathing instruction were provided for use over the 2-week period. There was a significant increase in the use of all nondrug treatments and a decrease in pain-related distress and current pain scores in the experimental group compared with the control group. This study informs nurses and other health care providers on the value of education for use of nondrug therapies in conjunction with pharmacologic pain management among rural older adults.

Using a standardized Viniyoga protocol for lung cancer survivors: a pilot study examining effects on breathing ease.

Abstract Although lung cancer is perceived as a dire diagnosis, increases in the 5-year survival rate of individuals with non-small cell lung cancer (NSCLC) have been reported. Survivors, however, continue to be excessively burdened with symptoms such as respiratory distress which interfere with functioning and quality of life. While exercise and physical activity are strongly recommended, NSCLC survivors may be reluctant to participate due to actual or anticipated shortness of breath exacerbated with movement. This quasi-experimental, intervention-only pilot study aimed to determine the effects of an 8-week standardized yoga protocol for Stage I–IIIa NSCLC survivors (n=9). The protocol was developed within the Viniyoga (Hatha) tradition with respiratory experts. Breathing ease, dyspnea, oxygen saturation, and respiratory function were explored in relationship to yoga practice (45-minute sessions once per week and home practice) using repeated-measures analysis. Number of participants reporting dyspnea ranged from 25 to 50% prior to practice with no significant increase during sessions, and moderate decreases noted at times. Oxygen saturation remained high and vital signs stable; forced expiratory volume in 1 second (FEV1) values increased significantly over the 14-week study period (p<0.0001). Yoga, with an emphasis on postures coordinated with breathing and meditation practices, offers a potentially feasible and beneficial option that requires further study in this population.