Laila Launsø

Use of complementary and alternative medicine in the scandinavian countries

Objective To describe the prevalence of use of complementary and alternative medicine (CAM) in Norway, Denmark and Stockholm County. Design, setting, and subjects In Norway, a national representative sample of 1000 participants completed telephone interviews regarding their CAM use in 1997 (response rate 51). In Denmark, a national representative sample of 16 690 participants completed questionnaires and interviews regarding their health and morbidity in 2000 (response rate 74). In Stockholm County, a randomly selected sample of 1001 participants completed telephone interviews about their CAM use in 2000 (response rate 63). Results Prevalence of ever-use of CAM was 34% in Norway, 45% in Denmark, and 49% in Stockholm. Use of CAM is associated with poor self-reported health in all three studies, and with visits to a medical doctor in Denmark and Norway. More women than men, and more with higher education, reported use of CAM. Most frequently used CAM therapy was homeopathy in Norway, reflexology in Denmark, and massage in Stockholm County. Conclusions Use of CAM is common in the Scandinavian countries, and there are national differences regarding therapy preferences. Many individuals use both CAM and conventional health services.

Choice of Unconventional Treatment by Patients with Cancer

OBJECTIVES Previous studies conducted on the use of unconventional treatment by patients with cancer have focused on unconventional treatment as a joint group of therapies. The objective of this study is to gather preliminary information about the use of different modes of unconventional cancer treatment by patients with cancer and to describe user profiles of standardized and individualized treatments. DESIGN Data originate from an ongoing explorative 5-year study of 441 consecutively registered cancer patients who have consulted medical doctors and alternative therapists practicing unconventional treatment in Denmark. This paper is based on data from the first and second of six questionnaires. The unconventional treatments included in this study are categorized into two forms of treatment: standardized and individualized treatment. SUBJECTS Four hundred and forty-one (441) Danish patients with cancer who use unconventional cancer treatment. OUTCOMES MEASURES The analysis shows significant correlations between type of treatment and the following variables: gender, education, occupational status, type of cancer, purpose of seeking unconventional treatment, metastatic spread, opinion regarding appropriate unconventional treatment, and simultaneous use of unconventional treatment. RESULTS The study shows that there are significant differences between patients with cancer choosing standardized and those choosing individualized unconventional treatment. The probability of choosing standardized unconventional treatment is greatest among male participants, patients having shorter school education, and for patients who have recovery as the goal of seeking unconventional treatment. The probability of choosing individualized unconventional treatment is greatest among women, for patients with longer school education, and for patients wanting relief from symptoms, information, and improvement of general condition as the purpose of seeking unconventional cancer treatment. Patients with breast and gynecologic cancer are more inclined to seek individualized treatment than patients with all other cancer diseases. CONCLUSIONS The study points to the fact that it might be essential to differentiate between different forms of unconventional treatment to understand the use by patients with cancer and the outcomes of these treatments.

Empowering the Cancer Patient or Controlling the Tumor? A Qualitative Study of How Cancer Patients Experience Consultations With Complementary and Alternative Medicine Practitioners and Physicians, Respectively

Objectives: The authors describe how patients with cancer, who have had consultations with both a conventional physician and a complementary and alternative medicine (CAM) practitioner, experience these consultations. The theoretical background of this study is inspired by a description of 2 models of principles of treatment. In the first model, the instrumental intervention (eg, the medicine) is defined as the causal factor for outcome. In the second model, the patient is defined as the causal factor; the outcomes of the treatment are dependent on the resources of the patient (eg, the body’s ability to heal itself) and the impact of the patient’s situation. Methods: Semistructured, in-depth interviews were conducted with 17 Norwegian cancer patients who had visited both a CAM practitioner and a physician. The patients were recruited from both an oncology department at a university hospital and a newspaper advertisement in the area of Trondheim in central Norway. Methods of data analysis used were open coding, relational coding, and categorizing of themes. Results: The cancer patients have experienced 2 different modes of consultations: one characterized by practitioners focusing on controlling the tumor and another characterized by practitioners focusing on the patient. The patients’ accounts of these 2 modes of consultation differ in a number of ways: which issues are discussed during the consultation, who is in control of the consultation agenda, what are the patients’ perceptions of the practitioners’ health and disease understanding (ontology), what are the practitioners’ communication skills, and how empowered the patient feels during the consultation. Conclusions: Patients in this study ask for a consultation style that conveys a focus on both the disease and the whole patient. The results of this study point to a possible connection between the practitioners’ understanding of health and disease and the content and form of the consultations. Future research should test this connection.

Understanding unexpected courses of multiple sclerosis among patients using complementary and alternative medicine: A travel from recipient to explorer

Complementary and alternative medicine (CAM) is frequently used by patients with multiple sclerosis (MS). Some MS patients experience unexpected improvements of symptoms, which they relate to their use of CAM. The aim of this study was to obtain knowledge and develop understandings of such self-defined unexpected improvement of MS symptoms. Two cases were constructed based on documents and 12 qualitative interviews. Our aim was not to make generalisations from the cases, but to transfer knowledge as working hypotheses. We identified four health-related change processes: the process of losing bodily competence; the process of developing responsibility; the process of taking control; and the process of choosing CAM. The patients explained unexpected improvements in their MS symptoms as results of their own efforts including their choice and use of CAM. In our theoretical interpretations, we found the patients’ redefinition of history, the concept of treatment and the importance of conventional health care to be essential, and leading to a change of patients’ position towards conventional health care from recipients to explorers. The explorers can be perceived as boundary walkers reflecting limitations within the conventional health care system and as initiators regarding what MS patients find useful in CAM.

Bridge Building and Integrative Treatment of People with Multiple Sclerosis. Research-based Evaluation of a Team-building Process

Background: The Danish Multiple Sclerosis Society has initiated a research project dealing with bridge building and integrative treatment. Little attention has been paid to research on the experience of conventional and alternative practitioners with bridge building and integrative treatment through teamwork. Objective: The objective of this article is to describe essential features of the preparatory phase of the research project focusing on the process of initiating and developing a team of conventional and alternative practitioners before treating people with Multiple Sclerosis at a specialized MS hospital in Denmark. The team consists of five conventional and five alternative practitioners. Materials and Methods: The preparatory phase took place from August 2004 to May 2005. In-depth, semi-structured interviews were conducted with the ten team practitioners. Each practitioner was interviewed before and eight months after joining the team, and after participating in four practitioner-researcher seminars. Written materials and participatory observations of practitioner-researcher seminars have been used in addition. Results: The team-building process involved motivation, emotions, challenges, professional and personal competences, and the development of a professional team identity. The practitioners assessed the preparatory phase based on researcher-practitioner seminars as an essential basis for moving on to provide treatments to people with MS.

An investigation of multidisciplinary complex health care interventions - steps towards an integrative treatment model in the rehabilitation of People with Multiple Sclerosis

BackgroundThe Danish Multiple Sclerosis Society initiated a large-scale bridge building and integrative treatment project to take place from 2004–2010 at a specialized Multiple Sclerosis (MS) hospital. In this project, a team of five conventional health care practitioners and five alternative practitioners was set up to work together in developing and offering individualized treatments to 200 people with MS. The purpose of this paper is to present results from the six year treatment collaboration process regarding the development of an integrative treatment model.DiscussionThe collaborative work towards an integrative treatment model for people with MS, involved six steps: 1) Working with an initial model 2) Unfolding the different treatment philosophies 3) Discussing the elements of the Intervention-Mechanism-Context-Outcome-scheme (the IMCO-scheme) 4) Phrasing the common assumptions for an integrative MS program theory 5) Developing the integrative MS program theory 6) Building the integrative MS treatment model. The model includes important elements of the different treatment philosophies represented in the team and thereby describes a common understanding of the complexity of the courses of treatment.SummaryAn integrative team of practitioners has developed an integrative model for combined treatments of People with Multiple Sclerosis. The model unites different treatment philosophies and focuses on process-oriented factors and the strengthening of the patients’ resources and competences on a physical, an emotional and a cognitive level.

Preliminary Initiatives in a Bridge Building Project between Conventional and Alternative Practitioners in Denmark

A growing number of the approximately 7,400 persons with multiple sclerosis (MS) in Denmark use alternative treatments. The Danish Multiple Sclerosis Society has been experiencing an increasing demand for research on the effects of combined conventional and alternative treatments. For this reason, the Society has initiated a bridge building project to be implemented from 2004-2011 at a specialized MS hospital. In that project, a team of five conventional and five alternative practitioners works together and offers integrative treatments to a total of 400 MS patients. Objective: The overall purpose of the project is to examine if integrative treatments may optimize treatment results for people suffering from MS, and to develop a model for a bridge building cooperation of conventional and alternative practitioners in the future. Material and Methods: In this article we give an overview of the steps taken before establishing the hospital- based team of practitioners: (1) a public hearing attended by conventional and alternative practitioners experienced in treating MS patients; (2) qualitative interviews among conventional practitioners at a specialized MS hospital; (3) a literature study on the use and effects of alternative treatments and integrative treatments related to MS. Results: The knowledge gained in the preliminary steps of the project showed that we had to add a preparatory phase to the project focusing on the development of the team before it would start treating MS patients.

Combination treatment of people with multiple sclerosis based on collaboration between conventional healthcare providers and alternative practitioners--patient perspectives on outcomes.

The use of alternative and complementary medicine (CAM) is prevalent among People with Multiple Sclerosis (PwMS) in Denmark as well as in other Western countries. Many PwMS combine conventional treatments and CAM; however there is little research-based knowledge about the outcomes that PwMS achieve from combined treatments. The purpose of this article is to describe which outcomes PwMS have experienced from combination treatment based on collaboration between conventional healthcare providers and CAM practitioners. A second purpose is to identify and study aspects of the courses of treatment that have generally characterized the achieved outcomes. During the course of their treatment, 59 PwMS participated in semi-structured individual or group interviews. The analyses show that the participants’ experienced outcomes can be classified in four ways 1) short-term positive outcomes; 2) long-term positive outcomes in specific areas; 3) long-term positive outcomes on the patient’s overall life situation; 4) no and/or negative outcomes. The analyses also show that two aspects of the courses of treatment have generally characterized the outcomes achieved: a) participants’ perception of the patient’s role; b) participants’ perception of treatment function. Outcomes are shown to differ for different PwMS, and results indicate that the combined interventions have played a role in a dynamic and process-oriented interaction with the entire life situation of the individual patient. The results described in the article further suggest that physical as well as cognitive learning constitutes an important element in understanding the dynamics of complex courses of treatment.