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Individualised and complex experiences of integrative cancer support care: combining qualitative and quantitative data

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Abstract

Objectives

The widespread use of complementary therapies alongside biomedical treatment by people with cancer is not supported by evidence from clinical trials. We aimed to use combined qualitative and quantitative data to describe and measure individualised experiences and outcomes.

Materials and methods

In three integrative cancer support centres (two breast cancer only) in the UK, consecutive patients completed the individualised outcome questionnaire Measure Yourself Concerns and Wellbeing (MYCaW) before and after treatment. MYCaW collects quantitative data (seven-point scales) and written qualitative data and the qualitative data were analysed using published categories.

Results

Seven hundred eighty-two participants, 92% female, mean age 51 years, nominated a wide range of concerns. Psychological and emotional concerns predominated. At follow-up, the mean change (improvement) in scores (n = 588) were: concern 1, 2.06 (95% CI 1.92–2.20); concern 2, 1.74 (95% CI 1.60–1.90); and well-being, 0.64 (95% CI 0.52–0.75). The most common responses to ‘what has been the most important aspect for you?’ were ‘receiving complementary therapies on an individual or group basis’ (26.2%); ‘support and understanding received from therapists’ (17.1%) and ‘time spent with other patients at the centres’ (16.1%). Positive (61.5%) and negative (38.5%) descriptions of ‘other things affecting your health’ correlated with larger and smaller improvement in concerns and well-being, respectively.

Conclusions

In a multicentre evaluation, the MYCaW questionnaire provides rich data about patient experience, changes over time and perceptions of what was important to each individual with cancer within that experience. It is unlikely that meaningful evaluations of this complex intervention could be carried out by quantitative methods alone.

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References

  1. Downer SM, Cody MM, McCluskey P, Wilson PD, Arnott SJ, Lister TA et al (1994) Pursuit and practice of complementary therapies by cancer patients receiving conventional treatment. BMJ 309:86–89

    PubMed  CAS  Google Scholar 

  2. Verhoef M, Balneaves LG, Boon H, Vroegindewey A (2005) Reasons for and characteristics associated with complementary and alternative medicine use among adult cancer patients: a systematic review. Integr Cancer Ther 4:274–286

    Article  PubMed  Google Scholar 

  3. Evans M, Shaw A, Thompson EA, Falk S, Turton P, Thompson T, Sharp D (2007) Decisions to use complementary and alternative medicine (CAM) by male cancer patients: information-seeking roles and types of evidence used. BMC Complementary and Alternative Medicine 7:25 (Aug 4). doi:10.1186/1472-6882-7-25

    Article  PubMed  Google Scholar 

  4. Correa-Velez I, Clavarino A, Eastwood H (2005) Surviving, relieving, repairing, and boosting up: reasons for using complementary/alternative medicine among patients with advanced cancer: a thematic analysis. J Palliat Med 8:953–961. doi:10.1089/jpm.2005.8.953

    Article  PubMed  Google Scholar 

  5. Lengacher CA, Bennett MP, Kip KE, Gonzalez L, Jacobsen P, Cox CE (2006) Relief of symptoms, side effects, and psychological distress through use of complementary and alternative medicine in women with breast cancer. Oncol Nurs Forum 33:97–104. doi:10.1188/06.ONF.97-104

    Article  PubMed  Google Scholar 

  6. National Institute for Clinical Excellence (2004) Improving supportive and palliative care for adults with cancer: the manual. National Institute for Clinical Excellence, London

    Google Scholar 

  7. Ernst E, Cassileth BR (1998) The prevalence of complementary and alternative cancer: a systematic review. Cancer 53:2736–2740

    Google Scholar 

  8. Molassiotis A, Fernadez-Ortega P, Pud D, Ozden G, Scott GA, Panteli V et al (2005) Use of complementary and alternative medicine in cancer patients: a European survey. Ann Oncol 16:663. doi:10.1093/annonc/mdi110

    Article  Google Scholar 

  9. Sparber A, Wootton JC (2001) Surveys of complementary and alternative medicine: part II. Use of alternative and complementary cancer therapies. J Altern Complement Med 7:281–287. doi:10.1089/107555301300328179

    Article  PubMed  CAS  Google Scholar 

  10. Verhoef M, Weeks L, Brazier A, Leis A (2007) Evaluating supportive cancer care: are we missing an opportunity? Support Care Cancer 15:905–907. doi:10.1007/s00520-007-0289-9

    Article  PubMed  Google Scholar 

  11. Campbell M, Fitzpatrick R, Haines A, Kinmouth AL, Sandercock P, Spiegelhalter D, Tyrer P (2000) Framework for design and evaluation of complex interventions to improve health. BMJ 321:694–696. doi:10.1136/bmj.321.7262.694

    Article  PubMed  CAS  Google Scholar 

  12. Campbell NC, Murray E, Darbyshire J, Emery J, Farmer A, Griffiths F et al (2007) Designing and evaluating complex interventions to improve health care. BMJ 334:455–459. doi:10.1136/bmj.39108.379965.BE

    Article  PubMed  Google Scholar 

  13. Black N (1996) Why we need observational studies to evaluate the effectiveness of health care. BMJ 312:1215–1218

    PubMed  CAS  Google Scholar 

  14. O’Cathain A, Murphy E, Nicholl J (2007) Why, and how, mixed methods research is undertaken in health services research in England: a mixed methods study. BMC Health Serv Res 7:85. doi:10.1186/1472-6963-7-85

    Article  PubMed  Google Scholar 

  15. Mulkins A, Verhoef MJ, Eng J, Findlay B, Ramsum D (2003) Evaluation of the Tzu Chi Institute for Complementary and Alternative Medicine’s Integrative Care Program. J Altern Complement Med 9:585–592. doi:10.1089/107555303322284893

    Article  PubMed  Google Scholar 

  16. Rosenbaum E, Gautier H, Fobair P, Neri E, Festa B, Hawn M, Andrews A, Hirshberger N, Selim S, Spiegel D (2004) Cancer supportive care, improving the quality of life for cancer patients. A program evaluation report. Support Care Cancer 12(5):293–301. doi:10.1007/s00520-004-0599-0

    Article  PubMed  Google Scholar 

  17. Paterson C, Thomas K, Manasse A, Cooke H, Peace G (2007) Measure Yourself Concerns and Wellbeing (MYCaW): an individualised questionnaire for evaluating outcome in cancer support care that includes complementary therapies. Complement Ther Med 15:38–45. doi:10.1016/j.ctim.2006.03.006

    Article  PubMed  Google Scholar 

  18. Vaghela C, Robinson N, Gore J, Peace B, Lorenc A (2007) Evaluating healing for cancer in a community setting from the perspective of clients and healers: a pilot study. Complement Ther Clin Pract 13:240–249. doi:10.1016/j.ctcp.2007.03.004

    Article  PubMed  CAS  Google Scholar 

  19. Polley M, Seers H, Cooke H, Hoffman C, Paterson C (2007) How to summarise and report written qualitative data from patients: a method for use in cancer support care. Support Care Cancer 15:963–971. doi:10.1007/s00520-007-0283-2

    Article  PubMed  Google Scholar 

  20. Paterson C (1996) Measuring outcome in primary care: a patient-generated measure, MYMOP, compared to the SF-36 health survey. BMJ 312:1016–1020

    PubMed  CAS  Google Scholar 

  21. Paterson C, Langan CE, McKaig GA, Anderson GDH, Maclaine GDH, Rose LH (2000) Assessing patient outcomes in acute exacerbations of chronic bronchitis: the measure yourself medical outcome profile (MYMOP), medical outcomes study 6-item general health survey (MOS-6) and EuroQol (EQ-5D). Qual Life Res 9:521–527. doi:10.1023/A:1008930521566

    Article  PubMed  CAS  Google Scholar 

  22. Juniper EF, Guyatt GH, Wilan A, Griffith LE (1994) Determining a minimal important change in a disease-specific quality of life questionnaire. J Clin Epidemiol 47:81–87. doi:10.1016/0895-4356(94)90036-1

    Article  PubMed  CAS  Google Scholar 

  23. Guyatt GH, Juniper EF, Walter S, Griffith L, Goldstein RS (1998) Interpreting treatment effects in randomised trials. BMJ 316:690–693

    PubMed  CAS  Google Scholar 

  24. Fasching PA, Theil F, Nicolaisen-Murmann K, Rauh C, Engel J, Lux MP et al (2007) Association of complementary methods with quality of life and life satisfaction in patients with gynecologic and breast malignancies. Support Care Cancer 15:1277–1284. doi:10.1007/s00520-007-0231-1

    Article  PubMed  CAS  Google Scholar 

  25. Peace G, Manasse A (2002) The Cavendish Centre for integrated cancer care: assessment of patients’ needs and responses. Complement Ther Med 10:33–41. doi:10.1054/ctim.2002.0500

    Article  PubMed  CAS  Google Scholar 

  26. Mulkins A, Verhoef M (2006) Supporting the transformative process: experiences of cancer patients receiving integrative care. Integr Cancer Ther 3:230–237. doi:10.1177/1534735404268054

    Article  Google Scholar 

  27. Verhoef MJ, Mulkins A, Boon H (2005) Integrative health care: how can we determine whether patients benefit? J Altern Complement Med 11:S–57–S-65. doi:10.1089/acm.2005.11.s-57

    Article  Google Scholar 

  28. Shaw A, Evans M, Sharp D, Thompson EA, Falk S, Turton P et al (2006) Male cancer patients’ views on and use of complementary and alternative medicine (CAM): a qualitative study. Final Report to the Department of Health. Department of Health, London

    Google Scholar 

  29. Steinsbekk A, Launso L (2005) 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. Integr Cancer Ther 4:195–200. doi:10.1177/1534735405276721

    Article  PubMed  Google Scholar 

  30. Truant T, Botorrf JL (1999) Decision making related to complementary therapies: a process of regaining control. Patient Educ Couns 38:131–142. doi:10.1016/S0738-3991(99)00060-9

    Article  PubMed  CAS  Google Scholar 

  31. Koithan M, Verhoef M, Bell IR, White M, Mulkins A, Ritenbaugh C (2007) The process of whole person healing: “unstuckness” and beyond. J Altern Complement Med 13:659–668. doi:10.1089/acm.2007.7090

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful to all patients and staff that took part in the study. MJP was supported, at Breast Cancer Haven, by funding from GlaxoSmithKline and Research Development funding when at the University of Westminster.

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Correspondence to Marie J. Polley.

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Seers, H.E., Gale, N., Paterson, C. et al. Individualised and complex experiences of integrative cancer support care: combining qualitative and quantitative data. Support Care Cancer 17, 1159–1167 (2009). https://doi.org/10.1007/s00520-008-0565-3

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  • DOI: https://doi.org/10.1007/s00520-008-0565-3

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