Lay perspectives on the use of biologically based therapies in the context of cancer: a qualitative study from Sweden.

WHAT IS KNOWN AND OBJECTIVE: Biologically based therapies (BBTs) such as herbal medicines represent the most commonly used type of complementary and alternative medicine by cancer patients. There is a paucity of data regarding individuals' motives for starting and continuing use of BBTs in cancer. Our objective is to explore lay perspectives on use of BBTs in cancer. Our hope is that the data generated will support pharmacists and other professionals in improving their communication about BBTs with patients. METHODS: Interviews with 12 individuals with cancer who used BBTs were analyzed with interpretive description and framework analysis, to build on previous literature and gain new knowledge of clinical relevance. RESULTS: The findings suggest that users are motivated to continue to use BBTs when they experience these as both effective and harmless. Perceived effects of BBTs include a wide range of responses such as improved physical and psychological well-being, and cancer-related benefits. These experiences go beyond the legal health and medical claims for these products. The findings indicate that users' views of side-effects, ascribed to BBT use, are situation-dependent with the potential to either facilitate or hinder continued BBT use. WHAT IS NEW AND CONCLUSION: Our results indicate the importance of acknowledging users' own views of BBTs to improve patient-provider communication. This should aid the design of more effective BBT surveillance systems and hence increase patient safety and satisfaction.

Push or pull? Relationships between lung cancer patients' perceptions of quality of care and use of complementary and alternative medicine.

UNLABELLED: Little is known about relationships between quality of care (QoC) and use of complementary and alternative medicine (CAM) among patients with lung cancer (LC). PURPOSE: This study examines CAM-use among patients with LC in Sweden, associations between QoC and CAM-use among these patients, and reported aspects of LC-care perceived as particularly positive and negative by patients, as well as suggestions for improving QoC. METHODS: Survey data from 94 patient members of the Swedish LC patient organization about CAM-use and QoC as measured by the instrument "Quality from the patient's perspective" were analyzed. RESULTS: Fifty (53%) LC-patients used CAM, with 40 of the CAM-users reporting that CAM helped them. The most common CAMs used were dietary supplements and natural remedies, followed by prayer. Significantly more patients reported using prayer and meditation for cure than was the case for other types of CAM used. Less than half the CAM-users reported having spoken with staff from the biomedical health care system about their CAM-use. Patients provided numerous suggestions for improving LC-care in a variety of areas, aiming at a more effective and cohesive care trajectory. No differences in QoC were found between CAM-users and non-CAM-users, but differences in CAM-use i.e. type of CAM, reasons for using CAM, and CAM-provider consulted could be associated with different experiences of care. CONCLUSIONS: It is important to recognize that CAM-users are not a homogeneous group but might seek different types of CAMs and CAM-providers in different situations depending on experiences of care.

Nutritional support and risk status among cancer patients in palliative home care services.

GOAL OF WORK: The aim of this study was to investigate the nutritional risk status and use of nutritional support among cancer patients enrolled in palliative home care services. Differences in the use of nutritional support in relation to nutritional, social and clinical factors, as well as survival were also investigated. PATIENTS AND METHODS: Structured telephone interviews were conducted with cancer patients enrolled in all 21 palliative home care services in the Stockholm region. An interview guide was designed to investigate topics related to the patient's nutritional situation. MAIN RESULTS: Interviews with 621 patients were analysed. Sixty-eight percent of the patients were scored as at nutritional risk according on a modified version of NRS-2002. Nutritional support was used by 55% of the patients, with oral nutritional supplements most common and 14% using artificial nutrition. Use of nutritional support was related to low BMI and severe weight loss and was more common in patients with shorter survival times. CONCLUSIONS: These findings demonstrate that nutritional support is used to treat already malnourished patients with shorter survival time, rather than to prevent malnutrition. A more structured approach to nutritional issues for patients in palliative phases, which considers life expectancy and psycho-social aspects of nutritional issues, could help identify potential candidates for nutritional support.

"Shopping" for sexually transmitted disease treatment: focus group discussions among lay persons in rural and urban Zambia.

BACKGROUND: In Zambia, persons use different types of services when seeking treatment for sexually transmitted diseases (STDs). GOAL: To gain insight into the rationale behind the selection of treatment sources by investigating perceptions of STDs and by identifying STD treatment sources used. STUDY DESIGN: Focus group discussions were held with 57 men and 44 women in one urban and one rural area in Zambia between May 1997 and June 1997. The focus group discussions were audiotaped and analyzed qualitatively. RESULTS: Participants combined traditional and modern treatment. The main reason given was that even when biomedical medicine was effective, STDs could only be totally cured if the patient was cleansed by traditional herbs. Factors influencing health-seeking behavior were the person's perception, how the diagnosis was determined, type and cost of treatment, demand for sexual partners, and attitudes of health workers, parents, and the church. CONCLUSION: Barriers and enabling factors for the use of treatment sources were identified. Interventions to improve services and cooperation between the health sectors need to consider these factors.