Short summary

This project is about open dialouge about complementary alternative medicine (CAM) integrated in conventional oncology care. 

Integrating open dialogue aboot CAM in the conventional oncology care is an opportunity of viewing the patient as a whole person and expert in his/her situation with individual needs, whishes, beliefs and preferences. Also, the open dialogue has potentials in improving the patients health, quality of life and well-being. However, we need knowlegde on how this open diaoluge actually will affect the patients in order to integrate the open dialogue in the best way. 

Rationale

Background

Sophisticated conventional medicine has led to significant advances in cancer prevention, detection and treatment. Still, many patients with cancer turn to complementary and alternative medicine (CAM). A study of Danish patients with colorectal cancer has shown that nearly half (49,4%) of them use CAM. Another study shows that CAM is also popular among patients with cancer across Europe with an application of up to 73,1%. In the USA the prevalence of CAM use among patients with cancer is up to 83,3%. Given the high rate of CAM usage as an adjunct to conventional cancer care and the potentially harmful interactions between certain types of CAM and conventional medicine, it is crucial to integrate open dialogue about CAM between patients and health professionals in daily oncology care. This type of conversation, however, is almost non-existing. 

Though patients prefer discussing CAM with conventional health professionals, they seek information online, in health stores, with alternative practitioners or from family and friends. Web-sites often contain erroneous or incomplete information and family and friends may not have the necessary knowledge to support patients with cancer using CAM. This may lead patients to use CAM in a potentially dangerous way. Thus, health professionals have both an ethical and a legal obligation to discuss CAM with their patients. The attitude of health professionals toward CAM, however, is perceived by patients to be negative with a lack of interest and knowledge and too little empathy and willingness to discuss CAM. Consequently, patient safety is impaired.

The lack of discussing CAM indicates that person centered care (PCC) is not fully implemented in the conventional oncology care. Literally listening to the patient and viewing the patient as an expert in his/her situation and how he or she manages illness combined with the medical knowledge of the health professionals is fundamental in PCC, and PCC has shown to improve quality of care, quality of life and well-being. 

Concurrently, studies show that CAM improves quality of life and well-being e.g. by reducing side-effects such as nausea and vomiting, fear, fatigue, depression and pain and CAM enhances hope, self-care, self-control and empowerment. Hence, reluctance to discuss with patients their use or wish to use CAM and their need for reliable information on benefits and risks, reduces the possibility of improving the health, quality of life and well-being of the patients. However, research on how open dialogue about CAM integrated in conventional oncology care actually affects patients' health, quality of life and well-being is sparse.

The multiple physical, psychological, social, cognitive, emotional and existential effects of CAM from a phenomenological point of view represent the reality of the lived experiences with CAM. Lived experiences relates to the assumptions that human beings are essentially embodied and inseparable body-subjects. The body is both a physical object and the source of subjective feelings, perceptions and sensations; a subject-object unique being. Thus, congruent with PCC - patients are persons who understand the impacts of illness and treatment better than anyone . Accordingly, understanding patients lived experiences is essential in improving the quality of life and well-being of the patients. In that sense, understanding the individual patient´s lived experiences when open dialogue about CAM is integrated in conventional oncology care, is essential in improving quality of life and well-being. 

Aim

This study aims to increase our knowledge on how open dialogue about CAM integrated in conventional oncology care influences patient's health, quality of life and well-being during their medical oncologic treatment  and/or radiotherapy and how they experience the meaning of their body and self when open dialogue about CAM is integrated in the medical oncologic treatment and/or radiotherapy. 

The following research questions will be scrutinized.

When open dialogue about CAM is integrated in medical oncologic treatment and/or radiotherapy:

• What is the patient reported frequency and level of clinical side effects?

• What is the patient reported level of quality of life, depression and anxiety?

• How does the patients perceive the received information?

• How does the patients experience the meaning of their body and self?

Description of the cohort

Adult patients (age 18 or more):

-who are diagnosed with a new primary cancer or a relapse of cancer within the last 3 months

-who have planned or initiated oncologic medical treatment and/or radiotherapy at the Department of Oncology, Vejle Hospital

- where at least two months of oncologic treatment is realistic 

- where at least six months of life expectancy is realistic

Data and biological material

Registration of clinical side effects: 

-Common Terminology Criteria for Adverse Events (CTCAEv4) 

Questionnaires: 

-Quality of life:EORTC QLQ C30

-Anxiety and depression: DepressionHospital Anxiety and Depression Scale (HADS)

-Percieved information: EORTC QLQ-INFO25

Qualitative interviews: Interviewguide

Collaborating researchers and departments

Department of Oncology, Vejle Hospital

• Consultant Oncologist, Clinical Associate Professor, PhD, Lars Henrik Jensen

Department of Nursing Science, Public Health, Aarhus.

• Professor in Nursing Science, MSc in Nursing, PhD., Charlotte Delmar

University of Southern Denmark

• Associate Professor, MScN, PhD, Birgitte Nørgaard