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Cross-cultural perspective in complementary & alternative therapies research

Cross-cultural perspective in complementary & alternative therapies research. First National Workshop on Cross Cultural Cancer Research and Care: Building Collaborative Communities Feb 20-21, 2004 Anne Leis, PhD University of Saskatchewan. Outline. Introduction

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Cross-cultural perspective in complementary & alternative therapies research

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  1. Cross-cultural perspective in complementary & alternative therapies research First National Workshop on Cross Cultural Cancer Research and Care: Building Collaborative Communities Feb 20-21, 2004 Anne Leis, PhD University of Saskatchewan

  2. Outline • Introduction • Current state of knowledge: some highlights about CAM in cross cultural cancer care • Current initiatives • Suggested targets • Top 3 questions

  3. Introduction • Lack of consensus around CAM definition • Definition Adopted by NIH National Centres on CAM (NCCAM) Complementary and Alternative Medicine (CAM) is a broad domain of healing resources that encompasses all health systems, modalities and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period. CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being. Boundaries within CAM and between the CAM domain and the domain of the dominant system are not always sharp or fixed. Alt Ther 1997; 3(2): 49-57

  4. Introduction (2) • Issues with CAM classification systems • Porous and flexible boundaries between conventional and non-conventional medicine • Any classification system depends on underlying premises and the ability to obtain mutually exclusive categories

  5. Introduction (3) • Issues in identifying CAM prevalence in the general and cancer population • world phenomenon • general population: CAM utilization is frequent and increasing: range from 9% to 75% • cancer populations: range of 7-81% • Range can be attributed to: • what is counted or included • nature of the sample

  6. Introduction (4) • Issues in defining culture and cross-cultural research • Culture as "a complex interplay of meanings that represent and shape the individual and collective lives of people" is adefinition recently adopted by a group of researchers who are establishing a team to study cross-cultural issues in the Canadian health care context. • Culture is often reduced to ethnicity, language spoken at home, or number of years spent in Canada • Acculturation is not well understood within health research • Necessity to promote research that transcends disciplinary boundaries and works with the populations of interest, using participatory methodologies.

  7. Current State of Knowledge • Attention to the health beliefs of minorities is likely to improve care and health outcomes for minority patients. • Reliance on an alternative health care system and use of self-care behaviours and practices are common among ethno-cultural minorities. • Western trained health practitioners not always knowledgeable about CAM; in addition some are not supportive of CAM or advice patients against them. • Concurrent use of alternative modalities and products while receiving standard treatments is common without any discussion occurring between patients and health care professionals.

  8. Recent Studies • Lee et al (2000). Telephone interviews with 379 women with breast cancer San Francisco • Prevalence of CAT in four ethnic groups (Latino, White, Black, and Chinese). • 48% used at least one type; 42% in Chinese to 54% in Whites • Blacks - spiritual healing, Chinese - herbal remedies, Latinos and Whites - dietary therapies. • Liu et al (1997). Chinese oncology patients in Taiwan • 64% actively undergoing conventional treatment used indigenous Chinese medicine after cancer diagnosis; • Utilization was concurrent with chemotherapy for 2/3 of the patients. • Maskarinec et al (2000). Mail survey of cancer patients in Hawaii. • 25% had used at least one type of CT; many reported using multiple therapies • Use range from 18% (Japanese) to 39% (Filipino); Caucasians reporting most multiple use and Filipinos the least.

  9. Recent Studies (2) • Leis et al (2003) • Telephone survey on the prevalence of CT use by 2064 Canadian cancer patients across 6 provinces • Sample distribution of major cancers was generally consistent with 1998 Canadian incidence estimates. • Prevalence estimated at 43% ranging from 24% (francophone) to 55% (oriental origin). • Large majority of users (71%) employed more than one CT (mean = 3.64; SD = 3.57), with various vitamin and mineral supplements being the most common modalities.

  10. Recent Studies (3) • Leis et al (2003) continued: • Usage was highest in BC and ON, as well as in brain and breast cancer patients. • Most commonly cited sources of information on CT were friends and family (31%). • Main reasons for using CT included • belief in strengthening the immune system (25%) • increasing well-being and quality of life (25%) • fighting cancer (17%) • increasing energy (12%) • combating the side effects of conventional cancer treatment.

  11. Recent Studies (4) • Leis et al (2003) continued: • In the univariate logistic regression analyses ethnicity and the influence ofcultural and religious backgroundwas found to be significantly related to CT use (p < .05). • The second variable remained in the final model following a forward stepwise multivariate logistic regression analysis.

  12. Some of the current Initiatives • Sep 2003: CAM in UME Workshop held for all Canadian medical schools to discuss incorporation of CAM into the medical curriculum. • Oct 2003:Nov 2003: • Workshop on Whole Systems Research held in London, UK • Establishment of the first International Society of Complementary and Alternative Medicine • Jan 2004: Canadian Interdisciplinary Research Network for Complementary & Alternative Medicine Research (INCAM) was launched. • Ongoing: • Study on Aboriginal perceptions of cancer and cancer care in Saskatchewan • a few on-going studies on CAHC by Chinese cancer patients and south-Asian populations in BC. • Important to develop target research in this field and build research capacity while building bridges with practice and policy.

  13. Some research areas to target • Patients need to know safety information of the CAM they use • Patient must be able to communicate effectively with health care providers about CAM • Encourage understanding of different systems of medicine (e.g. Western biomedical system, First Nation’s traditions, Ayurvedic medicine etc) • Involve cultural groups in the research. Let the patients identify the research questions.

  14. Top 3 Questions 1. Better understand the most common CAM approaches by ethnic patients across tumour sites and investigate safety. 2. Develop a step-wise approach for CAM research in ethno-cultural populations. 3. Focus on the interface and integration between conventional and alternative whole care systems.

  15. Questions?

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