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Assessing the Role of Evidence in Patients' Evaluation of Complementary Therapies: A Quality Study

Departments of Community Health Sciences and Medicine, University of Calgary, Calgary, AB, mverhoef{at}ucalgary.ca

Andrea Mulkins, MSc

Tzu Chi Research Group, Vancouver, BC

Linda E. Carlson, PhD

Department of Psychosocial Resources, Tom Baker Cancer Centre and the Department of Oncology, Division of Psychosocial Oncology, Faculty of Medicine, University of Calgary, Calgary, AB

Robert J. Hilsden, PhD, MD

Departments of Community Health Sciences and Medicine, University of Calgary, Calgary, AB

Anna Kania, BSc

Departments of Community Health Sciences and Medicine, University of Calgary, Calgary, AB

Background: Making the decision to use complementary and alternative medicine (CAM) for cancer treatment is difficult in light of the limited available evidence for these treatments. It is unclear how patients use evidence to make these decisions. Objectives: (1) Describe the type of information about CAM that cancer patients use in their decision making; (2) understand why certain types of information about CAM are accepted as evidence by cancer patients; and (3) explore the role of scientific evidence in treatment decision making. Methods: A qualitative study design using in-depth semistructured interviews with cancer patients attending 4 conventional and integrative health care institutions in Alberta and British Columbia, Canada, was used. Results: Twenty-seven patients were interviewed. Patients sought CAM information from a range of sources, including the Internet, health care providers, friends, relatives, and newspapers. Many expressed frustration about the overwhelming amount of available information and found it difficult to identify reliable information. Information was described as reliable if it supported them in arriving at a decision about CAM. Types of information participants identified included anecdotes, expert opinion, gut feeling, popular literature, scientific evidence, testimonials, advertising and trial and error. Profound differences were found between new CAM users, experienced CAM users, and users with late-stage cancer in type of information sought, the role of scientific evidence in decision making, and overall information needs. Conclusion: Although this was a relatively small qualitative study, the results suggest that (1) many patients do not value scientific evidence as highly as conventional providers and (2) it is important for clinicians and other information providers to be aware of the different types of information that patients seek out and access when making choices and decisions regarding CAM treatments and why they seek out these sources.

Key Words: complementary and alternative medicine • patient decision making • evidence • assessing information • cancer

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