Traditional, Complementary and Alternative Medicine and Cancer Care provides the first in-depth exploration of the role that patient support groups play in the provision of CAM in the UK and Australia. Traditional, complementary and alternative medicine and cancer care : an international analysis of grassroots integration / Philip Tovey, John Chatwin and Alex Broom.
Introduction
In the context of non-biomedical cancer practices, consideration of the multifaceted nature of evidence and legitimacy is absolutely imperative. With the example of Australia, the nature of the single case study is similarly described.
The empirical, theoretical and policy context in
The first section examines issues related to non-biomedical cancer treatments in the UK and Australia (complementary and alternative medicine). The second examines issues related to the use of non-biomedical cancer treatments in Pakistan (mainly, but not exclusively, traditional modalities).
Healthcare services operate with very limited resources, currently approximately 1 percent of GDP (Tovey et al. 2005). The following empirical sections should be seen in the context of the approach taken and the locations studied.
The nature of CAM-focused cancer support groups
Female group organizer, Group 5) Organizers report that they find it much more difficult to be 'accepted' and appreciated than they had envisaged when starting the group. Or if there is active disease, you have to be very careful.. there is a danger that they [unqualified complementary practitioners] are unaware of the problems in the cancer area. Successful organizers tend not to be abused in the assumption that people will inevitably and without question embrace the therapies they should.
Male group creator, Group 5) In terms of the types of patients who access CAM in the group settings we are dealing with, again, there seem to be no particularly idiosyncratic qualities by which they can be singled out. The largely pragmatic approach to CAM so often found among cancer patients may also have much to do with the nature of the disease. In this chapter we have begun to focus on some of the broad structural issues that underpin the development and organization of CAM-based cancer support groups.
Group performance
This therapist takes on all the tasks involved in the day-to-day organization of the support group. Group leader, CAM therapist, Group 3) The therapeutic activities of the group organizer were fundamentally linked to the activities of the support group. This dynamic can be observed in most of our groups, regardless of the CAM modalities offered.
Although the group's structured activities (ie, relaxation and meditation) greatly downplayed the kinds of social interactions normally associated with support groups, it is not to be assumed that these were completely absent. Also on a broader level, the physical geography of the area around where the therapist worked encouraged meetings outside the group. This placement of interactional activities away from the focus of the group meeting itself has important implications for the dissemination of CAM-related information.
Confined innovation
New members may feel as though they must follow the established ways of the group and fit into the implicit hierarchy. This appears to be built into the nature of the cancer support environment (an eclectic range of perspectives), as well as the wider tendency for hierarchical structures to develop in group contexts. From the reports of group members and organizers, it was clear that the use of CAM (and its implementation) was usually a predominantly female activity.
Organizer, Group 4) Of the relatively few men encountered in support group settings, a high proportion are likely to be carers rather than patients. In this chapter we have addressed the question of the extent to which the provision of CAM in cancer support groups can be considered innovative or even challenging the status quo. The aim of this chapter is to present the results of the first exploratory case study of the delivery of CAM in a cancer support group in Australia.
An exploratory comparative case study from Australia
What impact did this dynamic have on the group's ability to innovate in terms of CAM and CAM delivery? Participation in the meditation sessions that formed the main work of the group was free and open to all oncology and hematology patients attending Angel Hospital and Graceland Hospice. In the following excerpt, one of the group's facilitators talks about CAM therapies and recommends them to patients:.
If someone who was new to the group arrived, the facilitators were available to meet them and informally explain the flow of the session. The type of meditation practiced can therefore be easily adapted to the composition and wishes of the group on any given day. The discussions that took place during this period were generally much looser than during the first hiatus and represent important crossroads in the group's overt workings.
Consumption, and perceptions, of traditional, complementary
In the previous two sections of this book, we explored the role of non-biomedical therapeutic practice within the context of UK and Australian cancer care, focusing on such things as: how patient support groups engage with CAMs; the role of evidence in treatment decision-making. Westernizing certain facets of primary health care in many poorer countries, traditional medicine (TM) still receives significant grassroots support, especially in rural or remote locations (WHO 2001). According to the World Health Organization, almost 80 percent of the world's population continues to use their own traditional medicine systems despite the increasing presence of biomedical health services in many poorer countries (WHO 2001).
Previous research in the area also suggests that people's views of biomedicine in some poorer countries may have been tainted by the failures of certain facets of 'Westernisation' and international development programmes. This led to a reaffirmation of the value and importance of traditional practices and belief systems (Wayland 2004). Despite anecdotal evidence of continued support for non-biomedical therapeutic modalities, no empirical data exist on the use patterns of TM and CAM among cancer patients outside the West.
In terms of gender, 41.2 percent of those who participated in the study were female and 58.8 percent were male. As suggested in Chapter 1, the limited research conducted on TM and CAM use among cancer patients in Pakistan suggests that, as in the West, use is relatively high. Additionally, 59.7 percent of patients surveyed had used more than one type of TM or CAM.
Interestingly, gender was not a factor in Hakeem use, with 35.3 percent of women using Hakeem compared to 37 percent of men. Thus, when analyzing the survey data, we examined possible differences in the use of TM and CAM depending on the place of employment. Such complexities emerge strongly in the next two chapters, which provide further in-depth insight into stratification in TM use and sociodemographic factors.
Patients’ negotiation of therapeutic options
Here we illustrate how the active decision-making of patients lies in the middle of the three dimensions of influence. Of course, it is important to consider such experimentation within the context of the structural constraints discussed above. The spiritual healer] said: 'Your donkey will die when you get rid of the disease.'.
Obviously, this is a preliminary understanding of the situation from this initial study, but it is certainly worth examining critically in later studies. The study reported here was developed in response to the need for an understanding of the utilization of the many therapeutic options among people with cancer in poorer countries in general and Pakistan in particular. Here, traditional medicine could be seen to address important spiritual facets of the disease process – and was often used in conjunction with biomedical treatment.
Interprofessional conflict and strategic alliance
As with the previous two chapters, it emerged that a variety of religious and cultural belief systems play a role in mediating the dynamic between traditional healers and biomedical practitioners. There were numerous anecdotes of traditional healers who reacted angrily to the use of biomedical cancer treatments and refused to continue treatment. Traditional healers like the Hakeems follow vastly different views of disease than do biomedical clinicians.
As seen in the second extract above, although only mentioned by a minority of the patients interviewed, some traditional healers will also try to prevent their patients from seeing other traditional healers (sometimes those from the same therapeutic practice) . As we can see from the excerpts presented below, according to the majority of patients interviewed, their doctors would not refer them or other patients to most traditional healers. Traditional healers refer patients to doctors and doctors refer patients to these traditional healers.
Conclusion
The work in the richer countries is situated within the wider sociological study of the use and provision of CAM. A blanket advocacy of promoting 'the traditional' ignores the complexity of interactions and experiences at the grassroots level. So what are the next stages in the sociological study of the use of non-biomedical therapies in cancer treatment.
Given the under-researched nature of the area in both richer and poorer countries, the agenda is considerable. One of the issues raised in this context by the Western sociology of CAM is that of the relationship between the individual and the group. Of course, the above merely represents a selection of the issues that need to be addressed.
Notes
4 This particular therapist, having worked as a healer within the NHS for over fifteen years, can legitimately claim to have been at the vanguard of integration, being one of the first individuals to secure official funding for her activities. her. These were essentially guided meditations very similar to those implemented during group sessions - the CDs were based on audio recordings of the therapist and of the two DVDs that were produced, one was a full-length video of a 'live' session with support. the group. Eventually, things came to a head and the individual decided to leave and start her own band – much to the relief of the organisers.
The fact that she did this when the mood of the group was becoming relatively militant (and thus, in a way, cohesive) showed the priority she placed on expressing her neutrality. That this was resisted is illustrative of the sensitivity and awareness of her felt 'place'. 1984) Distinction: A Social Critique of the Judgment of Taste [translated by Richard Nice], London: Routledge and Kegan Paul.
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Index
