An exploration of healthcare providers\u2019 experiences and perspectives of Traditional and complementary medicine usage and disclosure by Indigenous cancer patients

K. Anderson,J. Adams,V. Matthews,A. Gall,G. Garvey

doi:10.1186/s12906-019-2665-7

Abstract

BackgroundTraditional and complementary medicines (T&CM) are any form of medicine, practice, treatment, product, technology, knowledge system or ceremony outside of conventional medical practice that aims to prevent and/or treat illness and/or promote well-being. Alongside conventional cancer treatments, T&CM usage is increasing; with 19% of indigenous Australians with cancer reporting using T&CM. There is limited evidence surrounding T&CM use and disclosure by indigenous patients. Our aim was to explore healthcare providers’ views about usage, disclosure/non-disclosure of T&CM by Indigenous cancer patients.MethodsSemi-structured, in-depth interviews with 18 healthcare providers, including three indigenous providers, at a large urban hospital providing care to Indigenous cancer patients were conducted to explore providers’ experiences and attitudes towards T&CM use by Indigenous cancer patients. An interpretive phenomenological approach was used to thematically analyse the data.ResultsAnalysis revealed six themes: concern about risk; no ‘real’ benefits; perception of T&CM and conventional medicine as antithetical; barriers to disclosure; ‘patients’ choice’ a double-edged sword; and providers’ lack of knowledge about T&CM. Healthcare providers perceived discord between T&CM and conventional medicine. Most lacked knowledge of T&CM, and had concerns around negative-interactions with conventional treatments. They considered T&CM outside their role, citing this as reasoning for their lack of knowledge. Indigenous healthcare providers had greater understanding and openness towards T&CM.ConclusionsGiven the potential usage of T&CM by Indigenous cancer patients, providers need a more comprehensive understanding of T&CM in order to inform discussion and facilitate effective disclosure on this topic. If indigenous Australians with cancer feel that cancer care providers are unreceptive to discussing T&CM, patient care risks being compromised; particularly given the potential for negative interactions between T&CM and conventional cancer treatments. Fostering health care interactions where indigenous patients feel comfortable to discuss T&CM usage should be a priority for all cancer care services.

Highlights

Traditional and complementary medicines (T&Complementary Medicine (CM)) are any form of medicine, practice, treatment, product, technology, knowledge system or ceremony outside of conventional medical practice that aims to prevent and/or treat illness and/or promote well-being
Six key themes were identified relating to the study aims: concern about risks using Traditional and complementary medicines (T&CM); no ‘real’ benefits of T&CM; perception of T&CM and conventional medicine as antithetical; barriers to disclosure; ‘patients’ choice’ is a double-edged sword, and; providers’ lack of knowledge of Traditional indigenous Medicine
Concern about risks associated with using T&CM A common thread throughout the interviews was a concern about potential risks of using T&CM in conjunction with conventional cancer treatments

Summary

Introduction

Traditional and complementary medicines (T&CM) are any form of medicine, practice, treatment, product, technology, knowledge system or ceremony outside of conventional medical practice that aims to prevent and/or treat illness and/or promote well-being. Cancer is the second leading cause of mortality among Aboriginal and Torres Strait Islander Australians (hereafter respectfully referred to as indigenous Australians), and most concerning is the cancer mortality gap between indigenous and non-indigenous Australians, which is increasing (1998–2015; 21% of indigenous vs 13% of nonindigenous) [1] While reasons for this disparity are complex, there is evidence that factors such as advanced cancer stage at diagnosis [2,3,4], reduced access to, uptake and/or completion of treatment [3, 5,6,7,8], and higher rates of co-morbidities [3, 7] amongst indigenous patients contribute to their poorer cancer outcomes relative to non-indigenous Australians. It is likely that traditional and complementary medicine (T&CM) plays an important role in re-establishing wellness for Indigenous cancer patients, rather than solely focussing on curing the disease

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