Abstract

Purpose: This study aimed to explore the decision-making process in patients with ulcerative colitis who were interested in and chose to use complementary and alternative medicine. Methods: This descriptive study used a grounded theory approach to study the decision-making process in patients with ulcerative colitis, including semi-structured interviews and constant comparative analysis. The study subjects were recruited from a self-help group for patients in Japan. A total of 14 adult patients with ulcerative colitis that was in remission participated in this study. Results: In this grounded theory study of patients with ulcerative colitis who choose to use complementary and alternative medicine, a core category was identified, i.e., “self-control trial,” along with five other categories included in the patients’ decision-making process: “health condition,” “feasibility,” “influenced by others,” “desire to restore my health,” and “distrust.” Patients whose health condition was not improved by their current treatment were interested in complementary and alternative medicine. While being influenced by others and examining the feasibility of complementary and alternative medicine, these patients weighed their desire to restore health with their distrust. When their desire to restore health outweighed their distrust, patients chose to use complementary and alternative medicine. Conclusions: This study provides an insight into patients’ decision-making processes about their choice of complementary and alternative medicine. Such insights might help nurses to better understand and respect patient choice. The findings may also be useful in the development of support programs addressing concerns about the choice of complementary and alternative medicine by patients with ulcerative colitis.

Highlights

  • Ulcerative colitis (UC) is an inflammatory bowel disease that causes ulcers in the mucous membrane of the large intestine

  • Treatment with anti-tumor necrosis factor (TNF) agents or an immunomodulator is often provided to control inflammation caused by an abnormal immunoreaction in the intestinal tract

  • A Japanese study reported that approximately 70% of patients with UC using an anti-TNF agent went into remission after 12 weeks, but 40% of them showed relapse or loss of response within 1 year [3]

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Summary

Introduction

Ulcerative colitis (UC) is an inflammatory bowel disease that causes ulcers in the mucous membrane of the large intestine. Complications may develop out of the intestinal tract,such as joint pain or iritis. The number of Japanese patients with UC is increasing annually; approximately 170,000 people contracted the disease in 2015 [2]. Treatment with anti-tumor necrosis factor (TNF) agents or an immunomodulator is often provided to control inflammation caused by an abnormal immunoreaction in the intestinal tract. These medications have the problems of severe side effects or loss of response. A Japanese study reported that approximately 70% of patients with UC using an anti-TNF agent went into remission after 12 weeks, but 40% of them showed relapse or loss of response within 1 year [3]. Half of patients with UC in Europe and America are reported to use some type of CAM, such as acupuncture, vitamin compounds, probiotics, and herbs [4,5,6]

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