Purpose. The purpose of this study is to describe the essential features of the transformative experience among people living with cancer who are seeking integrative care and to identify factors supporting this process. It is hoped that after establishing the nature and meaning of this change or shift, one will better understand what is most meaningful in terms of providing appropriate care and support to patients seeking integrative care. Study Design. An interpretational, qualitative approach guided sampling, data collection, and analysis with 11 individuals. A purposeful sample was drawn from selected integrative care facilities according to sociodemographics and type of cancer. Due to the complexity of this subject, second interviews were conducted with 5 participants to enhance the richness and validity of the data. Results. The experience of transformation is a dynamic 4-stage process in which participants learned about themselves and became more aware of who they are and how they relate to the world. Participants found that 4 dimensions of integrative medicine played a fundamental role in supporting this process. These dimensions include (1) having access to a range of appropriate therapies to support individual journeys, (2) care that focuses on one's overall well-being, (3) control over cancer management, and (4) developing healing relationships with care providers. Conclusion. Although practitioners may not be able to create transformative experiences for patients, they may be able to establish and maintain conditions that support this process.
BackgroundIntegrative health care (IHC) is an interdisciplinary blending of conventional medicine and complementary and alternative medicine (CAM) with the purpose of enhancing patients' health. In 2006, we designed a study to assess outcomes that are relevant to people using such care. However, we faced major challenges in conducting this study and hypothesized that this might be due to the lack of a research climate in these clinics. To investigate these challenges, we initiated a further study in 2008, to explore the reasons why IHC clinics are not conducting outcomes research and to identify strategies for conducting successful in-house outcomes research programs. The results of the latter study are reported here.MethodsA total of 25 qualitative interviews were conducted with key participants from 19 IHC clinics across Canada. Basic content analysis was used to identify key themes from the transcribed interviews.ResultsBarriers identified by participants fell into four categories: organizational culture, organizational resources, organizational environment and logistical challenges. Cultural challenges relate to the philosophy of IHC, organizational leadership and practitioner attitudes and beliefs. Participants also identified significant issues relating to their organization's lack of resources such as funding, compensation, infrastructure and partnerships/linkages. Environmental challenges such as the nature of a clinic's patient population and logistical issues such as the actual implementation of a research program and the applicability of research data also posed challenges to the conduct of research. Embedded research leadership, integration of personal and professional values about research, alignment of research activities and clinical workflow processes are some of the factors identified by participants that support IHC clinics' ability to conduct outcomes research.ConclusionsAssessing and enhancing the broader evaluation culture of IHC clinics prior to implementing outcomes research may be a critical step towards ensuring productive and cost-effective research programs. However, as IHC clinics are often complex systems, a whole systems approach to research should be used taking into account the multidimensional and complex nature of such treatment systems so that the results are useful and reflect real life.
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.
In order to capture the outcomes of this program properly, both qualitative and quantitative measures are needed.
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