Complementary and alternative medicine (CAM) is frequently used by patients with multiple sclerosis (MS). Some MS patients experience unexpected improvements of symptoms, which they relate to their use of CAM. The aim of this study was to obtain knowledge and develop understandings of such self-defined unexpected improvement of MS symptoms. Two cases were constructed based on documents and 12 qualitative interviews. Our aim was not to make generalisations from the cases, but to transfer knowledge as working hypotheses. We identified four health-related change processes: the process of losing bodily competence; the process of developing responsibility; the process of taking control; and the process of choosing CAM. The patients explained unexpected improvements in their MS symptoms as results of their own efforts including their choice and use of CAM. In our theoretical interpretations, we found the patients’ redefinition of history, the concept of treatment and the importance of conventional health care to be essential, and leading to a change of patients’ position towards conventional health care from recipients to explorers. The explorers can be perceived as boundary walkers reflecting limitations within the conventional health care system and as initiators regarding what MS patients find useful in CAM.

3 AbstractBreast cancer patients are frequent users of complementary and alternative medicine (CAM). They often have complex reasons for, and experiences from, their use of CAM.Bodily experiences are important and almost unexplored elements in CAM use. Our aim was to explore the meaning and importance of bodily experiences among breast cancer patients who were using CAM as a supplement or an alternative to conventional treatment (CT). Our findings based on qualitative interviews with 13 women suggest that bodily experiences were particularly important when positioned outside conventional health care prior to medical diagnosis and as user of CAM as alternative to CT. We introduce three central modes of embodiment related to CAM use: the right to one"s body, the body used as a gauge, and the body used as a guide. Patients" positioning between treatment systems should be further explored from a bodily perspective to safeguard and optimize patients" treatment choices. Keywordscancer, breast; embodiment/bodily experiences; health care, alternative and complementary; illness and disease, experiences; knowledge construction; safety, patient 4The most common cancer worldwide is breast cancer, representing 16% of all cancer diagnoses in women (World Health Organization, 2008). Breast cancer patients experience many physical and psycho-social challenges during their breast cancer continuum (Arman, Rehnsfeldt, Lindholm, Hamrin, & Eriksson, 2004;Bredin, 1999;Carter, 1993;Thomas-MacLean, 2004), and an increasing number of breast cancer patients in Western countries choose to use complementary and alternative medicine (CAM) to strengthen their health and well-being (Boon, Olatunde, & Zick, 2007;Kremser et al., 2008; Lengacher et al., 2002;Molassiotis et al., 2006;Nahleh & Tabbara, 2003). An international review revealed that the prevalence of CAM use varied between 63 % and 83 % among breast cancer patients using at least one type of CAM (Di Gianni et al., 2002).There is, however, a great variation in these rates, depending on the definition of CAM used in each study, the setting of the study and the sample size.In this article we will describe use of CAM among breast cancer patients in a Norwegian and Danish health care context. In these countries, breast cancer counted for 23% (Cancer Registry of Norway, 2009) No applicable official definition of CAM exists in Denmark, but the situation is quite similar to Norway. CAM in a Danish context can be defined as therapies that go beyond the treatments offered by the state-financed health system (Baarts & Pedersen, 2009). In general, the prevalence of CAM use in Scandinavia is higher among women, individuals with higher education, and people with poor self-reported health (Hanssen et al., 2005).In Denmark, patients with breast and gynecological cancer seem to be more likely to seek CAM treatments than patients with all other types of cancer (Kimby, Launsø, Henningsen, & Langgaard, 2003), and breast cancer patients using CAM seem to be healthier and more likely to hav...

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Recovery-oriented mental health service programs are often rather based on ideological or political considerations than on empirical evidence.At Klinikum Bremerhaven Reinkenheide, we have included peer support workers in our teams in order to improve the quality of our treatment program and the recovery attitudes of the staff members.To control and evaluate this process an independent investigator conducted 13 (T1: February 2012), respectively 15 (T2: September 2013) interviews with different stakeholders of the change process. The interviews were transcribed and analysed for the categories level of information, confidence, participation and profession/working conditions/team structure.The main result of T1 was that nursing staff fostered the projected transformation while physicians and psychologists focused on risk management and worried about losing their role. As implication of the T1 results, we offer a continuous in-house-training to improve interprofessional teamwork and social psychiatric expertise. At T2 all interviewed participants judged the involvement of the peer support workers positively. Many oft the interviewees expressed though that from their point of view their participation had decreased and/or, the reorganisation was already terminated. As implication of T2, we now try to improve our internal communication and cooperation and strengthen the involvement of all stakeholder groups.Besides the employment of peer support workers, it is essential in a recovery-oriented transformation of mental health services:– to train staff members continuously and;– to involve all stakeholder groups continuously in the change management.A third survey is projected for 2017 to implement further requirements for a successful change process.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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