Terminally ill patients’ and their relatives’ experiences and behaviors regarding complementary and alternative medicine utilization in hospice palliative inpatient care units: a cross-sectional, multicenter survey

Abstract

Background Terminally ill patients often experience exacerbations of diseases that render mainstream medicine ineffective in relieving symptoms, prompting attempts at complementary and alternative medicine (CAM). This study collected data from terminally ill patients and their relatives to determine differences between CAM use, behavioral patterns, and perceptions of health information about CAM. Methods A cross-sectional design using a self-administered questionnaire was adopted. Eight medical institutions in Taiwan with inpatient hospice palliative care units were chosen. Ninety-two terminally ill patients and 267 relatives met the inclusion criteria. The questions concerned the experience of CAM use, the kinds of products/services CAM provided, the purpose of CAM use, the source of CAM information, and the perceptions and attitudes toward CAM. Results Both terminally ill patients and their relatives have a high proportion of lifetime and one-year prevalence of CAM use (88.0% vs. 88.4%; p = 0.929). CAM use for musculoskeletal and neurological discomfort is higher among terminally ill patients than among their relatives. Relatives/friends are the most frequent sources of information on CAM (53.3% vs. 62.2%; p = 0.133). The percentage of terminally ill patients who discontinued mainstream medical treatment because of CAM use was higher than that of their relatives (18.5% vs. 9.3%; p = 0.026). More than half the terminally ill patients and their relatives had never been asked about CAM by medical staff (64.1% vs. 66.7%), nor had they informed medical professionals about the use of CAM products and services (63% vs. 66.9%). Random inquiries by medical professionals may be associated with increased disclosure of CAM use (terminally ill patients: odds ratio, 9.75; 95% confidence interval, 1.97–48.35 vs. relatives: odds ratio, 5.61; 95% confidence interval, 2.66–11.83). Conclusions The high prevalence and concealment of CAM use in terminally ill patients should be considered. Medical professionals should establish a friendly and barrier-free communication model, encourage patients to share CAM experiences, and provide evidence-based information on the use of CAM products and services, to reduce the potential damage caused by harmful use.

Perceptions and attitudes toward kidney supportive care among Elderly dialysis patients and medical staff in China：A Qualitative Study

“…The concept of KSC, which was rst proposed in 2013 [24] , emphasizes patient-centered efforts to prevent and alleviate the suffering of disease and improve the quality of life of end-stage patients through early identi cation, comprehensive assessment, and attention to patients' physical and psychological problems.In recent years, KSC's growth has been strongest in Canada, the United Kingdom, Australia and New Zealand [25] .A number of studies have actively explored attitudes and opinions on the application of KSC, as well as analyzed the obstacles faced by KSC in the development process and the advantages it brings [26] .Due to the in uence of Chinese traditional culture, the development of palliative care in China is slow, and KSC is still in its infancy.However, researchers in Hong Kong and Taiwan have actively explored Chinese culture [27] , while there are few relevant studies in mainland China.Taiwan was the rst region in Asia to adopt a law in favor of "natural death", and the Hong Kong government also supports the policy of palliative care.Studies have proved that the development of palliative care can help patients understand their own conditions and prognosis, and have a positive impact on improving the quality of life of patients [28] .At the same time, it can reduce excessive medical treatment and waste of medical resources, which provides inspiration and reference for the development of palliative care in mainland China [29] .…”

Communication in Cancer Care in Asia: A Narrative Review

“…In Asia, the use of complementary and alternative medicine (CAM) including spiritual healing practice is highly prevalent and it has various implications to decision making. 30 – 32 While some evidence exists in the effects of CAM on various symptoms related to cancer and its treatment, patients who use CAM often refuse other conventional cancer treatment and can have a higher risk of death than those who do not use CAM. 33 , 34 In particular, patients of low socioeconomic status may first approach the traditional healers with their medical problems, and only after failure of such treatment did they move to physicians for conventional therapies.…”

“… 31 Notably, it has been reported that more than half of patients with terminal illnesses conceal its use to HCPs. 30 , 35 Thus, the common application of CAM in Asia can affect the relationship between patients and HCPs. 36 …”

“… 35 , 39 As Asians have diverse values and preferences for CAM, HCPs should establish an open communication model, encourage patients to share CAM experiences, and provide evidence-based information on the use of CAM practice to improve patient satisfaction and reduce the potential damage caused by harmful use. 30 …”