Empowering the cancer patient or controlling the tumor? A qualitative study of how cancer patients experience consultations with complementary and alternative medicine practitioners and physicians, respectively.

摘要

OBJECTIVES: The authors describe how patients with cancer, who have had consultations with both a conventional physician and a complementary and alternative medicine (CAM) practitioner, experience these consultations. The theoretical background of this study is inspired by a description of 2 models of principles of treatment. In the first model, the instrumental intervention (eg, the medicine) is defined as the causal factor for outcome. In the second model, the patient is defined as the causal factor; the outcomes of the treatment are dependent on the resources of the patient (eg, the body's ability to heal itself) and the impact of the patient's situation. METHODS: Semistructured, in-depth interviews were conducted with 17 Norwegian cancer patients who had visited both a CAM practitioner and a physician. The patients were recruited from both an oncology department at a university hospital and a newspaper advertisement in the area of Trondheim in central Norway. Methods of data analysis used were opencoding, relational coding, and categorizing of themes. RESULTS: The cancer patients have experienced 2 different modes of consultations: one characterized by practitioners focusing on controlling the tumor and another characterized by practitioners focusing on the patient. The patients' accounts of these 2 modes of consultation differ in a number of ways: which issues are discussed during the consultation, who is in control of the consultation agenda, what are the patients' perceptions of the practitioners' health and disease understanding (ontology), what are the practitioners' communication skills, and how empowered the patient feels during the consultation. CONCLUSIONS: Patients in this study ask for a consultation style that conveys a focus on both the disease and the whole patient. The results of this study point to a possible connection between the practitioners' understanding of health and disease and the content and form of the consultations. Future research should test this connection.