Cross-cultural perspective in complementary and alternative therapies research
اسلاید 1: 1www.tabaye.ir
اسلاید 2: 2Cross-cultural perspective in complementary & alternative therapies researchFirst National Workshop on Cross Cultural Cancer Research and Care: Building Collaborative CommunitiesFeb 20-21, 2004Anne Leis, PhD University of Saskatchewan
اسلاید 3: 3OutlineIntroduction Current state of knowledge: some highlights about CAM in cross cultural cancer careCurrent initiatives Suggested targets Top 3 questions
اسلاید 4: 4IntroductionLack of consensus around CAM definitionDefinition Adopted by NIH National Centres on CAM (NCCAM) Complementary and Alternative Medicine (CAM) is a broad domain of healing resources that encompasses all health systems, modalities and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period. CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being. Boundaries within CAM and between the CAM domain and the domain of the dominant system are not always sharp or fixed. Alt Ther 1997; 3(2): 49-57
اسلاید 5: 5Introduction (2)Issues with CAM classification systemsPorous and flexible boundaries between conventional and non-conventional medicineAny classification system depends on underlying premises and the ability to obtain mutually exclusive categories
اسلاید 6: 6Introduction (3)Issues in identifying CAM prevalence in the general and cancer populationworld phenomenon general population: CAM utilization is frequent and increasing: range from 9% to 75%cancer populations: range of 7-81%Range can be attributed to:what is counted or includednature of the sample
اسلاید 7: 7Introduction (4)Issues in defining culture and cross-cultural researchCulture as "a complex interplay of meanings that represent and shape the individual and collective lives of people" is a definition recently adopted by a group of researchers who are establishing a team to study cross-cultural issues in the Canadian health care context. Culture is often reduced to ethnicity, language spoken at home, or number of years spent in CanadaAcculturation is not well understood within health researchNecessity to promote research that transcends disciplinary boundaries and works with the populations of interest, using participatory methodologies.
اسلاید 8: 8Current State of KnowledgeAttention to the health beliefs of minorities is likely to improve care and health outcomes for minority patients.Reliance on an alternative health care system and use of self-care behaviours and practices are common among ethno-cultural minorities.Western trained health practitioners not always knowledgeable about CAM; in addition some are not supportive of CAM or advice patients against them. Concurrent use of alternative modalities and products while receiving standard treatments is common without any discussion occurring between patients and health care professionals.
اسلاید 9: 9Recent Studies Lee et al (2000). Telephone interviews with 379 women with breast cancer San FranciscoPrevalence of CAT in four ethnic groups (Latino, White, Black, and Chinese). 48% used at least one type; 42% in Chinese to 54% in WhitesBlacks - spiritual healing, Chinese - herbal remedies, Latinos and Whites - dietary therapies. Liu et al (1997). Chinese oncology patients in Taiwan64% actively undergoing conventional treatment used indigenous Chinese medicine after cancer diagnosis;Utilization was concurrent with chemotherapy for 2/3 of the patients. Maskarinec et al (2000). Mail survey of cancer patients in Hawaii.25% had used at least one type of CT; many reported using multiple therapiesUse range from 18% (Japanese) to 39% (Filipino); Caucasians reporting most multiple use and Filipinos the least.
اسلاید 10: 10Recent Studies (2)Leis et al (2003)Telephone survey on the prevalence of CT use by 2064 Canadian cancer patients across 6 provinces Sample distribution of major cancers was generally consistent with 1998 Canadian incidence estimates. Prevalence estimated at 43% ranging from 24% (francophone) to 55% (oriental origin). Large majority of users (71%) employed more than one CT (mean = 3.64; SD = 3.57), with various vitamin and mineral supplements being the most common modalities.
اسلاید 11: 11Recent Studies (3)Leis et al (2003) continued: Usage was highest in BC and ON, as well as in brain and breast cancer patients. Most commonly cited sources of information on CT were friends and family (31%). Main reasons for using CT included belief in strengthening the immune system (25%)increasing well-being and quality of life (25%)fighting cancer (17%)increasing energy (12%)combating the side effects of conventional cancer treatment.
اسلاید 12: 12Recent Studies (4)Leis et al (2003) continued: In the univariate logistic regression analyses ethnicity and the influence of cultural and religious background was found to be significantly related to CT use (p < .05). The second variable remained in the final model following a forward stepwise multivariate logistic regression analysis.
اسلاید 13: 13Some of the current Initiatives Sep 2003: CAM in UME Workshop held for all Canadian medical schools to discuss incorporation of CAM into the medical curriculum. Oct 2003: Nov 2003:Workshop on Whole Systems Research held in London, UK Establishment of the first International Society of Complementary and Alternative Medicine Jan 2004: Canadian Interdisciplinary Research Network for Complementary & Alternative Medicine Research (INCAM) was launched.Ongoing:Study on Aboriginal perceptions of cancer and cancer care in Saskatchewana few on-going studies on CAHC by Chinese cancer patients and south-Asian populations in BC. Important to develop target research in this field and build research capacity while building bridges with practice and policy.
اسلاید 14: 14Some research areas to targetPatients need to know safety information of the CAM they usePatient must be able to communicate effectively with health care providers about CAMEncourage understanding of different systems of medicine (e.g. Western biomedical system, First Nation’s traditions, Ayurvedic medicine etc) Involve cultural groups in the research. Let the patients identify the research questions.
اسلاید 15: 15Top 3 Questions1. Better understand the most common CAM approaches by ethnic patients across tumour sites and investigate safety.2. Develop a step-wise approach for CAM research in ethno-cultural populations.3. Focus on the interface and integration between conventional and alternative whole care systems.
اسلاید 16: 16Questions?
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