Beliefs About CAM as Alternative to Conventional Treatment
CAM Contributed to Decision to Decline. The perception that CAM offered a feasible alternative to conventional treatment appeared to assist participants in making the decision to go against their physicians’ recommendations. In 6 cases, the actual decision to refuse conventional treatment appeared to be facilitated by the discovery or knowledge of CAM.
CAM Is Better than Conventional Treatment. In many cases, the CAM choice was perceived to be considerably less aversive than the conventional treatment option or was perceived to make more “intuitive” sense. A common viewpoint expressed by participants was that conventional treatment and CAM have different methods and purposes. Participants pointed out that CAM works with the body’s own resources in a natural way to promote healing, while conventional treatment is short-sighted and merely attacks the symptom without addressing underlying imbalances.
CAM Is Effective. In choosing CAM as an alternative to conventional treatment, the participants stated that they were satisfied with CAM’s effectiveness and described sources of evidence for this, including personal evidence (most frequently cited), medical and anecdotal evidence, and belief. Participants’ personal experience of continuing to be alive, feeling well, or having subjective improvement in symptoms was proof for them that a particular CAM treatment worked. Participants also used medical evidence (eg, PSA tests or mammography) to demonstrate that their condition was improved and attributed this to the CAM. Anecdotal evidence based on others’ reported benefits from CAM was sufficient for at least one participant to state that she felt CAM was effective. A number of participants stated that they did not have any demonstrable evidence of the effectiveness of CAM, such as improved, symptoms or medical evidence, but that they nonetheless continued to believe that CAM was working for them. Participants’ reasoning included statements about how the particular CAM made logical sense to them and therefore “must work,” or that they had a long history of belief in the benefits of CAM. Only one participant admitted that she was not sure if CAM had helped her.
Discussion
A predominant theme in our analysis was the finding that participants perceived CAM to be a harmless, natural, and effective alternative to the damaging effects of conventional cancer treatment. In the participants’ views, conventional treatment offered no guarantee of a cure, while guaranteeing almost certain harm and for some, possible death. Participants felt that CAM had a positive effect on their overall health and, with a few exceptions, participants were confident in CAM’s ability to cure their cancer or prevent recurrence. The quality of physician/patient communication was also a factor in the decision of participants to decline conventional treatment. While participants reported both positive and negative experiences with medical staff, the more negative perceptions, including distrust, lack of response, and perceived hostility from health care providers, possibly caused further alienation between participants and the medical community.
A study by Astin reported similar predictors for primary reliance on CAM in the general population (lack of trust and dissatisfaction with conventional treatment and providers, and belief in the efficacy of CAM).12 Astin also observed that CAM was perceived as promoting health, while conventional treatment focused on the illness, a belief expressed by several of our participants. While the desire for control over health was a predictor in Astin’s study, this did not emerge as a theme in our analysis.
Our analysis provides cross-validity evidence with an ethnically diverse sample for several themes observed by Montbriand19 (difficulty in communication with health care providers, previous negative experiences with medical care, belief in a cure from CAM, and lack of hope for a cure offered by biomedical therapies). Montbriand’s themes of expressed stress, the need of patients to take control of treatment, and mystical insights into health care also appear to have some similarities to our results, while the influence of social support and cost considerations on CAM use were not as evident in our analysis. Also, unlike the Montbriand study, our participants reported supportive as well as negative health care interactions regarding CAM use, sources of evidence for CAM’s effectiveness (personal, medical, anecdotal, and belief), and the belief that CAM offered an opportunity to avoid the harmful effects of conventional treatment.
The preceding analysis is qualitative and based on the self-report of a small sample of 14 participants. Generalizability of the findings is therefore limited. However, the use of a qualitative method allowed investigation of a relatively rare population (cancer treatment decliners) that is seldom studied. The results are also limited by the fact that participants were primarily cancer survivors in relatively good health.