Integrating Complementary Alternative Medicine into Nursing Education in Taiwan

Complementary and alternative medicine in paediatrics in daily practice—A European perspective

BackgroundThe globally growing demand for complementary and alternative medicine (CAM) has attracted educators' attention to integrate CAM into conventional nursing programs. This systematic review aimed to understand the status quo of nursing students (NSs)' overall rated knowledge of, attitude/belief toward, and practice/previous use or experience (KAP) of CAM in surveys, given these factors may influence NSs' receptivity to CAM curricula, and may be of value in guiding the development of effective teaching strategies.MethodsFormally published cross-sectional quantitative studies investigating the primary outcome of KAP toward CAM by NSs were searched for from eight databases from their inception through to 28 April 2022. PRISMA 2020 guidelines were followed.ResultsTwenty-six studies were included for analysis, 25 of which were judged to be of moderate to high quality. Despite limited and poorly informed knowledge of CAM therapies, the majority of NSs generally viewed them in a positive light. Furthermore, NSs usually reported an interest in further learning, and supported and welcomed the integration of CAM curricula, at least as elective modules, into existing nursing programs. Lack of evidence was perceived as a major barrier to the use or integration of CAM. Mass media and the internet were the main sources via which NSs access CAM information. Measurement of KAP in all included studies was via self-designed questionnaires/scales or adapted from previously developed questionnaires/scales.ConclusionsThe need for integrating and strengthening CAM curricula into current nursing education is identified. Besides theoretical knowledge and matched clinical placement, skills training in literature searching and evidence-based practice are advised to be included in the curricula design. The experiential learning mode is strongly recommended for delivering specific CAM modalities. In addition, a standard instrumentation for determining NSs' KAP toward CAM should be designed and examined for use in different cultural settings.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=300602, identifier: PROSPERO CRD42022300602.

BackgroundThe use of Complementary and Alternative Medicine (CAM) among Type 2 Diabetes Mellitus (T2DM) patients is increasing to manage the complexities of their condition, enhance their health, and ease complications. The burden of T2DM in the United Arab Emirates (UAE) coupled with the high prevalence of CAM use and its associated risks among patients with T2DM necessitated the investigation of the use of CAM by this patients’ population. The aim of this study is to examine the prevalence, types, and correlates of CAM use among T2DM patients in the UAE.MethodsPatients with T2DM attending the outpatient clinics in the two governmental hospitals in Dubai and Sharjah, UAE were invited to participate in a cross-sectional survey. Face-to-face interviews were conducted with participants to complete a multi-component questionnaire. The questionnaire comprised of three main sections: demographic data, diabetes-related information, and CAM use details. Data analysis employed descriptive statistics, univariate and multivariate logistic regression to assess the prevalence and correlates of CAM use.ResultsTwo hundred forty-four T2DM patients completed the questionnaire (response rate: 80%). A total of 39.3% of participants were CAM users since diagnosis. After adjustment; the logistic regression results showed that CAM use was significantly associated with age, sex, education, employment, and having health insurance. The most commonly used type of CAM by participants were folk foods and herbs followed by spiritual and natural healing and vitamins and minerals supplements. The majority of CAM users were referred or encouraged to use CAM by family (42.7%), friends (25%) or social media (17.7%). Only 13.5% of participants used CAM because it was suggested by health care practitioners. Only 1 in four of CAM users disclosed CAM use to their treating physician.ConclusionCAM use among T2DM patients in the UAE is considerably high. Health policy and decision-makers are encouraged to dedicate particular attention to facilitating proper regulation and integration of CAM within conventional medicine to protect the health and wellbeing of patients. A concerted effort by medical schools and public health authorities should be committed to educating health care providers and patients on the safe and effective use of CAM therapies.

Complementary and Alternative Medicine Use and Initiatives in Europe

This study explored counseling students’ attitudes toward beliefs and personal experience with complementary and alternative medicine (CAM) integration in counseling practices. A total of 113 clinical mental health counseling students completed a demographic questionnaire, the CAM use, and the Complementary and Alternative Medicine Beliefs Inventory. Data were analyzed using descriptive statistics, nonparametric Chi-Square testing, Mann–Whitney U test, and logistic regression analysis to determine the prevalence of CAM use, CAM beliefs, and predictive factors of CAM integration. The results indicated differences in ethnicity, gender, and age for CAM use, CAM beliefs, and predictors of attitudes toward CAM integration. Recommendations for counseling practice and education regarding CAM use and community-based health promotion were discussed.

Role of Complementary and Alternative Medicine in Cardiovascular Diseases

ObjectivesInflammatory bowel disease (IBD) constitutes a challenging and long‐lasting burden for pediatric patients. The management of IBD is multifaceted involving conventional medication but also dietary measures. An increasing number of patients are turning to complementary and alternative medicine (CAM) in their quest to alleviate IBD‐related symptoms and improve their overall well‐being. We therefore investigated the patterns of CAM use and associated patients' and disease characteristics to identify indicators of CAM use in pediatric IBD patients in Switzerland.MethodsPediatric and adolescent patients enrolled in the Swiss IBD Cohort Study, a nationwide prospective cohort study, completed a questionnaire about CAM and supplementation use as well as dietary restrictions. Associations of CAM use with disease characteristics including conventional medication and patient‐recorded outcomes were analyzed.ResultsA total of 111 pediatric IBD patients (59 Crohn′s disease, 41 ulcerative colitis, 11 IBD unclassified) answered the questionnaire. Sixty‐five percent (72/111) of patients used at least one CAM since diagnosis, 73% (81/110) took vitamins and micronutrient supplements and 53% (59/111) followed dietary restrictions. The latter was in 68% self‐imposed and significantly associated with CAM use in multivariable models (odds ratio [OR]: 4.48; 95% confidence interval [CI]: 1.84–10.92). CAM use was not associated with IBD subtype, need for biologicals or extraintestinal manifestations. Health‐related quality of life (HRQOL) and disease activity did not differ between CAM and no‐CAM users.ConclusionCAM use as well as self‐imposed dietary restrictions are frequent in IBD patients, whereby both are closely interrelated. While CAM users do not have higher HRQOL compared to no‐CAM users, they subjectively report an improvement in health associated with CAM use.

9057 Background: The incidence of CAM use among patients with cancer is higher when compared to the general population. However, there are few studies examining CAM use in NHL survivors, and limited data are available regarding beliefs in CAM. This study was conducted to examine the prevalence of CAM use in NHL, define CAM beliefs among NHL survivors, and explore differences between patients with indolent and aggressive lymphoma. Methods: Newly diagnosed lymphoma patients were prospectively enrolled within 9 months of diagnosis in the University of Iowa/Mayo Clinic SPORE Molecular Epidemiology Resource from 2002-2008. NHL patients who completed the 3-year post diagnosis questionnaire, which includes questions regarding CAM use and beliefs, were included in this study. Chi-squared tests and Wilcoxon rank-sum tests were used to assess the association of CAM use with prognostic and demographic factors. Results: 719 patients were included with a median age of 63 years (range 22-92). 53% were male. Overall, 636 (89%) reported ever using CAM. 78% of patients used vitamins and 54% alternative therapies (chiropractic (36%) and massage therapy (24%)). Among CAM users, 141 (22%) believe CAM can assist the body to heal, 123 (19%) believe CAM can relieve cancer symptoms, 115 (18%) believe CAM use gives a feeling of control, 106 (17%) believe CAM can boost immunity, 24 (4%) believe CAM can cure cancer, and 35 (6%) believe CAM can prevent the spread of cancer. Female gender was associated with increased overall CAM use (p<0.0001) as well as use of vitamins (p<0.0001), herbal supplements (p=0.006) and alternative therapy (p=0.0002) specifically for cancer. Older age was also associated with increased vitamin use (p=0.005) and decreased herbal supplements use (p=0.008). There was no significant difference in overall CAM use between those with follicular lymphoma grades I-II (n=195, 91%) and non-relapsed diffuse large B-cell lymphoma (n=151, 87%), although massage therapy was utilized more often by FL survivors (29% versus 18%, p=0.005). Conclusions: CAM modalities are used by the majority of NHL survivors (89%). The assessment of CAM use and education regarding potential harms is imperative for the NHL survivor.

Background: Recent surveys concluded that the elderly people are using complementary and alternative medicine (CAM) frequently. Use of CAM among older patients is considered significant challenge. Preventing adverse reactions and drug interactions associated with CAM use is complicated by the fact that only less than 50% of older patients disclose CAM use to their treating physicians. That is why it is essential for family physicians to explore knowledge, attitude and practice of elderly people towards CAM. Objective: This study aimed to assess knowledge, attitude and practices of elderly people towards complementary and alternative medicine. Methods: This is a cross sectional descriptive study; it was conducted in March and April 2016, in health insurance outpatients clinics in Ismailia governorate. Sample size was 150 elderly people allocated consecutively over the two months. Results: About 84% of elderly have some knowledge regarding CAM; herbs were known by (75%) of the selected sample and their source of knowledge was mainly the media (56%) followed by their family and friends. The reported success rate of CAM to relieve symptoms of the study population was (54.7%). Regarding beliefs of the study participants about the use of CAM; (76%) believe in CAM safety, (58.7%) believe that CAM is effective, while (54.7%) do not believe that CAM are better than drugs ,(64%) perceive that they need health education about CAM. Conclusion: The current study concludes that CAM use is highly prevalent among people. However, there is a demand for better and consistent information about herbal medicine regarding effectiveness and safety

Use of complementary and alternative medicine (CAM) is common among Latinos living with HIV in the United States (US)–Mexico border region. Health providers may vary in their approach to communicating acceptance or non acceptance of CAM use, which can undermine patient confidence in disclosing CAM use. Patient–provider communication about CAM is important because certain types of CAM can affect antiretroviral therapy (ART) adherence. We undertook the present binational study to understand US and Mexican provider beliefs, and perceptions surrounding CAM use among Latino patients, and to learn if and how CAM communication occurs. Between July and December 2010, we conducted in-depth, qualitative interviews in Tijuana and San Diego. Analysis procedures drew upon principles of Grounded Theory. The sample was comprised of 19 HIV-health care providers, including 7 women and 12 men. Emerging CAM-related themes were: Provider's perceptions, attitudes and knowledge about CAM; CAM types and modalities; and patient–provider CAM communication. Many clinicians were uncomfortable supporting CAM use with their patients. San Diego providers reported more frequent instances of CAM use among Latino patients than Tijuana providers. Providers from both cities reported that patients infrequently disclose CAM use and almost half do not routinely ask patients about CAM practices. Most of the providers acknowledged that they lack information about CAM, and are concerned about the drug interaction as well as the effects of CAM on adherence. Our findings have important implications for understanding provider communication surrounding CAM use in a highly transnational population and context. Because CAM use may undermine ART adherence and is highly prevalent among Latinos, provider communication about CAM is critical to improved health outcomes among HIV-positive Latinos. Considering the significant growth of US Latinos, especially in the US–Mexico border region, assessment of Mexican and US provider training and communication needs surrounding Latino patient CAM use is warranted.

1013 Background: We sought to compare change in complementary and alternative medicine (CAM) use from enrollment into a randomized BRCA1/2 testing project to CAM use one-year following results disclosure. We also explored factors influencing new CAM use at one-year by women not using CAM at program entry, including BRCA1/2 test result, anxiety, cancer-related surveillance behaviors, and prophylactic surgical choices. Methods: A matched cohort of 243 high-risk women completed questionnaires at enrollment into BRCA1/2 randomized control trial (with semi-structured counseling intervention) and one-year post results disclosure. Women were asked about their use of several types of CAM, including ingestible, behavioral and physical modalities. Assessment of the pattern of change in CAM use from baseline to one-year was done using McNemar's Test of Change for Paired Samples. Correlates of new CAM use at one-year were explored using logistic regression models for the subset of 113 women (46.5%) who did not report CAM use at enrollment into the testing program. Results: Among women that changed their CAM behavior from baseline enrollment to one-year following BRCA1/2 results disclosure, there was a significantly higher proportion that changed from no CAM use to CAM use among the overall cohort (p=. 01), women without cancer (p=. 003), BRCA1/2 carriers (p=. 03), and among women randomized to the genetic counseling intervention arm of the study (p=. 009). Additionally, new CAM use at one-year was positively associated with the reported number of cancer-related surveillance behaviors for both healthy women and cancer survivors. Conclusions: High-risk women who have received BRCA1/2 testing may adopt new CAM use in the first year post disclosure. Healthy high-risk women and cancer survivors may utilize both CAM and other cancer-related surveillance strategies. The correlation between CAM use and genetic counseling deserves further study. No significant financial relationships to disclose.

In this study, we explored parents' perspectives toward complementary and alternative medicine (CAM) use by their children and its impact on parent-doctor and doctor-CAM-practitioner communication. We designed a 2-arm study of parents who approached either conventional primary care or CAM clinics with their children to consult physicians or practitioners regarding their child's health. A total of 599 parents responded to our questionnaire (319 in 5 conventional clinics [83.9% response rate] and 280 in 21 CAM clinics [71.2% response rate]). Parents in conventional clinics reported less use of CAM by their children within the previous year (35.3% vs 73.7%; P < .0001) but used more traditional and homemade remedies (46.4% vs 12.7%; P < .0001). Both parent groups largely supported informing their child's physician regarding CAM use and expected the physician to initiate a CAM-related conversation and to refer their child to a CAM practitioner. The 2 groups' respondents largely supported communication between the child's physician and the CAM practitioner by the use of a referral/medical letter. Compared with respondents in CAM clinics, parents in conventional clinics were more supportive of CAM integration in a pediatric primary care setting and envisioned a more dominant role of physicians regarding CAM referral and a significant role of physicians in providing CAM. Parents who are referred to conventional and CAM clinics express distinctive attitudes toward CAM integration in pediatric care. Parents perceive physician-CAM practitioner communication as highly important and instrumental in promoting their children's health and safety.

Complementary and alternative medicine (CAM) use is high among people with multiple sclerosis (MS), yet there are no reports on the association between CAM use and health-related quality of life (HRQL) in MS. To examine this relationship, a cross-sectional survey and SF-12 was used to collect demographic and HRQL data from 1667 survey respondents. Factors examined for their association with CAM use included, age, gender, race, self-reported disease severity, disease-modifying drug (DMT) use, MS duration, MS type, education level, physical and mental well-being. Multiple regression analysis revealed that female gender, high education level, longer MS duration, lower physical well-being and not using DMT were independent factors associated with both ‘ever’ and ‘current’ CAM use. The finding that a drop in physical component score (PCS) of the SF-12 is independently associated with an increased odds of ‘ever’ CAM use, ‘current’ CAM use, and ‘past’ CAM reflect an association of CAM use with PCS regardless of time of use. Although, temporality of this relationship cannot be established, as this was a cross-sectional study, a longitudinal study is warranted so that we can establish if HRQL is predictive for CAM use in MS.

Only a few studies assessed the prevalence and the predictors of complementary and alternative medicine (CAM) use specifically in melanoma patients. The aim of this study was to assess the extent of CAM use in Turkish melanoma patients. To assess the extent of CAM use and to compare sociodemographic and clinical characteristics between users and non-users in melanoma patients. One hundred melanoma patients who were seen in outpatient clinics were included in a survey using questionnaire on CAM use. Twenty-seven patients used at least one type of CAM, the majority of which were herbs (73%). Turmeric (curcumin) was the most popular herb that was used alone or in conjunction with various other herbs (41%). Living in rural areas was significantly associated with CAM use (p = 0.02). The most common reason for CAM use was intent to cure of the disease (52%). The primary source of information about CAM was a close friend or a family contact (44%). CAMs were generally used together with conventional anticancer treatment modalities (64%) and they were ingested on a regular base (72%). CAMs could easily be acquired at regular herbal stores (88%). The patients experienced almost no adverse effects with CAM use; and most cases (71%) had confidence in CAM. About half of the patients consulted with their physicians about CAM use. Minority, nearly one fourth of the melanoma cases used at least one type of CAM, the majority of which were herbs and turmeric (curcumin) was the most popular agent.

Background: There is increasing evidence for the extensive use of complementary and alternative medicine (CAM) by patients with psoriasis. Clinical research in the arena of CAM and psoriasis treatment is evolving and includes some randomized controlled trials. Objective: To study CAM use among patients with psoriasis attending a dermatology clinic in a major university hospital in northern Israel. Prevalence, reasons for CAM use and its relevance to doctor-patient communication were emphasized. Methods: Semistructured interviews were conducted with psoriasis patients in a dermatology clinic. Consent was obtained for 78 patients. Post-visit questionnaires were given to 5 physicians. Results: Seventy-eight patients with psoriasis were interviewed and 77 were studied. Sixty-two percent used CAM. Fifty-eight percent of users had seen a CAM practitioner. The study found a trend of CAM use among patients with psoriasis from Arab compared to Jewish descent (p = 0.087). CAM users reported on average 2 different CAM modalities. Herbal medicine and nutritional treatments ranked first, followed by homeopathy, traditional Chinese medicine and nutritional supplements. The main reason for CAM use was stated to be to do everything to heal the disease, followed by a quest for improved quality of life. Others mentioned an interest in a less toxic treatment, disappointment with conventional treatment and stress reduction. Well over half of the study participants and their dermatologists did not initiate a discussion about CAM use. The dermatologists’ ability to predict CAM use in their patients was relatively low. Conclusion: There is growing evidence of extensive CAM use among patients with psoriasis. Most patients use CAM as a complementary treatment, rather than an alternative to conventional treatment. Teaching CAM should be integrated into the dermatology residency curriculum. Dermatologists need to increase their awareness of CAM use by their patients in order to improve therapeutic communication.