Complementary and Alternative Therapy Use During Treatment of Breast Cancer Camille Eckerd ...

184 Pages·2006·1.5 MB·English

Complementary and Alternative Therapy Use During Treatment of Breast Cancer

Camille Eckerd Lambe

Adissertation submitted to the faculty of the University of North Carolina at Chapel Hill in
partial fulfillment of the requirements for the degree of Doctor of Philosophy in the School of
Nursing

Chapel Hill
2006

Approved by:
Dr. Barbara Germino: Advisor

Dr. Julie Barroso: Reader

Dr. Yvonne Eaves: Reader

Dr Cathie Fogel: Reader

Dr. Susan Gaylord: Reader
©2006
Camille Eckerd Lambe
ALL RIGHTS RESERVED
ABSTRACT
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CAMILLE LAMBE: Complementary and Alternative Therapy Use During Treatment of
Breast Cancer
(Under the direction of Dr. Barbara Germino)
Complementary and alternative medicine (CAM) is used often by women having
treatment for breast cancer and has been studied extensively in European American,
educated, affluent women. However, it is poorly understood in poor, uneducated, rural and
African American women. Studies of folk medicine, spirituality and those few studies with
ethnically diverse samples indicate that CAM is also used in these groups. The process by
which women make decisions to use CAM during and after breast cancer treatment has not
been clearly described.
The aims of this study were to characterize CAM use during treatment for breast cancer
in a sample of African American and Caucasian women; to examine precipitating and
influential factors in Caucasian and African American women’s choices to use CAM during
breast cancer treatment; to describe the process and timing of decisions to use CAM; and to
clarify the use of CAM for treatment of breast cancer related issues as compared to the use of
CAM for maintaining and improving health.
This exploratory descriptive study used a cross sectional design and multiple methods
including a card sort, individual interviews and quantitative measures. A convenience
sample of 19 African American and European American women participated, all of whom
were CAM users and were receiving or recovering from breast cancer treatment. The women
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in the sample were generally educated beyond high school, were varied in age and income as
well as type of residence (urban/rural).
The results of this study indicate the importance of participant definitions of CAM.
African American women in the sample reported higher use of CAM treatments than the
European American women both for managing side effects of treatment and for their general
health. The types of CAM treatments used by African American and Caucasian women were
different. Having breast cancer motivated all the women to engage in a type of life review to
search for reasons for having breast cancer and to affect adoption of healthy lifestyle choices
in the form of CAM. These women used a process of deciding about CAM use that was
shaped by people they considered to be experts, a variety of other information sources, their
health beliefs and their own personal experiences with the CAM treatment. The decision to
use CAM therapies involved weighing the pros and cons and trying out CAM therapies for
their effectiveness.
The importance of faith and spirituality, especially but not exclusively for African
American breast cancer patients, was supported by these findings. Prayer was the CAM
therapy chosen most often by all of the women in the sample. The study raises questions
about literature indicating that women do not discuss CAM use with their health care
providers. In fact, the findings indicate the importance of providers as a resource for patients
considering CAM during treatment of breast cancer and the need for study of precise doses
of CAM and conventional treatment given concurrently.

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DEDICATION
From the time I can remember breast cancer has been a part of my life and a part of my
family. The women in the clan of the one-breasted women (Williams, 1992) are truly
courageous and they have honored me with their stories. I dedicate this work to them.

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ACKNOWLEDGEMENT
At times we surprise ourselves with what we do. The completion of this dissertation
would have been impossible without the support and guidance of Dr. Barbara Germino, the
committee Chair. She was able to hear my questions and reframe them to help me grow to
answer them for myself while providing encouragement, correction and a safe place to
express dismay with the whole process. The other members of my committee provided a
wide view of my questions and a balance to put my inquiry into context. Dr. Cathie Fogel
was a wonderful hall-way encourager and gave an expanded view of my research questions.
Dr. Yvonne Eaves helped me to frame my questions to bring a cultural sensitivity I needed to
bring clarity to the study and its aims. Dr. Julie Barroso egged me on and provided an
example for my possibilities as a clinician researcher. When the process became onerous she
was available to help me refocus and get the train back on the track. Dr. Susan Gaylord,
Becky Coble and the UNC Program on Integrative Medicine were instrumental from the
beginning to give information and to help me investigate possibilities for the study. I had no
idea at the beginning of my study how important to the process Dr. Gaylord would become.
Aspecial acknowledgement must go to June McDermott. At the beginning of my study I
presented this research to Ms. McDermott and her interest and commitment to my process
helped me to stay true to women with breast cancer and to their use of Complementary
Therapy. Her spirit is throughout this work and I hope that the work honors her.
Iam very grateful to the UNC School of Nursing family, both faculty and staff who
supported me and my quest to complete this study. Dr. Margarete Sandelowski was
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invaluable as a sounding board and an interested observer of my journey. The faculty and
staff of the Center for Innovation in Health Disparities Research (CIHDR) provided
emotional and financial support (NIH/NINR Grant #P20-NR008369) to make the work
possible. Special thanks, goes to Dr. Marge Miles, a director of the Pilot/Feasibility Core and
Dr. Bobbie Reddick, a CIHDR director from Winston Salem State University, who mentored
me during my research process. My study in the School of Nursing was also funded by a T32
grant (Grant Number T32 NR007091 1996-2011) from the Center for Research on Chronic
Illness. Dr. Merle Mishel and Deanne Holt from this department were invaluable resources as
my studies progressed.
The expert panel that I consulted prior to beginning my study helped mold and shape the
way this study was executed. Janet Dickmander added CAM therapies that were currently
being used by patients; Dr. Marva Price provided feedback to my process and the instruments
Iused; and Dr. Holly Mathews provided input about cultural relevance with African
American breast cancer survivors. Dr. Nancy Stephenson was an ever present encourager,
always quick to see the positive in my work, and Dr. Elizabeth Woodard helped by her
confidence that I was equal to this task. This study would never have been completed without
the rescue of Dr. Miriam Rogers and Darlene Gardner. They opened their sites to me and
allowed me to meet patients in private and comfortable surroundings.
Aspecial acknowledgement must go to friends and family who have boosted my spirit
and understood my angst when I was low. They have been cheerleaders, defenders, and
detractors and all this has added to this work. Most special thanks goes to my husband Louis,
without whom I would have never completed this portion of my life.

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TABLE OF CONTENTS

Page

LIST OF TABLES vi

Chapter

I The Problem 1

Study Aims 6

II Literature Review 7

Difficulties in Defining Complementary Therapy:

Historical Background 8

Differences in CAM Definitions 9

Complementary Therapy Use in Patients With Breast Cancer 21

Use of complementary therapy within
the African American community 29

Decision Making for CAM 32

III Study Methods 44

Design 44

Methods 44

The Sample 45

The Setting 47

Procedures 47

Variables and Instruments 52
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Analysis 57

Human Subjects Protection 59
IV Results 60

Description of the Sample 60

CAM Use for Breast Cancer 66

CAM for Health 76

Precipitating and Influential Factors in the Choices to Use CAM 84

Overview of the Process of Using CAM for Breast Cancer 103

V Discussion 107

Limitations of the Study 107

Discussion of Findings-

CAM Use During Treatment for Breast Cancer in
African American and Caucasian Women
in the Urban and Rural South 109

Methods for Studying CAM Use
With Understudied Populations 109

Characteristics of African American Women’s
CAM Use: Similarities and differences 110

Use of CAM During Treatment 115

CAM Use for Treatment of Breast Cancer–Related Issues
as Compared to CAM Use for Self-Care and
Lifestyle Issues 119

Precipitating and Influential Factors in the Choices of
Breast Cancer Patients to Use CAM 121

The Process and Timing of Decision-Making by
Breast Cancer Patients to Choose CAM
Around the Time of Treatment 125

Summary of the Study 128
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Recommendations for Future Study 129

APPENDICES 132

REFERNECES 151

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