Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Journal of Complementary and Integrative Medicine

Editor-in-Chief: Lui, Edmund

Ed. by Ko, Robert / Leung, Kelvin Sze-Yin / Saunders, Paul / Suntres, PH. D., Zacharias

CiteScore 2017: 1.41

SCImago Journal Rank (SJR) 2017: 0.472
Source Normalized Impact per Paper (SNIP) 2017: 0.564

See all formats and pricing
More options …

From the conventional to the alternative: exploring patients’ pathways of cancer treatment and care

Andrea L. Mulkins / Emily McKenzie / Lynda G. Balneaves / Anita Salamonsen
  • National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine at the University of Tromsp, Norway
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Marja J. Verhoef
Published Online: 2015-08-08 | DOI: https://doi.org/10.1515/jcim-2014-0070


Background: Complementary and alternative medicine (CAM) use is widespread and on the increase among cancer patients. Most research to date has involved a cross-sectional snapshot of CAM use rather than an exploration into the longitudinal, nonlinear treatment trajectories that cancer patients develop. Our aim is to explore and describe different treatment and decision-making pathways that individuals develop after receipt of a diagnosis of either breast, colorectal, or prostate cancer.

Methods: The study was part of a larger mixed-methods pilot project to explore the feasibility of conducting a five-year international study to assess cancer patients’ treatment pathways, including health care use and the perceived impact of different patterns of use on health outcomes over the course of one year. The results presented in this paper are based on the analysis of personal interviews that were conducted over the course of 12 months with 30 participants.

Results: Five pathways emerged from the data: passive conventional, self-directed conventional, cautious integrative, aggressive integrative, and aggressive alternative. Factors that shaped each pathway included health beliefs, decision-making role, illness characteristics, and the patient–practitioner relationship.

Conclusions: The results of this examination of the longitudinal treatment and decision-making trajectory provide important information to support health care professionals in their quest for individualized, targeted support at each stage of the patient pathway.

Keywords: cancer; complementary/alternative medicine; conventional cancer treatment; decision making; integrative medicine; treatment pathways; typology


  • 1. Boon HS, Olatunde F, Zick SM. Trends in complementary/alternative medicine use by breast cancer survivors: comparing survey data from 1998 and 2005. BMC Womens Health 2007;7:4.Google Scholar

  • 2. Horneber M, Gueschel G, Dennert G, Less D, Ritter E, Zwahlen M. How many cancer patients use complementary and alternative medicine: a systematic review and meta analysis. Integr Cancer Ther 2012;11:187–203.Web of ScienceGoogle Scholar

  • 3. Link AR, Gammon MD, Jacobson JS, Abrahamson P, Bradshaw PT, Terry M, et al. Use of self-care and practitioner-based forms of complementary and alternative medicine before and after a diagnosis of breast cancer. Evid Based Complement Alternat Med 2013;2013:301549.Web of ScienceGoogle Scholar

  • 4. Stumpf SH, Shapiro SJ, Hardy ML. Divining integrative medicine. Evid Based Complement Alternat Med 2008;5:409–13.Google Scholar

  • 5. Website: National Centre for Complementary and Alternative Medicine. Definition of Integrative Medicine. Available at: http://nccam.nih.gov/sites/nccam.nih.gov/files/D347_05-25-2012.pdf. Accessed: 10 Sept 2014.

  • 6. Singh H, Maskarinee G, Shumay DM. Understanding the motivation for conventional and complementary/alternative medicine use among men with prostate cancer. Integr Cancer Ther 2005;4:187–94.Google Scholar

  • 7. Smithson J, Britten N, Paterson C, Lewith G, Evans M. The experience of using complementary therapies after a diagnosis of cancer: a qualitative synthesis. Health 2012;16:19–39.Web of ScienceGoogle Scholar

  • 8. Verhoef MJ, Balneaves LG, Boon HS, Vroegindewey A. Reasons for and characteristics associated with complementary and alternative medicine use among adult cancer patients: a systematic review. Integr Cancer Ther 2005;4:274–86.Google Scholar

  • 9. Wanchai A, Armer JM, Stewart BR. Complementary and alternative medicine use among women with breast cancer: a systematic review. Clin J Oncol Nurs 2010;14:E45–E55.CrossrefGoogle Scholar

  • 10. White MA, Verhoef MJ. Decision-making control: why men decline treatment for prostate cancer. Integr Cancer Ther 2003;2:217–24.Google Scholar

  • 11. Greenlee H, Kwan ML, Ergas IJ, Sherman KJ, Krathwohl SE, Bonnell C, et al. Complementary and alternative therapy use before and after breast cancer diagnosis: the pathways study. Breast Cancer Res Treat 2009;117:653–65.Web of ScienceGoogle Scholar

  • 12. Boon H, Brown JB, Gavin A, Kennard A, Stewart M. Breast cancer survivors’ perceptions of complementary/alternative medicine (CAM): making the decision to use or not to use. Qual Health Res 1999;9:639–53.Google Scholar

  • 13. Caspi O, Koithan M, Alternative CM. Medicine or “alternative” patients: a qualitative study of patient-oriented decision-making processes with respect to complementary and alternative medicine. Med Decis Making 2004;24:64–79.Google Scholar

  • 14. Evans MA, Sharp DJ, Thompson EA, Falk S, Turton P, Thompson T. Men with cancer: is their use of complementary and alternative medicine a response to needs unmet by conventional care? Eur J Cancer Care 2007;16:517–25.Web of ScienceGoogle Scholar

  • 15. Balneaves LG, Truant TL, Kelly M, Verhoef MJ, Davison BJ. Bridging the gap: decision-making processes of women with breast cancer using complementary and alternative medicine (CAM). Support Care Cancer 2007;15:973–83.Web of ScienceGoogle Scholar

  • 16. Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med 1999;49:651–61.Google Scholar

  • 17. Halkett GKB, Arbon P, Scutter SD, Borg M. The experience of making treatment decisions for women with early stage breast cancer: a diagrammatic representation. Eur J Cancer Care 2005;14:249–55.Google Scholar

  • 18. Verhoef MJ, Vanderheyden LC, Fonnebo V. A whole systems research approach to cancer care: why do we need it and how do we get started? Integr Cancer Ther 2006;5:287–92.Google Scholar

  • 19. Kondracki NL, Wellman NS. Content analysis: review of methods and their applications in nutrition education. J Nutr Educ Behav 2002;34:224–30.Google Scholar

  • 20. Hsieh HF, Shannon S. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277–88.Google Scholar

  • 21. Miles MB, Huberman AM. Qualitative data analysis, 2nd ed. Thousand Oaks, CA: Sage Publications, 1994:58.Google Scholar

  • 22. Morse JM, Field PA. Qualitative research methods for health professionals. Thousand Oaks, CA: Sage Publications, 1995:139–40.Google Scholar

  • 23. Tesch R. Qualitative research: analysis types and software tools. New York, Philadelphia, London: Falmer Press, 1990:127–34.Google Scholar

  • 24. Morgan DL. Qualitative content analysis: a guide to paths not taken. Qual Health Res 1993;1:112–21.Google Scholar

  • 25. Morse JM. Qualitative methods: the state of the art. Qual Health Res 1999;9:393–406.Google Scholar

  • 26. Patton M. Qualitative research & evaluation methods, 3rd ed. Thousand Oaks, CA: Sage Publications, 2002:82–3.Google Scholar

  • 27. Lincoln YS, Guba EG, Guba E. Naturalistic inquiry: the paradigm revolution. London: Sage Publications, 1985:28–33.Google Scholar

  • 28. NVivo qualitative data analysis software; QSR International Pty Ltd. Version 8, 2008.

  • 29. Ayres L, Knafl K. Typological analysis. In: L. Given, editor. The SAGE encyclopedia of qualitative research methods. Thousand Oaks, CA: Sage Publications, 2008:901–2.Google Scholar

  • 30. Shumay DM, Maskarinec G, Gotay CC, Heiby EM, Kakai H. Determinants of the degree of complementary and alternative medicine use among patients with cancer. J Altern Complement Med 2002;8:661–71.Google Scholar

  • 31. Truant TL, Porcino AJ, Ross BC, Wong ME, Hilario CT. Complementary and alternative medicine (CAM) use in advanced cancer: a systematic review. J Support Oncol 2013;11:105–13.Google Scholar

  • 32. Broom A. Intuition subjectivity, and Le Bricoleur: cancer patients’ accounts of negotiating a plurality of therapeutic options. Qual Health Res 2009;19:1050–9.Web of ScienceGoogle Scholar

  • 33. Salamonsen A, Kruse T, Eriksen SH. Modes of embodiment in breast cancer patients using complementary and alternative medicine. Qual Health Res 2012;22:1497–512.Google Scholar

  • 34. McClean S, Shaw A. From schism to continuum? The problematic relationship between expert and lay knowledge. An exploratory conceptual synthesis of two qualitative studies. Qual Health Res 2005;15:729–49.Google Scholar

  • 35. Arora NK. Interacting with cancer patients: the significance of physicians’ communication behaviour. Soc Sci Med 2003;57:791–806.Google Scholar

  • 36. Salamonsen A. Doctor-patient communication and cancer patients’ choice of alternative therapies as supplement or alternative to conventional care. Scan J Caring Sci 2013;27:70–6.Google Scholar

  • 37. Frenkel M, Ben-Arye E, Cohen L. Communication in cancer care: discussing complementary and alternative medicine. Integr Cancer Ther 2010;9:177–85.Web of ScienceGoogle Scholar

  • 38. Rowe R, Calnan M. Trust relations in health care – the new agenda. Eur J Public Health 2006;16:4–6.Google Scholar

  • 39. Balneaves LG, Weeks L, Seely D. Patient decision making about complementary and alternative medicine in cancer management: context and process. Integr Oncol 2008;15:S94–S100.Google Scholar

  • 40. Hack TF, Degner LF, Dyck DG. Relationship between preferences for decisional control and illness information among women with breast cancer: a quantitative and qualitative analysis. Soc Sci Med 1994;39:279–89.Google Scholar

  • 41. Lupton D. Consumerism reflexivity and the medical encounter. Soc Sci Med 1997;45:373–81.Google Scholar

  • 42. Evans M, Sharp D, Shaw A. Developing a model of decision-making about complementary therapy use for patients with cancer: a qualitative study. Patient Educ Couns 2012;89:374–80.Google Scholar

  • 43. Weeks L, Balneaves LG, Paterson C, Verhoef M. Decision-making about complementary and alternative medicine by cancer patients: integrative literature review. Open Med 2014;8:e54–66.Google Scholar

About the article

Received: 2014-11-17

Accepted: 2015-07-23

Published Online: 2015-08-08

Published in Print: 2016-03-01

Citation Information: Journal of Complementary and Integrative Medicine, Volume 13, Issue 1, Pages 51–64, ISSN (Online) 1553-3840, ISSN (Print) 2194-6329, DOI: https://doi.org/10.1515/jcim-2014-0070.

Export Citation

©2016 by De Gruyter.Get Permission

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

Anita Salamonsen and Rolf Ahlzén
Health:An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 2017, Page 136345931769340

Comments (0)

Please log in or register to comment.
Log in