Design and Testing of the Use of a Complementary and Alternative Therapies Survey in Women With Breast Cancer

Cecile A. Lengacher

Mary P. Bennett

Kevin Kip

Adrienne Berarducci

Charles E. Cox

ONF 2003, 30(5), 811-821. DOI: 10.1188/03.ONF.811-821

Purpose/Objectives: To design and test a reliable and valid instrument to determine the frequency of use of complementary and alternative medicine (CAM) therapies among women diagnosed with breast cancer.

Design: A descriptive cross-sectional survey.

Setting: Women were recruited from the southeastern area and a rural midwestern area of the United States.

Sample: 105 predominantly Caucasian women (X = 59 years of age) with a diagnosis of breast cancer.

Methods: The Use of Complementary and Alternative Therapies Survey was designed with a content validity index, and reliability was determined with the coefficient alpha. Exploratory factor analysis using a principal components analysis identified primary components (factors) embedded within the survey. Frequency of CAM therapy use was calculated for 33 individual therapies listed on the survey and among three survey-defined subscales of CAM therapies (i.e., diet and nutritional supplements, stress-reducing techniques, and traditional and ethnic medicines).

Main Research Variables: Psychometric properties of an instrument to assess frequency of use of CAM among women with breast cancer.

Findings: The reported prevalence of use of the individual CAM therapies varied considerably. The coefficient alpha estimate for the total survey was 0.86. Estimates for the individual hypothesized subscales were 0.67 for diet and nutritional supplements, 0.79 for stress-reducing techniques, and 0.80 for traditional and ethnic medicines. The principal components analysis resulted in a two-factor solution with nine items that loaded heavily and uniquely on a factor conceptualized as stress and anxiety reduction and six items that loaded heavily and uniquely on a factor conceptualized as dietary and physical manipulation. The remaining five items (vitamins and minerals, prayer and spiritual healing, massage, reflexology, and aromatherapy) indicated moderate loadings on factors one and two and, thus, were interpreted as equivocal items.

Conclusions: Preliminary data indicated that the instrument is reliable and valid. Additional work is needed to improve the range of items and to test the instrument with other populations.

Implications for Nursing: Use of CAM by women with breast cancer is believed to be increasing. However, limited data exist on the frequency and predictors of its use in this patient population; therefore, reliable and valid instruments are needed to determine use. If nurses can determine which CAM therapies women are employing, nurses can educate patients with breast cancer on the safe use of these therapies.

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    Adler, S.R., & Fosket, J.R. (1999). Disclosing complementary and alternative medicine use in the medical encounter. A qualitative study in women with breast cancer. Journal of Family Practice, 48, 453-458.

    Alferi, S., Antoni, M., Ironson, G., Kilbourn, K., & Carver, C. (2001). Factors predicting the use of complementary therapies in a multi-ethnic sample of early-stage breast cancer patients. Journal of the American Medical Women's Association, 56, 120-123.

    Astin, J.A. (1998). Why patients use alternative medicine: Results of a national study. JAMA, 279, 1548-1553.

    Balneaves, L.G., Kristjanson, L.J., & Tataryn, D. (1999). Beyond convention: Describing complementary therapy use by women living with breast cancer. Patient Education and Counseling, 38, 143-153.

    Begbie, S.D., Kerestes, Z.L., & Bell, D.R. (1996). Patterns of alternative medicine use by cancer patients. Medical Journal of Australia, 165, 545-548.

    Bennett, M., & Lengacher, C.A. (1999). Use of complementary therapies in rural populations. Oncology Nursing Forum, 26, 1282-1294.

    Boon, H., Brown, J.B., Gavin, A., Kennard, M.A., & Stewart, M. (1999). Breast cancer survivors' perceptions of complementary/alternative medicine (CAM): Making the decision to use or not to use. Qualitative Health Research, 9, 639-653.

    Boon, H., Stewart, M., Kennard, M., Gray, R., Sawka, C., Brown, J., et al. (2000). Use of complementary/alternative medicine by breast cancer survivors in Ontario: Prevalence and perceptions. Journal of Clinical Oncology, 18, 2515-2521.

    Burstein, H. J., Gelber, S., Guadagnoli, E., & Weeks, J.C. (1999). Use of alternative medicine by women with early-stage breast cancer. New England Journal of Medicine, 340, 1733-1739.

    Crocetti, E., Crotti, N., Feltrin, A., Ponton, P., Geddes, M., & Buiatti, E. (1998). The use of complementary therapies by breast cancer patients attending conventional treatment. European Journal of Cancer, 34, 324-328.

    Eisenberg, D., Davis, R., Ettner, S., Appel, S., Wilkey, S., Van Rompay, M., et al. (1998). Trends in alternative medicine use in the United States, 1990-1997: Results of a follow-up national survey. JAMA, 280, 1569-1575

    Eisenberg, D., Kessler, R., Foster, C., Norlock, F., Calkins, D., & Delbanco, T. (1993). Unconventional medicine in the United States: Prevalence, costs, and patterns of use. New England Journal of Medicine, 328, 246-252.

    Ernst, E. (1995). Complementary cancer treatments: Hope or hazard? Clinical Oncology, 7, 259-263.

    Ernst, E., & Cassileth, B. (1998). The prevalence of complementary/alternative medicine in cancer. Cancer, 83, 777-782.

    Fisher, P., & Ward, A. (1994). Complementary medicine in Europe. BMJ, 309, 107-111.

    Gray, C., Tan, A., Pronk, N., & O'Connor, P. (2002). Complementary and alternative medicine use among health care plan members. A cross-sectional survey. Effective Clinical Practice, 5, 17-22.

    Jacobson, J., Workman, S., & Kronenberg, F. (2000). Research on complementary/alternative medicine for patients with breast cancer: A review of the biomedical literature. Journal of Clinical Oncology, 18, 668-683.

    Jemal, A., Murray, T., Samuels, A., Ghafoor, A., Ward, E., & Thun, M. (2003). Cancer statistics, 2003. CA: A Cancer Journal for Clinicians, 53, 5-26.

    Lee, M.M., Lin, S.S., Wrensch, M.R., Adler, S.R., & Eisenberg, D. (2000). Alternative therapies used by women with breast cancer in four ethnic populations. Journal of the National Cancer Institute, 92, 42-47.

    Lerner, I.J., & Kennedy, B.J. (1992). The prevalence of questionable methods of cancer treatment in the United States. CA: A Cancer Journal for Clinicians, 42, 181-191.

    Morris, K.T., Johnson, N., Homer, L., & Walts, D. (2000). A comparison of complementary therapy use between breast cancer patients and patients with other primary tumor sites. American Journal of Surgery, 179, 407-411.

    Moschen, R., Kemmler, G., Schweigkofler, H., Holzner, B., Dunser, M., Richter, R., et al. (2001). Use of alternative/complementary therapy in breast cancer patients—A psychological perspective. Supportive Care in Cancer, 9, 267-274.

    Murray, R.H., & Rubel, A.J. (1992). Physicians and healers—Unwitting partners in health care. New England Journal of Medicine, 326, 61-64.

    Office of Alternative Medicine Advisory Panel. (1994). Classification of alternative medical practices. Fact sheet #3. Bethesda, MD: National Institutes of Health.

    Rees, R.W., Fiegel, I., Vickers, A., Zollman, C., McGurk, R., & Smith, C. (2000). Prevalence of complementary therapy use by women with breast cancer. A population-based survey. European Journal of Cancer, 36, 1359-1364.

    Risberg, T., Lund, E., Wist, E., Kaasa, S., & Wilsgaard, T. (1998). Cancer patients use of nonproven therapy: A 5-year follow-up study. Journal of Clinical Oncology, 16, 6-12.

    Sollner, W., Maislinger, S., DeVries, A., Steixner, E., Rumpold, G., & Lukas, P. (2000). Use of complementary and alternative medicine by cancer patients is not associated with perceived distress or poor compliance with standard treatment but with active coping behavior: A survey. Cancer, 89, 873-880

    Sparber, A., Wootton, J.C., Bauer, L., Curt, G., Eisenberg, D., Levin, T., et al. (2000). Use of complementary medicine by adult patients participating in HIV/AIDS clinical trials. Journal of Alternative and Complementary Medicine, 6, 415-422.

    VandeCreek, L., Rogers, E., & Lester, J. (1999). Use of alternative therapies among breast cancer outpatients compared with the general population. Alternative Therapies in Health and Medicine, 5(1), 71-76.

    Verhoef, M.J., Russell, M.L., & Love, E.J. (1994). Alternative medicine use in rural Alberta. Canadian Journal of Public Health, 85, 308-309.

    Whitman, M. (2001). Understanding the perceived need for complementary and alternative neutraceuticals: Lifestyle issues. Clinical Journal of Oncology Nursing, 5, 190-194.

    Yates, P., Beadle, G., Clavarino, A., Najman, J., Thomson, D., Williams, G., et al. (1993). Patients with terminal cancer who use alternative therapies: Their beliefs and practices. Sociological Health III, 15, 1999-2016.