title: Using mixed methods for evaluating an integrative approach to cancer care: a case study.
abstract: OBJECTIVE
  To evaluate the impact of participating in an integrative cancer care program at the Centre for Integrated Healing in Vancouver, British Columbia, on patients' lifestyle, quality of life, and overall well-being.
  
  
  METHODS
  A mixed-methods case study with a pre- and posttest design. No control group was utilized.
  
  
  METHODS
  All new patients starting at the Centre for Integrated Healing between May and September of 2004 were invited to join the study. Forty-six of 77 new patients agreed to participate. Quantitative data measuring quality of life, social support, anxiety and depression, locus of control, and hope were assessed at baseline (pre-program start) and at 6 weeks and 5 months from the start of the program. Qualitative data in the form of focus groups and interviews were collected midway through the follow-up period to further explore program impacts.
  
  
  RESULTS
  No statistically significant improvements or declines were noted on the quantitative measures between baseline and the 5-month follow-up point. The qualitative findings revealed a theme of patients' active engagement in their cancer care involving empowered decision making and creating personal change. Facilitators of active patient engagement in their own care from the integrative program included healing partnerships with practitioners, information and resources, managing the integration of complementary and conventional therapies, emotional support, and a sense of hope.
  
  
  CONCLUSIONS
  This case study was a first attempt at documenting the impact of an integrative cancer care program at the Centre for Integrated Healing. Study limitations included a small sample size, which limited power to detect quantitative changes on the questionnaires and a lack of a control group. Qualitative findings indicated that patients found value in the "person-oriented" holistic approach to care, which encouraged patients to take an active role in decision making and self-care. The use of a mixed-methods research design proved to be an effective approach to not only evaluating outcomes but also examining process issues of the experience. Additional research is greatly needed to better understand potential impacts of integrative approaches to cancer care.
authors.affiliation: School of Nursing, University of British Columbia, Canada. alison.brazier@nursing.ubc.ca
authors.forename: Alison
authors.initials: A
authors.lastname: Brazier
authors.forename: Karen
authors.initials: K
authors.lastname: Cooke
authors.forename: Veronika
authors.initials: V
authors.lastname: Moravan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia; D000529:Complementary Therapies; D019033:Delivery of Health Care, Integrated; D005260:Female; D017144:Focus Groups; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D005791:Patient Care / Q000523:psychology; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires