title: Mapping patterns of complementary and alternative medicine use in cancer: an explorative cross-sectional study of individuals with reported positive "exceptional" experiences.
abstract: BACKGROUND
  While the use of complementary and alternative medicine (CAM) among cancer patients is common and widespread, levels of commitment to CAM vary. "Committed" CAM use is important to investigate, as it may be associated with elevated risks and benefits, and may affect use of biomedically-oriented health care (BHC). Multiple methodological approaches were used to explore and map patterns of CAM use among individuals postulated to be committed users, voluntarily reporting exceptional experiences associated with CAM use after cancer diagnosis.
  
  
  METHODS
  The verbatim transcripts of thirty-eight unstructured interviews were analyzed in two steps. First, manifest content analysis was used to elucidate and map participants' use of CAM, based on the National Center for Complementary Medicine (NCCAM)'s classification system. Second, patterns of CAM use were explored statistically using principal component analysis.
  
  
  RESULTS
  The 38 participants reported using a total of 274 specific CAM (median = 4) consisting of 148 different therapeutic modalities. Most reported therapies could be categorized using the NCCAM taxonomy (n = 224). However, a significant number of CAM therapies were not consistent with this categorization (n = 50); consequently, we introduced two additional categories: Spiritual/health literature and Treatment centers. The two factors explaining the largest proportion of variation in CAM usage patterns were a) number of CAM modalities used and b) a category preference for Energy therapies over the categories Alternative Medical Systems and Treatment centers or vice versa.
  
  
  CONCLUSIONS
  We found considerable heterogeneity in patterns of CAM use. By analyzing users' own descriptions of CAM in relation to the most commonly used predefined professional taxonomy, this study highlights discrepancies between user and professional conceptualizations of CAM not previously addressed. Beyond variations in users' reports of CAM, our findings indicate some patterns in CAM usage related to number of therapies used and preference for different CAM categories.
authors.affiliation: Karolinska Institutet, Dept of Neurobiology, Care Sciences and Society, Division of Nursing, Unit for Studies of Integrative Care, 23 300, SE-141 83 Huddinge, Sweden. johanna.hok@ki.se
authors.forename: Johanna
authors.initials: J
authors.lastname: Hök
authors.forename: Carol
authors.initials: C
authors.lastname: Tishelman
authors.forename: Alexander
authors.initials: A
authors.lastname: Ploner
authors.forename: Anette
authors.initials: A
authors.lastname: Forss
authors.forename: Torkel
authors.initials: T
authors.lastname: Falkenberg
mesh_terms: D000328:Adult; D002755:Choice Behavior; D000529:Complementary Therapies / Q000145:classification / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012648:Self Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome