title: Decision-making about complementary and alternative medicine by cancer patients: integrative literature review.
abstract: BACKGROUND
  Patients with cancer consistently report conflict and anxiety when making decisions about complementary and alternative medicine (CAM) treatment. To design evidence-informed decision-support strategies, a better understanding is needed of how the decision-making process unfolds for these patients during their experience with cancer. We undertook this study to review the research literature regarding CAM-related decision-making by patients with cancer within the context of treatment, survivorship, and palliation. We also aimed to summarize emergent concepts within a preliminary conceptual framework.
  
  
  METHODS
  We conducted an integrative literature review, searching 12 electronic databases for articles published in English that described studies of the process, context, or outcomes of CAM-related decision-making. We summarized descriptive data using frequencies and used a descriptive constant comparative method to analyze statements about original qualitative results, with the goal of identifying distinct concepts pertaining to CAM-related decision-making by patients with cancer and the relationships among these concepts.
  
  
  RESULTS
  Of 425 articles initially identified, 35 met our inclusion criteria. Seven unique concepts related to CAM and cancer decision-making emerged: decision-making phases, information-seeking and evaluation, decision-making roles, beliefs, contextual factors, decision-making outcomes, and the relationship between CAM and conventional medical decision-making. CAM decision-making begins with the diagnosis of cancer and encompasses 3 distinct phases (early, mid, and late), each marked by unique aims for CAM treatment and distinct patterns of information-seeking and evaluation. Phase transitions correspond to changes in health status or other milestones within the cancer trajectory. An emergent conceptual framework illustrating relationships among the 7 central concepts is presented.
  
  
  CONCLUSIONS
  CAM-related decision-making by patients with cancer occurs as a nonlinear, complex, dynamic process. The conceptual framework presented here identifies influential factors within that process, as well as patients' unique needs during different phases. The framework can guide the development and evaluation of theory-based decision-support programs that are responsive to patients' beliefs and preferences.
authors.affiliation: Laura Weeks, PhD, is a Senior Research Fellow at the Ottawa Integrative Cancer Centre, Ottawa, Ontario.
authors.forename: Laura
authors.initials: L
authors.lastname: Weeks
authors.affiliation: Lynda G. Balneaves, RN, PhD, is an Associate Professor in the School of Nursing, University of British Columbia, Vancouver, British Columbia.
authors.forename: Lynda G
authors.initials: LG
authors.lastname: Balneaves
authors.affiliation: Charlotte Paterson, MSc, PhD, MBChB, MRCGP, is a Research Fellow in the School of Social and Community Medicine at the University of Bristol, Bristol, England.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Paterson
authors.affiliation: Marja Verhoef, PhD, is a Professor and Canada Research Chair in Complementary Medicine in the Department of Community Health, University of Calgary, Calgary, Alberta.
authors.forename: Marja
authors.initials: M
authors.lastname: Verhoef
mesh_terms: D000529:Complementary Therapies / Q000523:psychology*; D003469:Culture; D003657:Decision Making; D006801:Humans; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D010166:Palliative Care / Q000379:methods / Q000523:psychology; D057240:Patient Preference / Q000523:psychology*; D012945:Social Values