title: From the conventional to the alternative: exploring patients' pathways of cancer treatment and care.
abstract: 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.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Mulkins
authors.forename: Emily
authors.initials: E
authors.lastname: McKenzie
authors.forename: Lynda G
authors.initials: LG
authors.lastname: Balneaves
authors.forename: Anita
authors.initials: A
authors.lastname: Salamonsen
authors.forename: Marja J
authors.initials: MJ
authors.lastname: Verhoef
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000529:Complementary Therapies; D019091:Critical Pathways; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D010865:Pilot Projects; D057285:Precision Medicine; D011788:Quality of Life; D055815:Young Adult