title: Use of complementary and alternative medicine in patients with cancer or multiple sclerosis: possible public health implications.
abstract: BACKGROUND
  The use of complementary and alternative medicine (CAM) among Scandinavian patients with cancer or multiple sclerosis (MS) may be perceived as closely connected to their experiences from conventional care and thus contextualized by Scandinavian public healthcare systems. This study aimed at providing more insight into such patients' widespread, complex, self-initiated and unregulated use of CAM, analysed from a public health perspective.
  
  
  METHODS
  Twenty-nine qualitative in-depth interviews with 31 CAM users diagnosed with cancer or MS were conducted. Qualitative content analysis was used to interpret the data.
  
  
  RESULTS
  The participants were 'active patients' because they initiated their use of CAM and wanted to take part in decision-making and contribute to positive health outcomes. They moved in and out of CAM and public healthcare contexts as 'boundary walkers'. Experience-based knowledge such as bodily experiences as well as scientific knowledge was perceived as relevant sources of knowledge in decision-making. CAM treatments were in general perceived as safe and conventional treatments as being potentially risky.
  
  
  CONCLUSIONS
  Boundary walkers often challenge the understandings of illness behaviour, evidence and treatment traditionally incorporated in Scandinavian public healthcare systems. CAM may be perceived as a healthcare system that acknowledges experience-based knowledge and patient involvement in treatment processes. Patient-centeredness is an important goal in current European public health programmes, but is often not recognized by CAM users in clinical practice. Thus, studies of CAM users' healthcare needs and their strategies to meet them may provide crucial knowledge to future development of patient-centred public health and medical education programmes.
authors.affiliation: The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway anita.salamonsen@uit.no.
authors.forename: Anita
authors.initials: A
authors.lastname: Salamonsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D003657:Decision Making; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000628:therapy*; D009369:Neoplasms / Q000628:therapy*; D010465:Perception; D036301:Qualitative Research; D012307:Risk Factors; D012537:Scandinavian and Nordic Countries