Charles Darwin University An exploration of healthcare providers' experiences and perspectives of Traditional and complementary medicine usage and disclosure by Indigenous cancer patients Gall, A.; Anderson, K.; Adams, J.; Matthews, V.; Garvey, G. Published in: BMC Complementary and Alternative Medicine DOI: 10.1186/s12906-019-2665-7 Published: 18/09/2019 Document Version Publisher's PDF, also known as Version of record Link to publication Citation for published version (APA): Gall, A., Anderson, K., Adams, J., Matthews, V., & Garvey, G. (2019). An exploration of healthcare providers' experiences and perspectives of Traditional and complementary medicine usage and disclosure by Indigenous cancer patients. BMC Complementary and Alternative Medicine, 19(1), 1-9. 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BMC Complementary and Alternative Medicine (2019) 19:259 https://doi.org/10.1186/s12906-019-2665-7 RESEARCHARTICLE Open Access An exploration of healthcare providers’ experiences and perspectives of Traditional and complementary medicine usage and disclosure by Indigenous cancer patients A. Gall1* , K. Anderson1, J. Adams2, V. Matthews3 and G. Garvey1 Abstract Background: Traditional and complementary medicines (T&CM) are any form of medicine, practice, treatment, product, technology, knowledge system or ceremony outside of conventional medical practice that aims to prevent and/or treat illness and/or promote well-being. Alongside conventional cancer treatments, T&CM usage is increasing; with 19% of indigenous Australians with cancer reporting using T&CM. There is limited evidence surrounding T&CM use and disclosure by indigenous patients. Our aim was to explore healthcare providers’ views about usage, disclosure/non-disclosure of T&CM by Indigenous cancer patients. Methods: Semi-structured, in-depth interviews with 18 healthcare providers, including three indigenous providers, at a large urban hospital providing care to Indigenous cancer patients were conducted to explore providers’ experiences and attitudes towards T&CM use by Indigenous cancer patients. An interpretive phenomenological approach was used to thematically analyse the data. Results: Analysis revealed six themes: concern about risk; no ‘real’ benefits; perception of T&CM and conventional medicine as antithetical; barriers to disclosure; ‘patients’ choice’ a double-edged sword; and providers’ lack of knowledge about T&CM. Healthcare providers perceived discord between T&CM and conventional medicine. Most lacked knowledge of T&CM, and had concerns around negative-interactions with conventional treatments. They considered T&CM outside their role, citing this as reasoning for their lack of knowledge. Indigenous healthcare providers had greater understanding and openness towards T&CM. Conclusions: Given the potential usage of T&CM by Indigenous cancer patients, providers need a more comprehensive understanding of T&CM in order to inform discussion and facilitate effective disclosure on this topic. If indigenous Australians with cancer feel that cancer care providers are unreceptive to discussing T&CM, patient care risks being compromised; particularly given the potential for negative interactions between T&CM and conventional cancer treatments. Fostering health care interactions where indigenous patients feel comfortable to discuss T&CM usage should be a priority for all cancer care services. Keywords: Aboriginal people, Cancer, Cancer care, Complementary medicine, Indigenous medicine, Traditional medicine, Communication * Correspondence: [email protected] 1Menzies School of Health Research, Charles Darwin University, Wellbeing and Preventable Chronic Disease Division, 1/147 Wharf Street, Spring Hill, Brisbane, Queensland 4000, Australia Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Gall et al. BMC Complementary and Alternative Medicine (2019) 19:259 Page 2 of 9 Background to encompass their family, community and environ- Australian cancer patients in general have one of the ment [16– 18]. CM is also underpinned by a model highest survival rates in the world; however, this is not of holism, which may be why indigenous people who so for all groups of Australian cancer patients [1]. Can- lack access to TM may choose to make use of avail- cer is the second leading cause of mortality among Abo- able CM alternatives. Moreover, as with all cultures, riginal and Torres Strait Islander Australians (hereafter indigenous Australian culture is continually evolving respectfully referred to as indigenous Australians), and and many indigenous Australians also identify other most concerning is the cancer mortality gap between in- cultural groups. This makes the line between TM digenous and non-indigenous Australians, which is in- and CM unclear and largely superfluous. For these creasing (1998–2015; 21% of indigenous vs 13% of non- reasons, it was important to include CM in our dis- indigenous) [1]. While reasons for this disparity are cussions with providers, as their Indigenous cancer complex, there is evidence that factors such as advanced patients are potentially using CM, TM or T&CM. cancer stage at diagnosis [2–4], reduced access to, up- There is a dearth of evidence relating to the use of take and/or completion of treatment [3, 5–8], and higher T&CM among Indigenous cancer patients. In a 2015 rates of co-morbidities [3, 7] amongst indigenous pa- study conducted by Adams and colleagues in Queens- tients contribute to their poorer cancer outcomes rela- land, 18.7% of indigenous Australian cancer patients tive to non-indigenous Australians. Indigenous people used at least one form of T&CM for support with their tend to have a holistic concept of health, which contrasts care [19]. Furthermore, there is evidence that some with the biomedical model [9, 10]. This differing per- herbs and nutritional supplements can upregulate en- spective incorporates their need for connection to cul- dogenous antioxidants that negate the effects of chemo- ture, heritage, land and the spirits of their ancestors, therapy drugs [20–22]. This potential for risk has which alongside the social and spiritual support that contributed to a stark divide between healthcare pro- traditional healer’s provide, is seen as highly important viders’ views on T&CM use alongside conventional can- to indigenous people [9, 10]. It is therefore likely that cer medicine [23–25]. Broom and Adams found traditional and complementary medicine (T&CM) plays oncology consultants used ‘risk’ as a means to discour- an important role in re-establishing wellness for Indigen- age T&CM use by cancer patients, and that they held ous cancer patients, rather than solely focussing on cur- the view that the main drivers of patients to use T&CM ing the disease. were ‘irrationality’, ‘seeking control’ and ‘desperation’ The use of T&CM alongside conventional cancer treat- [25]. These findings highlight potential barriers for can- ments such as chemotherapy and radiotherapy is increasing cer patients to disclose their use of T&CM with their [11, 12]. Traditional Medicine (TM) and Complementary healthcare providers [25]. Medicine (CM) [14] include a broad range of practices, The importance of open and effective patient-clin- technologies, products, knowledge systems and approaches ician communication is paramount in modulating the to preventing and/or treating illness and/or promoting potential risks and benefits associated with the use of well-being that are not historically associated with conven- T&CM in the cancer setting [25, 26]. The communi- tional medicine [13]. While TM refers to health care that is cation gap between healthcare providers and indigen- indigenous to the local culture of users (including treat- ous Australians has a significant impact on health ments such as herbal medicines and practices provided by outcomes [27–30]. Cass and colleagues used qualita- traditional indigenous healers), CM refers to health care, tive methods to observe both healthcare providers both self-administered or practitioner-led, which is often and indigenous renal patient communicative