Factors Involved in Decision Making

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Factors Involved in Decision Making

• Complementary Therapies and Rheumatoid Arthritis

Merilee Brockway
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Background
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Rheumatoid Arthritis (RA)

• A chronic, systemic illness
• Treated symptomatically
• Affects 0.3 - 1.5 of population
• Affects all aspects of bio-psycho-social
  wellness spectrum
• Patients are often experts in their illness and
  are very active in their health care regimen
• Many pursue CAM

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Complementary Therapy

• 20-30 of Canadians use CAM (17 of which
  are people with RA)
• lt40 inform their primary physician
• Very few studies on WHY people choose to use
  CAM

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Complementary / Alternative Medicine
(CAM)
Medical practice that does not conform to the
standards of the medical community, that is not
taught widely at North American medical schools
and that is generally unavailable at North
American hospitals (Verhoef Sutherland, 1995)
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Research Questions

• What leads RA sufferers to pursue or
  not to pursue alternative therapies?
• What factors contribute to their decision?
• What information sources do these individuals
  use in their decision making process?

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Purpose

• To examine which factors patients with RA take
  into account when making decisions about whether
  or not to use alternative therapies and their
  reasons for choice.

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Method
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Design

• A qualitative descriptive study, based on
  participants experiences with decision making
  regarding use of alternative or complementary
  therapies.

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Participant Recruitment

• Placement of posters in the office of the
  Arthritis Society
• Attendance at support group meetings for
  arthritis sufferers
• Word of mouth through the
• arthritis community

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Sample

• Eleven participants - 10 female, 1male
• Caucasian
• Mid 30s to late 60s
• High school - University degree
• RA diagnoses for 4 - 37 years

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Data Collection
Semi-structured face-to-face interviews, 30
minutes - 1 hour in duration, were conducted
using open questioning with direct probes used as
necessary. Interviews were tape recorded and
transcribed.
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Data Analysis

• Transcribed text was
• Submitted to standard
• content analysis
• Divided into units of meaning
• Categorized
• Grouped into thematic descriptions

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Findings
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Themes

• Desperation
• Empowerment
• Legitimization / Integration

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Desperation

• Somebody do anything for me, please. Just stop
  the pain.

You get to a point where youll try anything
cause it might be the one that might work
I was pretty desperate, I was looking for
anything - any sort of relief from the pain
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Empowerment
I would prefer to treat my body with respect
It really appeals to me to keep treating my
system in a natural way.
Im enjoying the fact that Im involving my own
self and using discovery in my own wellness
journey

• Were too dependent sometimes on ...
  conventional medicine which doesnt work in all
  cases

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Integration / Legitimization

• I wish that the healthcare system would
  incorporate alternative approaches as well as
  mainstream together

The other issue is of course money. My Enbrel
is 100 covered and homeopathy is 0.
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Resources Accessed
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Implications
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Significance to Nursing

• Improved understanding of patient perspectives
  experience
• Facilitate more effective patient teaching
• Guide practice in primary,secondary and
  tertiary care settings

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Thank You

• Questions?

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References

• Allen, M., Oberle, K., Grace, M. Russell, A.
  (2002). Elk velvet antler in rheumatoid
  arthritis Phase II trial. Biological Research
  for Nursing. 3(3), 111-118.
• Astin, J. A. (1998). Holistic health Alternative
  methods and patient choice. American Journal of
  Nursing. 98(9), 9
• Burns, N. and Grove, S.K. (2001). The practice
  of nursing research Conduct, critique and
  utilization. 4th ed. Saunders, Philadelphia.
• Chan, H. K. (2002). The utilization and reasons
  of choice for Chinese or western medicine among
  rheumatoid arthritis patients in Hong Kong. Hong
  Kong Nursing Journal. 3(3), 7-16
• Eisenburg, D.M. et al (1998) Trends in
  alternative medicine use in the United States
  1990-1997. JAMA 290 1596-1575.
• Kanning, M. (1999). Why would I want to use
  complementary and alternative therapy A
  patients perspective. Rheumatic Disease Clinics
  of North America. 25(4), 823-831
• Mason, J. (2002). Qualitative Researching (2nd
  ed.). Sage. London
• Millar, W. J. (1997). Use of alternative health
  care practitioners by Canadians. Canadian
  Journal of Public Health. 88(3), 154-158.
• Porth, C.M. (2002). Pathophysiology Concepts of
  Altered Disease States. Philadelphia Lippincott
• Sandelowski, M. (2000). Focus on research
  methods Whatever happened to qualitative
  description. Research in Nursing Health. 23,
  334-340
• Verhoef, M.J. and Sutherland, L.R. (1995).
  General practitioners assessment of and
  interest in alternative medicine in Canada.
  Social Science Medicine. 41(4), 511-515.