Therapeutic pluralism and the politics of disclosure: breast cancer patients’ experiences in public healthcare

Abstract

Background: Despite the widespread utilisation of complementary and or alternative medicine (CAM) by breast cancer patients in low-and-middle-income countries, few disclose CAM use to their physicians.
 Objective: This study examines disclosure CAM use among a small sample of women attending a breast cancer clinic in a public health hospital in the Western Cape, South Africa.
 Methods: An Interpretative Phenomenological Analysis (IPA) approach was utilised in this study. Semi-structured in-depth interviews were conducted with a convenience sample of 17 women attending a breast clinic in a public hospital.
 Results: Non-disclosure of CAM use was attributed to minimal time for patient-doctor interactions due to resource constraints in public health facilities and the superior status accorded to biomedical doctors’ superior knowledge, associated with paternalism, leading to patients’ fear of reproach for using CAM. Consequently, disclosure of CAM only occurred in instances where it was deemed an absolute necessity.
 Conclusion: Considering the reality of an overstretched public healthcare system, what may be possible is an active attempt to communicate to patients that doctors are aware that patients may use a range of resources (such as CAM), which is their right, and further, recommend patient disclosure of CAM use to their doctors, because of the possibility of drug interactions and other potentially negative effects.
 Keywords: Breast cancer; alternative medicine; South Africa.

Symptoms, concerns, and experiences of women living with and beyond breast cancer in Africa: A mixed‐methods systematic review

“…Qualitative studies were conducted across a range of settings including tertiary, teaching and government hospitals, 52,[54][55][56][57][58][59][61][62][63][64][65][66][68][69][70]72,73,75 non-governmental organisations, 60,67 private hospitals 53,71 and the community. 74 Studies sought to understand the lived experiences of women with breast cancer 52,53,55,57,61-63,65,66,72,75,76 including cultural and social influences and support received and from whom, 54,60,64,67,71,73,74 alongside understanding patterns of initial symptoms and their management 56,58,59,68,69 (Suppplementary File 7:…”

“…inform their healthcare providers that they were using CAM. 73 In addition, many women attended churches and prayer houses, assuming their breast cancer to have a spiritual cause or be a charm, with some refusing medical treatment, instead fasting, praying, drinking holy water, and using holy mud or soil, only engaging with cancer treatments when their cancer had progressed. 58,60,65,75 In a study conducted in Ethiopia, breast cancer was reported to potentially be caused by mich (an Ethiopian ethnomedical category roughly equivalent to 'bad air').…”

“…In total, 48 studies were included, comprising quantitative (n = 24), qualitative (n = 23) and mixed methods 75 (n = 4) 33,35,41,50 ), (qualitative studies (n = 8) [53][54][55][56]58,60,66,71 ); Ghana (n = 11) (quantitative studies (n = 6) 31,32,36,39,48,51 ), (qualitative studies (n = 5) 57,61,63,69,72 ); Mali (n = 1) (quantitative studies (n = 1) 29 )); Central or Middle Africa (Cameroon (n = 1) (quantitative studies (n = 1) 28 )), Southern Africa (South Africa (n = 9) (quantitative studies (n = 1) 34 ), (qualitative studies (n = 8) 59,62,64,65,67,68,70,73 )), East Africa (Ethiopia (n = 9) (quantitative studies (n = 7) 30,37,40,42,44,46,47 ) (qualitative studies (n = 1) 74 ) (mixed method studies (n = 1) 75 );…”

“…52,55,56,58,64,66,71 Across some studies, women believed that breast cancer was a disease inflicted by an enemy, a spiritual attack, also called an arrow, and could only be treated with traditional medicine. 54,56,58 Traditional approaches were also thought to be better for their pain and extending life 73,74 and often they did not ASUQUO ET AL.…”

Varieties of silence – A mixed-methods study exploring reasons and justifications for nondisclosure of the use of complementary therapies to physicians

“…Patient silence, i.e., the patient´s perspective on CT nondisclosure may re ect patients´ di culties to communicate with physicians. The incongruence of world views and different interpretations of the consequences of CT are suggested to be associated with the disclosure of CT use (16,17). Also, CT users may feel disempowered or silenced by biomedicine (18) and to fall into 'mainstream marginality' in society (19).…”