Therapeutic pluralism? Evidence, power and legitimacy in UK cancer services

Abstract

The integration of complementary and alternative medicine (CAM) into cancer services is increasingly discussed as a potential part of UK health policy but as yet there has been little sociological research examining this process. This paper examines the results of a study on the provision of CAM to cancer patients in two distinct organisational contexts: the hospice and the hospital. It is based on interviews with medical specialists, nursing staff and CAM therapists. This paper focuses on how integration is managed in each organisation, examining professional boundary disputes and inter-professional dynamics. Discussion focuses on the rhetorical and practical strategies that are employed by a variety of differently positioned interviewees to negotiate the complexities of the interface of CAM and biomedicine. The results show significant differentiation in how differently positioned cancer clinicians view and utilise the biomedical hierarchy of evidence. We argue that the integration of CAM should not be conceptualised as a mere challenge to biomedicine, or, as resulting in a linear process of deprofessionalisation. Rather, it should be seen as producing a complex array of processes, including strategic adaptation on the part of medical specialists and NHS organisations.

The role of gender, environment and Individual biography in shaping qualitative interview data

“…Study 1 (Author A) involved 80 in-depth interviews with cancer patients in the UK, examining treatment decision-making and experiences of disease (see Broom & Tovey, 2007). Study 2 (Author A) was a study of experiences of prostate cancer and patient's information-seeking behaviour (see Broom, 2005), with a total of 33 in-depth interviews with Australian prostate cancer patients.…”

Organizational Determinants of Interprofessional Collaboration in Integrative Health Care: Systematic Review of Qualitative Studies

“…Whereas the potential financial benefits to BM institutions and practitioners form the business case for providing IHC services [20], [38], [42], [43], securing funding for launching and sustaining IHC services is a major challenge for the central authorities before such gain is harvested [19], [28], [37]. Sufficient funding is not only essential for recruiting experienced, qualified TCAMP [44], but it also carries strong implications for TCAMP's sense of belonging within predominantly BM institutions as well as effecting the intention to work collaboratively with BMD [19], [35], [45].…”

“…Acceptance of emergent leadership to integrate services is more likely because it is a shared process with agreement of different partners [21]. BMD are often the emergent leaders because their professional affinity and credibility can better facilitate the innovation of new services [28], [41], [42]. Clinicians accredited both in BM and TCAM (dual accredited clinicians) are particularly suitable as they can anticipate tensions between the two paradigms, and possibly resolve them by translating TCAM terminology into BM terms [31], [39].…”

“…The choice of a service site is often of paramount strategic importance. Compared to an acute inpatient environment, primary and palliative care settings are more flexible and are more likely to endorse the provision of TCAM services [27], [42].…”

“…At the operational level, leaders need to enlist support from BMD, including those who are not involved in IHC services; this is because peer pressure exerted by them can hinder participation by other interested BMD [34], [42]. Ensuring the safety of additional TCAM treatment is at the heart of the business [39].…”