TREATMENT DECISION-MAKING AND COMPLEMENTARY AND ALTERNATIVE MEDICINE: ONE MODEL DOES NOT FIT ALL.

Over 60% of Canadian women with breast cancer use complementary and alternative medicine (CAM). The popularity of CAM has led to a body of inquiry into the reasons why cancer patients use CAM. While knowledge of the predictors of CAM use has been helpful in identifying patients most likely to use CAM, the development of decisional models is needed to illustrate the complexity of decisions specific to CAM. The purpose of this study was to understand the processes through which women with breast cancer make decisions about CAM. The goal is to provide a foundation for the development of information and decisional resources that support cancer patients in making informed choices about CAM. Using grounded theory methodology, this study involved 21 women living with early-stage breast cancer who were identified as being consumers of CAM. In-depth, open-ended interviews were conducted and transcribed verbatim. Thematic and open coding was initially conducted, followed by a constant comparison of the data Three distinct styles of CAM decision-making exist among women with breast cancer. For some women, a "stepwise" decision-making model occurred, in which CAM decisions shifted as they moved through the conventional treatment trajectory. Other women expressed a "parallel" decision-making style that had conventional and CAM treatment decisions being made concurrently but independently from one another and with minimal conflict. In the "integrative" decision-making style, women perceived conventional cancer treatments and CAM to be part of a continuum of care and made treatment decisions in an integrated manner. The results of this study have important clinical implications, including better prediction of CAM utilization across the breast cancer experience, improved provider- patient communication about CAM, and the development of appropriate educational and decisional support services, such as decision aids. Funding Sources: Canadian Institutes of Health Research and Canadian Breast Cancer Research Alliance [ABSTRACT FROM AUTHOR]