METHODS: A cross-sectional design using a self-administered questionnaire was adopted. Eight medical institutions in Taiwan with inpatient hospice palliative care units were chosen. Ninety-two terminally ill patients and 267 relatives met the inclusion criteria. The questions concerned the experience of CAM use, the kinds of products/services CAM provided, the purpose of CAM use, the source of CAM information, and the perceptions and attitudes toward CAM.
RESULTS: Both terminally ill patients and their relatives have a high proportion of lifetime and one-year prevalence of CAM use (88.0% vs. 88.4%; p = 0.929). CAM use for musculoskeletal and neurological discomfort is higher among terminally ill patients than among their relatives. Relatives/friends are the most frequent sources of information on CAM (53.3% vs. 62.2%; p = 0.133). The percentage of terminally ill patients who discontinued mainstream medical treatment because of CAM use was higher than that of their relatives (18.5% vs. 9.3%; p = 0.026). More than half the terminally ill patients and their relatives had never been asked about CAM by medical staff (64.1% vs. 66.7%), nor had they informed medical professionals about the use of CAM products and services (63% vs. 66.9%). Random inquiries by medical professionals may be associated with increased disclosure of CAM use (terminally ill patients: odds ratio, 9.75; 95% confidence interval, 1.97-48.35 vs. relatives: odds ratio, 5.61; 95% confidence interval, 2.66-11.83).
CONCLUSIONS: The high prevalence and concealment of CAM use in terminally ill patients should be considered. Medical professionals should establish a friendly and barrier-free communication model, encourage patients to share CAM experiences, and provide evidence-based information on the use of CAM products and services, to reduce the potential damage caused by harmful use.
方法:采用自编问卷的横断面设计。选择了台湾八家设有住院临终关怀姑息治疗单位的医疗机构。92名绝症患者和267名亲属符合纳入标准。问题涉及CAM使用的经验,CAM提供的产品/服务的种类,CAM使用的目的,CAM信息的来源,以及对CAM的看法和态度。
结果:绝症患者及其亲属使用CAM的终生和一年患病率都很高(88.0%vs.88.4%;p=0.929)。在绝症患者中,CAM用于肌肉骨骼和神经系统不适的比例高于其亲属。亲戚/朋友是CAM上最常见的信息来源(53.3%vs.62.2%;p=0.133)。因使用CAM而停止主流医学治疗的绝症患者的百分比高于其亲属(18.5%vs.9.3%;p=0.026)。超过一半的绝症患者及其亲属从未被医务人员询问过CAM(64.1%vs.66.7%),他们也没有告知医疗专业人员使用CAM产品和服务(63%与66.9%)。医疗专业人员的随机询问可能与CAM使用的披露增加有关(绝症患者:赔率比,9.75;95%置信区间,1.97-48.35vs.亲属:赔率比,5.61;95%置信区间,2.66-11.83)。
结论:应考虑在绝症患者中使用CAM的高患病率和隐蔽性。医务人员应建立友好、无障碍的沟通模式,鼓励患者分享CAM经验,并提供有关CAM产品和服务使用的循证信息,减少有害使用造成的潜在损害。