Future research should include participants with more advanced cancers, as compliance with treatment may be dependent on the patients’ expectation of the likely progression of their disease.23
Our findings have a number of clinical implications. Given some of the examples of interactions with medical professionals, it is possible that the participants did not fully understand their treatment options, including their chances of experiencing serious or debilitating consequences of conventional treatment, and may have overestimated such consequences. A better understanding of individual patients’ concerns about conventional treatment can guide how health care professionals in framing recommendations when talking to patients. While patients should be made as aware as possible of the pros and cons of all options for cancer treatment, including conventional methods, CAM, or no treatment, patient education efforts alone are not sufficient. Our findings, as well as those of Montbriand,19 indicate that fear and anxiety may be issues for patients who decline conventional treatment in favor of CAM. Some patients may require psychological and health behavior interventions aimed at improved adjustment and better coping with cancer, as well as addressing the motivational and emotional barriers to compliance. And finally, treatment decision making is an ongoing process, treatment decliners may choose conventional cancer treatment at a later date if given the adequate support, information, and time necessary to make the decision.23 Even if patients have declined oncologic care, they may continue to see their primary care and family physicians. Patients need to feel that they have not been permanently excluded from the health care system even if they make choices that are contrary to the recommendations of their medical team.
Acknowledgments
We want to thank all participants for taking the time and effort to respond to our questionnaire and to participate in the interviews. The help of Marc Goodman, PhD, and the staff of the Hawaii Tumor registry is greatly appreciated. We would also like to thank our research team, including Professor Thomas Maretzki, Yvonne Tatsumura, Katsuya Tasaki, Tammy Brown, Carole Prism, and David Henderson for their help with transcription and analysis. This research was supported by a special study grant from the National Cancer Institute, Surveillance, Epidemiology, and End Results program under contract number N01-PC67001.