The use of complementary and alternative medicine for breast cancer management in Indonesia: a phenomenological study

Author: Juliana Christina

Christina, Juliana, 2021 The use of complementary and alternative medicine for breast cancer management in Indonesia: a phenomenological study, Flinders University, College of Nursing and Health Sciences

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Abstract

Complementary and alternative medicine (CAM) describes a group of non-conventional health practises and products that are commonly used in conjunction with, or in place of, medical treatment. Globally, the demand for CAM use in the cancer population is continuously increasing, particularly among women with breast cancer in Indonesia. Misuse of CAM may, however, cause adverse effects, health deterioration, delayed healing and incur high financial costs. Thus, this study aimed to explore women’s lived experiences and CAM providers’ views on the use of CAM for breast cancer management in Indonesia.

An integrative literature review was conducted to understand what is currently known about the experiences of women with breast cancer and CAM providers’ perceptions regarding the use of CAM for breast cancer specifically in Asian countries. The majority of reviewed studies were quantitative research projects that mainly reported the prevalence of CAM use, sociodemographic factors, and types of CAM, efficacy and safety, and sources of information about CAM. Qualitative studies investigating the phenomena of CAM use for breast cancer were minimal. There were no studies that explored the lived experiences of women with breast cancer and CAM providers’ views regarding the use of CAM for breast cancer management specifically in Indonesia.

van Manen’s hermeneutic phenomenology was used as the methodology and method to understand the meaning of the lived experiences of women with breast in relation to their use of CAM, and to understand CAM providers’ experiences and their views in providing CAM for breast cancer management. A total of 21 women with breast cancer and 10 CAM providers from two regions of Indonesia voluntarily participated to share their lived experiences. The examples of lived experiences were gathered by undertaking in-depth interviews guided by semi-structured questions. The interviews were conducted in Bahasa (Indonesian language) and audio - digitally recorded. All the interviews were transcribed verbatim and then translated into the English language for data analysis.

The findings of the study emerged through thematic analysis and using van Manen’s guided existential reflection. Four main themes were generated from the thematic analysis including:

• Access, affordability and support for medical treatment

• Beliefs in CAM treatment

• Feeling the potential benefits of CAM

• Acknowledging the negative aspects of CAM

These themes were used for phenomenological reflection guided by the existential concept of the lifeworld: relationality (lived self-other), corporeality (lived body), spatiality (lived space), temporality (lived time), and materiality (lived things). Additionally, the views of CAM providers about the use of CAM for breast cancer management provided greater depth of understanding of the findings of the lived experiences of women with breast cancer. The CAM providers’ views produced four main themes: characteristics of women with breast cancer who used CAM therapy, providing non-evidence-based CAM, CAM providers’ beliefs in potential benefits of CAM, and progressive and not so progressive attitudes toward CAM. All the study’s findings were discussed using the CAM healthcare model. This model specifically structured the discussion of the lived experiences of women with breast cancer on the use of CAM, and CAM providers’ views on CAM into determinant factors that influenced CAM utilisations such as:

• Predisposing factors (age, knowledge and cultural practice)

• Enabling factors (poverty and lack of access and availability of medical cancer treatment)

• Need for care factors (relieve breast cancer symptoms, reduce the side effects of chemotherapy, and prevent recurrent breast cancer)

• Health service use (the need of professional CAM providers, the need of standardised CAM products, promotion on self-care activity, as well as purpose and manner of CAM service use)

• Outcomes of care (improved quality of life, and delayed medical cancer treatment and aggravated health condition).

The lived experiences of women with breast cancer and CAM providers’ views in this study revealed that the use of CAM for breast cancer management has both potential therapeutic effects and negatives effects. The outcomes from using CAM based on the lived experiences of women with breast cancer as presented in the findings chapter indicated that some CAM could improve quality of life. However, some fraudulent CAM obtained from unprofessional CAM providers could cause harmful effects, delay medical cancer treatment, and increase breast cancer treatment costs. Therefore, there is an urgent need to enhance the awareness of women with breast cancer related to the importance of appropriate breast cancer treatment, and to increase CAM providers’ knowledge to provide evidence-based CAM. Insight and knowledge from this thesis may inform healthcare professionals, CAM providers, CAM educators and researchers as well as policy makers to improve cancer care services in Indonesia. Ultimately, improving quality cancer care services could contribute to increasing the quality of life and survival rates of women with breast cancer in Indonesia.

Keywords: Complementary, alternative medicine, breast cancer, women, lived experience, phenomenology

Subject: Public Health thesis

Thesis type: Doctor of Philosophy
Completed: 2021
School: College of Nursing and Health Sciences
Supervisor: Dr Wendy Abigail