Motivations for consulting complementary and alternative medicine practitioners: A comparison of consumers from 1997–8 and 2005

Background: Use of complementary and alternative medicine (CAM), and especially CAM practitioners, has continued to rise in recent years. Although several motivators of CAM use have been identified, little is known about how and if the motivations for using CAM have changed over time. The purpose of the current study was to compare the reasons for consulting CAM practitioners in consumers in 1997–8 and eight years later in 2005. Methods: Surveys were displayed in CAM and conventional medicine offices and clinics in Ontario, Canada in 1997–8 and again in 2005, and self-selected participants returned the surveys by mail. Results: In 1997–8, 141 CAM consumers were identified from the 199 surveys returned, and 185 CAM consumers were identified from the 239 surveys returned in 2005. Five of the six CAM motivations were more likely to be endorsed by the 2005 CAM consumers compared to the 1997– 8 CAM consumers (all p's < .0001). In 1997–8 the two top reasons for using CAM were that CAM allowed them to take an active role in their health (51.8%), and because conventional medicine was ineffective for their health problem (41.8%). In 2005, the treatment of the whole person (78.3%) was the top reason for using CAM followed by taking an active role in one's health (76.5%). The 2005 consumers were less educated, had slightly more chronic health complaints, had been using CAM for longer, and were more likely to consult chiropractors, reflexologists, and therapeutic touch practitioners than the 1997–8 consumers. Otherwise, the socio-demographic and health profiles of the two groups of CAM consumers were similar, as was their use of CAM. Conclusion: Compared to consumers in 1997–8, consumers in 2005 were more likely to endorse five of the six motivations for consulting CAM practitioners. A shift towards motivations focusing more on the positive aspects of CAM and less on the negative aspects of conventional medicine was also noted for the 2005 consumers. Findings suggest that CAM motivations may shift over time as public knowledge of and experience with CAM also changes

An International Consensus Definition of the Wish to Hasten Death and Its Related Factors

Background: The desire for hastened death or wish to hasten death (WTHD) that is experienced by some patients with advanced illness is a complex phenomenon for which no widely accepted definition exists. This lack of a common conceptualization hinders understanding and cooperation between clinicians and researchers. The aim of this study was to develop an internationally agreed definition of the WTHD. Methods: Following an exhaustive literature review, a modified nominal group process and an international, modified Delphi process were carried out. The nominal group served to produce a preliminary definition that was then subjected to a Delphi process in which 24 experts from 19 institutions from Europe, Canada and the USA participated. Delphi responses and comments were analysed using a pre-established strategy. Findings: All 24 experts completed the three rounds of the Delphi process, and all the proposed statements achieved at least 79% agreement. Key concepts in the final definition include the WTHD as a reaction to suffering, the fact that such a wish is not always expressed spontaneously, and the need to distinguish the WTHD from the acceptance of impending death or from a wish to die naturally, although preferably soon. The proposed definition also makes reference to possible factors related to the WTHD. Conclusions: This international consensus definition of the WTHD should make it easier for clinicians and researchers to share their knowledge. This would foster an improved understanding of the phenomenon and help in developing strategies for early therapeutic intervention

What Lies behind the Wish to Hasten Death? A Systematic Review and Meta-Ethnography from the Perspective of Patients

BACKGROUND: There is a need for an in-depth approach to the meaning of the wish to hasten death (WTHD). This study aims to understand the experience of patients with serious or incurable illness who express such a wish. METHODS AND FINDINGS: Systematic review and meta-ethnography of qualitative studies from the patient's perspective. Studies were identified through six databases (ISI, PubMed, PsycINFO, CINAHL, CUIDEN and the Cochrane Register of Controlled Trials), together with citation searches and consultation with experts. Finally, seven studies reporting the experiences of 155 patients were included. The seven-stage Noblit and Hare approach was applied, using reciprocal translation and line-of-argument synthesis. Six main themes emerged giving meaning to the WTHD: WTHD in response to physical/psychological/spiritual suffering, loss of self, fear of dying, the desire to live but not in this way, WTHD as a way of ending suffering, and WTHD as a kind of control over one's life ('having an ace up one's sleeve just in case'). An explanatory model was developed which showed the WTHD to be a reactive phenomenon: a response to multidimensional suffering, rather than only one aspect of the despair that may accompany this suffering. According to this model the factors that lead to the emergence of WTHD are total suffering, loss of self and fear, which together produce an overwhelming emotional distress that generates the WTHD as a way out, i.e. to cease living in this way and to put an end to suffering while maintaining some control over the situation. CONCLUSIONS: The expression of the WTHD in these patients is a response to overwhelming emotional distress and has different meanings, which do not necessarily imply a genuine wish to hasten one's death. These meanings, which have a causal relationship to the phenomenon, should be taken into account when drawing up care plans

Meaning of Life For Patients in Palliative and End-of-Life Care

The article presents the author's reflection on the concept of meaning of life for patients provided with palliative care and those who are at the end of life within the framework of public health in Great Britain. The concept covers several experiences including a change in life priorities, presence of spiritual growth and development of self-knowledge. The purposes of interactions between health professionals and families of patients are outlined

Miedo a la muerte y su relación con la inteligencia emocional de estudiantes de enfermería de Concepción Medo da morte e sua relação com a inteligência emocional de estudantes de enfermagem de Concepción Fear of death and its relationship with emotional intelligence of nursing students in Concepción

OBJETIVO: Conocer el miedo a la muerte y su relación con la inteligencia emocional y otras variables en estudiantes de enfermería de los últimos años de estudio. MÉTODOS: Estudio descriptivo y correlacional. Los estudiantes (n=188) respondieron a un cuestionario sobre: características socioculturales; Escalas de Miedo a la Muerte y de Inteligencia Emocional. RESULTADOS: Se obtuvo un promedio medio-alto en miedo a la muerte (3,35). La percepción emocional se correlacionó positivamente con miedo a la muerte, mientras que la comprensión y la regulación emocional se correlacionaron negativamente con el miedo a la muerte. Las puntuaciones más altas de miedo a la muerte se asociaron con el sexo femenino, con los niveles inferiores de los cursos y con la percepción de menor preparación académica en el tema. CONCLUSIONES: Los niveles altos de inteligencia emocional, se asociaron con menos miedo a la muerte, lo que evidencia la necesidad de desarrollar en los estudiantes habilidades emocionales frente a situaciones trascendentales y desconocidas, como son la muerte y el proceso de morir.<br>OBJETIVO: Conhecer o medo da morte e sua relação com a inteligência emocional e outras variáveis em estudantes de enfermagem dos últimos anos de estudo. MÉTODOS: Estudo descritivo e correlacional. Os estudantes (n=188) responderam a um questionário sobre: características socioculturais; Escalas de Medo da Morte e de Inteligência Emocional. RESULTADOS: Obteve-se uma medida de médio para alto em medo da morte (x=3,35) e também o componente percepção emocional se correlacionou positivamente com o medo da morte, enquanto a compreensão e regulação emocional se correlacionaram negativamente com o medo da morte. As pontuações mais altas de medo da morte associaram-se com o gênero feminino, com os niveis inferiores dos cursos e com a percepção de menor preparo acadêmico no tema. CONCLUSÕES: Os níveis altos de inteligência emocional, associaram-se com menos medo da morte, o que evidencia a necessidade de desenvolver nos estudantes habilidades emocionais frente a situações transcendentais e desconhecidas, como são a morte e o processo morrer.<br>OBJECTIVE: To understand fear of death and its relationship with emotional intelligence and other variables in nursing students in the last years of study. METHODS: A descriptive and correlational study. Students (n = 188) responded to a questionnaire about: socio-cultural characteristics; Fear of Death and Emotional Intelligence Scales. RESULTS: We obtained a measure of medium to high for fear of death (x = 3.35) and also the emotional perception component was positively correlated with the fear of death, while understanding and emotional regulation were negatively correlated with fear of death. The higher scores for fear of death were associated with the female gender, with lower levels of courses, and the perception of lower academic preparation on the subject. CONCLUSIONS: High levels of emotional intelligence, associated with less fear of death, provides evidence for the necessity of developing emotional skills in students facing transcendent situations and the unknown, such as death and the dying process