Reasons for Use of and Experiences with Homeopathic Treatment as an Adjunct to Usual Cancer Care: Results of a Small Qualitative Study

Background A significant proportion of patients with cancer consult with homeopaths. No former qualitative study has reported on experiences with homeopathy in this patient group. This study aimed to learn about the reasons for, and experiences with, treatment provided by homeopaths among Danish patients with cancer. Methods A small qualitative semi-structured interview study was carried out to collect preliminary knowledge to learn about reasons for and experiences with treatment provided by homeopaths as an adjunct to usual care among patients with cancer. Thematic analysis was used for the development of themes. Results Five patients, diagnosed with cancer, were interviewed. On the basis of qualitative interviews five themes emerged: concerns and hopes, obstacles and support, internal health locus of control, whole person approach, and improved well-being. Conclusion The cancer patients in this study sought homeopathy to address their hopes and concerns and to help them face obstacles and find support. They were actively taking responsibility for their own health and valued the whole person approach used by their homeopaths. Participants reported improved well-being both at the physical and mental levels. The results provide a basis for further research to learn more from patients' experiences with this intervention. Such knowledge could potentially be helpful to improve healthcare practitioners' communication with patients, and thereby patients' overall car

Depressed patients’ experiences with and perspectives on treatment provided by homeopaths. A qualitative interview study embedded in a trial

Introduction Depression is one of the clinical conditions patients most commonly consult homeopaths. This study therefore aimed to learn about patients’ experiences having this intervention. Methods A semi-structured qualitative interview study was nested within a randomised controlled trial to learn about depressed patients’ experiences with treatment provided by homeopaths. A purposive selection of adults with moderate to severe self-reported depression were included. Interviews were conducted post initial consultation and six months post-randomisation. Thematic analysis was used to develop themes describing participants’ experiences, thoughts and understandings. Results Forty-six interviews were carried out with 33 adults. Sixteen themes were developed and have been categorised under three main headings: 1) changed understanding of the intervention, with themes such as understanding the intervention as being adapted; 2) experiences with the consultation and the medication, such as caring support, trust and optimism arising from consultations with homeopaths; and 3) changes in state of health, such as improvement in mood, wellbeing and ability to cope, or little or no change, or transient adverse events. Conclusion This is the first qualitative study of depressed patients’ experiences with treatment provided by homeopaths. Results provide an insight into their experiences with consultations and homeopathic and antidepressant medication, their understanding of the intervention, and the changes in their state of health over time

Can self-reported depression be helped by homeopaths? A pragmatic cohort randomised controlled trial with qualitative interviews with patients.

Introduction: Depression is a common health problem. Some patients seek help from homeopaths as a complement or an alternative to conventional treatment. This may be due to reluctance to using or insufficient effect of “talking therapies” or antidepressants, or side-effects of such drugs. Insufficient evidence exists to determine whether homeopathy is acceptable, effective and safe. Aims: To evaluate the effectiveness of offering adjunctive treatment by homeopaths to patients with self-reported moderate to severe depression, and assess acceptability and safety. Methods: A pragmatic cohort multiple randomised controlled trial design was used. One third who fulfilled inclusion criteria were randomly selected to be offered a course of treatment by a homeopath. The primary outcome was the Patient Health Questionnaire (PHQ-9), 6 months post-randomisation. An intention-to-treat analysis compared “Offer” and “No offer” groups. An instrumental-variables-analysis (IV) assessed effects of received treatment. Safety was assessed through patients’/practitioners’ reports. Qualitative interviews were used to learn about patients’ experiences. Results: The full sample (n=566) was recruited. One third (n= 185) were randomly selected to the “Offer group” were offered treatment by a homeopath, 40% (n=74/185) accepted the offer of treatment. Four-hundred-and-fifty-eight (81%) responded to the 6 month questionnaire. At 6 months, the “Offer” group (ITT-analysis) reported lower PHQ-9 scores (mean 1.4, 95% CI 0.2, 2.5) compared to the “No offer” group (p=0.019), with a small effect size (d=0.30). Secondary analyses showed similar results. IV-analysis showed 2.6 points (95% CI 0.5, 4.7, p=0.018) lower depression scores for those who received treatment by a homeopath (medium effect size, d=0.57). Although 14 adverse events were possibly linked to the intervention, most were mild, none were life-threatening and all were transient. Themes developed from 46 qualitative interviews with 33 patients regarding their experiences included feeling listened to, supported and accepted during consultations, and as a result, opening up and coming to realisations. Some patients described improvement in their mood, wellbeing, energy and physical symptoms, others experienced little or no change, or felt worse. Conclusion: These preliminary (6 month) results suggest that treatment provided by homeopaths for patients with self-reported depression is acceptable. The effect size (d=0.30) is comparable to “talking therapies”; however, wide confidence intervals preclude firm conclusions from being drawn. There was no evidence that treatment by a homeopath was unsafe. Analysis of 12-month results is now required

Perceived benefits and challenges one year after receiving brief therapy in a district psychiatric centre. An exploration of patients’ and GPs’ experiences: A qualitative study

Abstract Background Scarce treatment resources put pressure on mental health services prompting innovations in service provision. Various innovative strategies have been introduced to provide patients with improved and effective treatment due to increased demands for mental health services. In 2016 a district psychiatric centre (DPC) started a brief treatment program to provide early and effective help for moderate depression and anxiety. There is little evidence regarding the potential benefits that different mental health patients may experience after receiving brief therapy treatment. Moreover, few studies have explored the experiences of referring general practitioners (GPs) with different patient outcomes after brief therapy. The aim of this study was to investigate the long-term experiences of patients who received brief therapy at a DPC at least one year ago, as well as the experiences of general practitioners (GPs) who referred patients for such treatment since 2016. Specifically, the study sought to determine patterns in the patients’ stories and GPs’ experiences to see if it could provide new insight for further studies. Methods We conducted individual interviews with a total of seventeen participants, consisting of eleven patients and six GPs. Using an exploratory approach, we analyzed patients’ narratives as they described them in the interviews, employing inductive and thematic analysis techniques. The GPs’ experiences of referring several patients to brief therapy were also subjected to thematic analysis. In addition, we synthesized the patients’ experiences into condensed stories for comparison. The experiences of GPs, who had referred patients to this brief treatment program over several years, were compared with the patients’ experiences and reflections one year after receiving brief therapy. This comparison aimed to challenge and deepen the understanding of condensed patient stories. Results The main results are presented as three condensed patient stories: A) Coping with mental problems; B) A path to another treatment; and C) Confusion and lost hope. The GPs’ experiences are included in each condensed patient story to challenge and elaborate on relevant aspects. Conclusion Time-limited brief therapy was experienced as beneficial for patients with moderate affective and anxiety disorders but was experienced as unsuitable for those with more severe conditions. This raises important questions about the appropriateness of offering brief therapy to a diverse patient population and the efficient use of healthcare resources. We recommend further research to enhance understanding and develop tailored treatment services for different ailments. Identifying which patients benefit most from specific therapies can improve outcomes and resource allocation. An important improvement measure might be to enhance early communication between patients, General Practitioners (GPs), and District Psychiatric Centres (DPCs) before referrals. Ensuring brief therapy is targeted to those likely to benefit the most will enhance treatment effectiveness. Additionally, we suggest implementing joint assessment meetings to facilitate comprehensive information exchange and coordination among different care levels. This approach would improve assessments, treatment planning, and follow-up strategies, ultimately leading to better patient care and resource management.publishedVersio

Prevalence of homeopathy use by the general population worldwide: a systematic review

Aim: To systematically review surveys of 12-month prevalence of homeopathy use by the general population worldwide Methods: Studies were identified via database searches to October 2015. Study quality was assessed using a six-item tool. All estimates were in the context of a survey which also reported prevalence of any complementary and alternative medicine use. Results: A total of 36 surveys were included. Of these, 67% met four of six quality criteria. Twelve-month prevalence of treatment by a homeopath was reported in 24 surveys of adults (median 1.5%, range 0.2% to 8.2%). Estimates for children were similar to those for adults. Rates in the US, UK, Australia and Canada all ranged from 0.2% to 2.9% and remained stable over the years surveyed (1986-2012). Twelve-month prevalence of all use of homeopathy (purchase of over-the-counter homeopathic medicines and treatment by a homeopath) was reported in 10 surveys of adults (median 3.9%, range 0.7% to 9.8%) while a further 11 surveys which did not define the type of homeopathy use reported similar data. Rates in the US and Australia ranged from 1.7% to 4.4% and remained stable over the years surveyed. The highest use was reported by a survey in Switzerland where homeopathy is covered by mandatory health insurance. Conclusions: This review summarises 12-month prevalence of homeopathy use from surveys conducted in eleven countries (USA, UK, Australia, Israel, Canada, Switzerland, Norway, Germany, South Korea, Japan and Singapore). Each year a small but significant percentage of these general populations use homeopathy. This includes visits to homeopaths as well as purchase of over-the-counter homeopathic medicines

A treatment strategy for meeting life as it is. Patients' and therapists' experiences of brief therapy in a district psychiatric centre: A qualitative study

Abstract Background: Young adults increasingly seek help for mental health problems. In 2016, a district psychiatric centre in Norway started a brief treatment program to provide early and effective help for moderate depression and anxiety. Aim: Exploring patients' and therapists' experiences of brief therapy, especially how the time limitation influences the treatment process. Methods: Individual interviews with 12 patients and focus group interviews with eight therapists analyzed using systematic text condensation. Results: The results constitute five themes: (1) Time-limit as a frame for targeted change, (2) Clarifying expectations and accountability, (3) Shared agreement on a defined treatment-project, (4) Providing tools instead of searching for causes, and (5) Learning to cope-not being cured. Conclusion: Time-limitation in brief therapy appeared to play a positive role, helping the therapists to structure the therapeutic process and strengthening patients' motivation. Shared understanding and activation during brief therapy may reinforce patients' responsibility and expectations to achieve individual goals. Brief therapy can be viewed as the start of a personal process towards "mastering life as it is". More research is needed to investigate the patients' long-term outcomes after treatment and to shed light on the potential for, and limitations of, mastering everyday-life.publishedVersio

Psychometric properties of the full and short version Nursing Home Survey on Patient Safety Culture (NHSOPSC) instrument: a cross-sectional study assessing patient safety culture in Norwegian homecare services

Objectives: Measure patient safety culture in homecare services; test the psychometric properties of the Nursing Home Survey on Patient Safety Culture (NHSOPSC) instrument; and propose a short-version Homecare Services Survey on Patient Safety Culture instrument for use in homecare services. Design: Cross-sectional survey with psychometric testing. Setting: Twenty-seven publicly funded homecare units in eight municipalities (six counties) in Norway. Participants: Five-hundred and forty health personnel working in homecare services. Interventions: Not applicable. Primary and secondary outcome measures: Primary: Patient safety culture assessed using the NHSOPSC instrument. Secondary: Overall perception of service users’ safety, service safety and overall care. Methods: Psychometric testing of the NHSOPSC instrument using factor analysis and optimal test assembly with generalised partial credit model to develop a short-version instrument proposal. Results: Most healthcare personnel rated patient safety culture in homecare services positively. A 19-item short-version instrument for assessing patient safety culture had high internal consistency, and was considered to have sufficient concurrent and convergent validity. It explained a greater proportion of variance (59%) than the full version (50%). Short-version factors included safety improvement actions, teamwork, information flow and management support. Conclusion: This study provides a first proposal for a short-version Homecare Services Survey on Patient Safety Culture instrument to assess patient safety culture within homecare services. It needs further improvement, but provides a starting point for developing an improved valid and reliable short-version instrument as part of assessment of patient safety and quality improvement processes.publishedVersio

Homeopathy in the treatment of depression: a systematic review

Introduction: Depression is a common reason for patients to consult homeopaths. This review aims to assess the efficacy, effectiveness and safety of homeopathy in depression. Methods: Thirty databases/sources were used to identify studies reporting on homeopathy in depression, published between 1982 and 2016. Studies were assessed for their risk of bias, model validity, aspect of homeopathy and comparator. Results: Eighteen studies assessing homeopathy in depression were identified. Two double-blind placebo-controlled trials of homeopathic medicinal products (HMPs) for depression were assessed. The first trial (N = 91) with high risk of bias found HMPs were non-inferior to fluoxetine at 4 (p = 0.654) and 8 weeks (p = 0.965); whereas the second trial (N = 133), with low risk of bias, found HMPs was comparable to fluoxetine (p = 0.082) and superior to placebo (p < 0.005) at 6 weeks. The remaining research had unclear/high risk of bias. A non-placebo-controlled RCT found standardised treatment by homeopaths comparable to fluvoxamine; a cohort study of patients receiving treatment provided by GPs practising homeopathy reported significantly lower consumption of psychotropic drugs and improved depression; and patient-reported outcomes showed at least moderate improvement in 10 of 12 uncontrolled studies. Fourteen trials provided safety data. All adverse events were mild or moderate, and transient. No evidence suggested treatment was unsafe. Conclusions: Limited evidence from two placebo-controlled double-blinded trials suggests HMPs might be comparable to antidepressants and superior to placebo in depression, and patients treated by homeopaths report improvement in depression. Overall, the evidence gives a potentially promising risk benefit ratio. There is a need for additional high quality studies

Adolescents’ involvement in mental health treatment and service design: a systematic review

Background Adolescents’ involvement in their mental healthcare is considered a fundamental human right. However, there is a lack of consensus regarding the extent and nature of user involvement and limited research on user involvement in adolescent mental healthcare has previously been identified. Given the evolving focus on this area, this study explores the experiences with, the effectiveness of, and safety issues related to adolescents’ user involvement in mental healthcare. Method We conducted a systematic review, updating our original review with current research evidence relating to adolescents’ involvement in mental healthcare at individual and organizational levels. Searches across six databases, screening of reference lists, and suggestions from experts within the field helped to identify 5,527 records, of which 251 full text articles were screened. Established guidelines were used for data extraction, critical appraisal, and reporting of results. Results Collectively, the literature searches resulted in 36 eligible studies, of which 28 provided qualitative data and eight provided quantitative data. The quantitative studies identified the importance of personal help and online tools to support adolescents’ involvement in their mental healthcare. A few qualitative studies suggested shared decision-making is associated with improved self-reported mental health and treatment satisfaction. No studies focused on safety issues. A thematic synthesis of qualitative studies yielded four themes at the individual level and two themes at the organizational level. The findings highlight the growing recognition of adolescents’ right to be involved and their capacity to take part in decision-making, emphasizing shared decision-making, two-way communication, and trust as key components of a collaborative relationship fundamental to user involvement. Further facilitators for user involvement at both individual and organizational levels are described. Conclusion The significance of user involvement in adolescent mental healthcare is underscored by a sense of increased empowerment and services tailored to meet adolescents’ needs. The evidence gathered from qualitative studies suggests involving adolescents in their treatment contributed to greater motivation for treatment, higher attendance rates, and treatment continuation. User involvement should emphasize adolescents’ preferences and a collaborative relationship that incorporates shared decision-making. Further implications for future practice and research are discussed

User involvement in adolescents’ mental healthcare: a systematic review

More than one out of ten adolescents suffer from mental illness at any given time. Still, there is limited knowledge about their involvement in mental healthcare. Adolescents have the right to be involved in decisions affecting their healthcare, but limited research focuses on their engagement and decision-making. Therefore, this systematic review aims to explore the existing experiences with, the effectiveness of, and safety issues associated with user involvement for adolescents’ mental healthcare at the individual and organizational level. A systematic literature review on user involvement in adolescents’ mental healthcare was carried out. A protocol pre-determined the eligibility criteria and search strategies, and established guidelines were used for data extraction, critical appraisal, and reporting of results. Quantitative studies were analysed individually due to heterogeneity of the studies, while qualitative studies were analysed using thematic synthesis. A total of 31 studies were included in the review. The experiences with user involvement were reported in 24 studies with three themes at the individual level: unilateral clinician control versus collaborative relationship, capacity and support for active involvement, the right to be involved; and two themes at the organizational level: involvement outcomes relevant to adolescents’ needs, conditions for optimal involvement. The effectiveness of user involvement was reported in seven studies documenting fragmented evidence related to different support structures to facilitate adolescents’ involvement. The safety associated with user involvement was not reported in any studies, yet a few examples related to potential risks associated with involvement of adolescents in decision-making and as consultants were mentioned.publishedVersio