Barriers to working with people affected by cancer: Preliminary qualitative data from a mixed methods exploration of practitioner perspectives in nutritional therapy

Granger, C.A., Pilkington, K., Draper, A. and Polley, M.J. 2015. Barriers to working with people affected by cancer: Preliminary qualitative data from a mixed methods exploration of practitioner perspectives in nutritional therapy. European Journal of Integrative Medicine. 7 (6), p. 681. https://doi.org/10.1016/j.eujim.2015.07.009

TitleBarriers to working with people affected by cancer: Preliminary qualitative data from a mixed methods exploration of practitioner perspectives in nutritional therapy
AuthorsGranger, C.A., Pilkington, K., Draper, A. and Polley, M.J.
Abstract

Introduction: Cancer is a leading cause of death worldwide. Nutrition may affect occurrence, recurrence and survival rates and many cancer patients and survivors seek individualized nutrition advice. Appropriately skilled nutritional therapy (NT) practitioners may be well-placed to safely provide this advice, but little is known of their perspectives on working with people affected by cancer. This mixed-methods study seeks to explore their views on training, barriers to practice, use of evidence, and other resources, to support the development of safe evidence-based practice. Preliminary data on barriers to practice are reported here.

Methods: Two cohorts of NT practitioners were recruited from all UK registered NT practitioners, by an on-line anonymous survey. 84 cancer practitioners (CP) and 165 non-cancer practitioners (NCP) were recruited. Mixed quantitative and qualitative data was collected by the survey. Content analysis was used to analyze qualitative data on the use of evidence, barriers to practice and perceived needs for working with clients with cancer, for further exploration using interviews and focus groups.

Preliminary results: For the NCP cohort, exploring themes of perceived barriers to working with people affected by cancer suggested that perceived complexity, risk and need for caution in this area of practice were important barriers. Insufficient specialist knowledge and skills also emerged as barriers. Some NCPs perceived opposition from medical practitioners and other mainstream healthcare professions as an obstacle to starting cancer practice. To overcome these barriers, specialist training emerged as most important. For the CP cohort, in exploring the skills they considered enabled them to undertake cancer work, specialist clinical and technical knowledge emerged strongly. Only 10% CP participants did not want more work with people affected by cancer. 10% CPs reported some NHS referrals, whereas most received clients by self-referral or from other practitioners. When considering barriers that impede their cancer practice, the dominant categories for CPs were hostility or opposition by mainstream oncology professionals, and lack of dialogue and engagement with them. To overcome these barriers, CPs desired engagement with oncology professionals and recognized specialist cancer NT training. For both NCPs and CPs, evidence resources, practice guidelines and practitioner support networks also emerged as potential enablers to cancer practice.

Conclusions: This is the first detailed exploration of NT practitioners’ perceived barriers to working with people affected by cancer. Acquiring specialist skills and knowledge appears important to enable NCPs to start cancer work, and for CPs with these skills, the perceived barriers appear foremost in the relationship with mainstream cancer professionals. Further exploration of these themes, and other NT practitioner perspectives on working with people affected by cancer, is underway. This work will inform and support the development of professional practice, training and other resources.

JournalEuropean Journal of Integrative Medicine
Journal citation7 (6), p. 681
ISSN1876-3820
Year2015
PublisherElsevier
Digital Object Identifier (DOI)https://doi.org/10.1016/j.eujim.2015.07.009
Publication dates
Published20 Dec 2015

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Shariff, F., Carter, J., Dow, C., Polley, M.J., Salinas, M. and Ridge, Damien T. 2009. Mind and body management strategies for chronic pain & rheumatoid arthritis: strategies in search of wellbeing. Qualitative Health Research. 19 (8), pp. 1037-1049. https://doi.org/10.1177/1049732309341189

Mind and body strategies for chronic pain and rheumatoid arthritis: strategies in search of wellbeing
Ridge, Damien T., Shariff, F., Carter, J., Dow, C., Polley, M.J. and Salinas, M. 2009. Mind and body strategies for chronic pain and rheumatoid arthritis: strategies in search of wellbeing. Medical Sociology Group 41st Annual Conference 2009. University of Manchester 03 - 05 Sep 2009 pp. 99

Complementary and alternative therapies
Pilkington, K. and Rampes, H. 2009. Complementary and alternative therapies. in: Norman, I.J. and Ryrie, I. (ed.) The art and science of mental health nursing. 2nd edition Open University Press.

Workshop - Navigating the web-based world of complementary and alternative information
Pilkington, K. 2009. Workshop - Navigating the web-based world of complementary and alternative information. Journal of Alternative & Complementary Medicine. 15 (4), pp. 446-458. https://doi.org/10.1089/acm.2009.1503-A

The social aspects of food and nutrition
Gustafsson, U. and Draper, A. 2009. The social aspects of food and nutrition. Journal of Human Nutrition and Dietetics. 22 (2), pp. 87-88. https://doi.org/10.1111/j.1365-277X.2009.00951.x

Complementary therapies for depression: what is the evidence and how does it compare with the advice? Proceedings of the UKCPA Spring Meeting 2007
Pilkington, K. 2008. Complementary therapies for depression: what is the evidence and how does it compare with the advice? Proceedings of the UKCPA Spring Meeting 2007. Pharmacy World and Science. 30 (5), pp. 622-623. https://doi.org/10.1007/s11096-008-9199-2

Staple foods
Draper, A. and Tuffrey, V. 2008. Staple foods. in: Millstone, E. and Lang, T. (ed.) The atlas of food: who eats what, where and why. 2nd edition London, UK Earthscan. pp. 80-81

Nutritional deficiencies
Draper, A. and Tuffrey, V. 2008. Nutritional deficiencies. in: Millstone, E. and Lang, T. (ed.) The atlas of food: who eats what, where and why. 2nd edition London, UK Earthscan. pp. 26-27

Changing diets
Draper, A. and Tuffrey, V. 2008. Changing diets. in: Millstone, E. and Lang, T. (ed.) The atlas of food: who eats what, where and why. 2nd edition London, UK Earthscan. pp. 82-83

Diabetes and complementary therapies: mapping the evidence
Pilkington, K., Stenhouse, E., Kirkwood, G. and Richardson, J. 2007. Diabetes and complementary therapies: mapping the evidence. Practical Diabetes International. 24 (7), pp. 371-376. https://doi.org/10.1002/pdi.1150

An overview of research on complementary therapies in life-limiting conditions
Richardson, J. and Pilkington, K. 2007. An overview of research on complementary therapies in life-limiting conditions. Nursing Times. 103 (32), pp. 32-33.

How to summarise and report written qualitative data from patients: a method for use in cancer support care
Polley, M.J., Seers, H.E., Cooke, H.J., Hoffman, C. and Paterson, C. 2007. How to summarise and report written qualitative data from patients: a method for use in cancer support care. Supportive Care in Cancer. 15 (8), pp. 963-971. https://doi.org/10.1007/s00520-007-0283-2

Community participation in nutrition programmes for child survival and anemia
Rifkin, S.B., Hewitt, G. and Draper, A. 2007. Community participation in nutrition programmes for child survival and anemia. Centre for Public Health Nutrition, University of Westminster for A2Z, Washington DC.

Acupuncture for anxiety and anxiety disorders: a systematic literature review
Pilkington, K., Kirkwood, G., Rampes, H., Cummings, M. and Richardson, J. 2007. Acupuncture for anxiety and anxiety disorders: a systematic literature review. Acupuncture in Medicine. 25 (1-2), pp. 1-10.

Improving food provision in a Guyanese home for the elderly: a participatory approach
Hewitt, G., Draper, A., Ismail, S. and Patterson, S. 2007. Improving food provision in a Guyanese home for the elderly: a participatory approach. Public Health Nutrition. 10 (6), pp. 552-558. https://doi.org/10.1017/S1368980007246804

Searching for CAM evidence: an evaluation of therapy-specific search strategies
Pilkington, K. 2007. Searching for CAM evidence: an evaluation of therapy-specific search strategies. Journal of Alternative & Complementary Medicine. 13 (4), pp. 451-459. https://doi.org/10.1089/acm.2007.6308

Evaluating complementary therapies
Richardson, J. and Pilkington, K. 2007. Evaluating complementary therapies. in: Barraclough, J. (ed.) Enhancing cancer care: complementary therapy and support Oxford Oxford University Press.

St John's wort for depression: time for a different perspective?
Pilkington, K., Boshnakova, A. and Richardson, J. 2006. St John's wort for depression: time for a different perspective? Complementary Therapies in Medicine. 14 (4), pp. 268-281. https://doi.org/10.1016/j.ctim.2006.01.003

Complementary medicine for depression
Pilkington, K., Rampes, H. and Richardson, J. 2006. Complementary medicine for depression. Expert Review of Neurotherapeutics. 6 (1), pp. 1741-1751. https://doi.org/10.1586/14737175.6.11.1741

The nutritional vulnerability of older Guyanese in residential homes
Hewitt, G., Ismail, S., Patterson, P. and Draper, A. 2006. The nutritional vulnerability of older Guyanese in residential homes. West Indian Medical Journal. 55 (5), pp. 334-339.

Homeopathy for anxiety and anxiety disorders: a systematic review of the research
Pilkington, K., Kirkwood, G., Rampes, H., Fisher, P. and Richardson, J. 2006. Homeopathy for anxiety and anxiety disorders: a systematic review of the research. Homeopathy. 95 (3), pp. 151-162. https://doi.org/10.1016/j.homp.2006.05.005

The development of criteria to analyse qualitative data from Measure Yourself Concerns and Wellbeing (MYCaW) questionnaire
Polley, M.J. and Seers, H.E. 2006. The development of criteria to analyse qualitative data from Measure Yourself Concerns and Wellbeing (MYCaW) questionnaire. Diversity and Debate in Alternative and Complementary Medicine: an Academic and Experiential Conference for Researchers and Practitioners. Nottingham, UK 05-07 Jul 2006

The benefit of individualised programmes of complementary therapies for breast cancer patients at Breast Cancer Haven
Polley, M.J., Hoffman, C., Brydon, N., Cox, C. and Deveraux, F. 2006. The benefit of individualised programmes of complementary therapies for breast cancer patients at Breast Cancer Haven. European Journal of Cancer Supplements. 4 (2), p. 89.

Risk and trust: determinants of public perceptions
Draper, A., Green, J., Dowler, E., Fele, G., Hagenhoff, V., Rusanen, M. and Rusanen, T. 2006. Risk and trust: determinants of public perceptions. in: Dora, C. (ed.) Health, hazards and public debates: lessons for risk communication from the BSE/CJD saga Copenhagen, Denmark WHO Regional Office for Europe. pp. 62-83

Hypnosis for procedure-related pain and distress in pediatric cancer patients: a systematic review of effectiveness and methodology related to hypnosis interventions
Richardson, J., Smith, J.E., McCall, G. and Pilkington, K. 2006. Hypnosis for procedure-related pain and distress in pediatric cancer patients: a systematic review of effectiveness and methodology related to hypnosis interventions. Journal of Pain and Symptom Management. 31 (1), pp. 70-84. https://doi.org/10.1016/j.jpainsymman.2005.06.010

Yoga for depression: the research evidence
Pilkington, K., Kirkwood, G., Rampes, H. and Richardson, J. 2005. Yoga for depression: the research evidence. Journal of Affective Disorders. 89 (1-3), pp. 13-24. https://doi.org/10.1016/j.jad.2005.08.013

Yoga for anxiety: a systematic review of the research evidence
Kirkwood, G., Rampes, H., Tuffrey, V., Richardson, J. and Pilkington, K. 2005. Yoga for anxiety: a systematic review of the research evidence. British Journal of Sports Medicine. 39 (12), pp. 884-891. https://doi.org/10.1136/bjsm.2005.018069

Mindfulness-based stress reduction as supportive therapy in cancer care: systematic review
Smith, J.E., Richardson, J., Hoffman, C. and Pilkington, K. 2005. Mindfulness-based stress reduction as supportive therapy in cancer care: systematic review. Journal of Advanced Nursing. 52 (3), pp. 315-327. https://doi.org/10.1111/j.1365-2648.2005.03592.x

A compilation of energy costs of physical activities
Vaz, M., Karaolis, N., Draper, A. and Shetty, P. 2005. A compilation of energy costs of physical activities. Public Health Nutrition. 8 (7A), pp. 1153-1183. https://doi.org/10.1079/PHN2005802

Public understanding of food risks in four European countries: a qualitative study
Green, J., Draper, A., Dowler, E., Fele, G., Hagenhoff, V., Rusanen, M. and Rusanen, T. 2005. Public understanding of food risks in four European countries: a qualitative study. European Journal of Public Health. 15 (5), pp. 523-527. https://doi.org/10.1093/eurpub/cki016

Aloe vera for preventing radiation-induced skin reactions: a systematic literature review
Richardson, J., Smith, J.E., McIntyre, M., Thomas, R. and Pilkington, K. 2005. Aloe vera for preventing radiation-induced skin reactions: a systematic literature review. Clinical Oncology. 17 (6), pp. 478-484. https://doi.org/10.1016/j.clon.2005.04.013

Homeopathy for depression: a systematic review of the research evidence
Pilkington, K., Kirkwood, G., Rampes, H., Fisher, P. and Richardson, J. 2005. Homeopathy for depression: a systematic review of the research evidence. Homeopathy. 94 (3), pp. 153-163. https://doi.org/10.1016/j.homp.2005.04.003

Complementary and alternative medicine evidence online for cancer
Richardson, J., Pilkington, K. and Thomas, R. 2005. Complementary and alternative medicine evidence online for cancer. British Journal of Cancer Management. 2 (2), pp. 9-11.

The long and winding road: tracking down the evidence on CAM in cancer
Pilkington, K. and Richardson, J. 2005. The long and winding road: tracking down the evidence on CAM in cancer. NCRI Cancer Conference. Birmingham, UK 02-05 Oct 2005

"No language restrictions" in database searches: what does this really mean?
Pilkington, K., Boshnakova, A., Clarke, M. and Richardson, J. 2005. "No language restrictions" in database searches: what does this really mean? Journal of Alternative & Complementary Medicine. 11 (1), pp. 205-207.

Engaging the hard-to-reach: an evaluation of participatory methods used in research with secondary school students
Mitchell, J., Draper, A., Green, J., Thorogood, N. and Gustafsson, U. 2005. Engaging the hard-to-reach: an evaluation of participatory methods used in research with secondary school students. British Sociological Association Annual Conference 2005. York, UK 21-23 Mar 2005

All the nuts in one basket: participatory research and unexpected ethics
Mitchell, J., Draper, A., Green, J., Thorogood, N. and Gustafsson, U. 2005. All the nuts in one basket: participatory research and unexpected ethics. British Sociological Association Annual Conference 2005. York, UK 21-23 Mar 2005

Public involvement in food policy: guidelines for commissioning consultative activities with the hard-to-reach
Mitchell, J., Draper, A., Green, J., Gustafsson, U. and Thorogood, N. 2005. Public involvement in food policy: guidelines for commissioning consultative activities with the hard-to-reach. London, UK University of Westminster.

Women health care provider projects: joint findings from Ghana and Uganda
Hewitt, G., Draper, A., Hall, A., Amoaful, E., Newton, S., Jitta, J. and Kyaddondo, D. 2005. Women health care provider projects: joint findings from Ghana and Uganda. London, UK University of Westminster.

Tony Blair won't eat our dinner, why do we?
Gustafsson, U., Mitchell, J., Draper, A., Green, J. and Thorogood, N. 2005. Tony Blair won't eat our dinner, why do we? British Sociological Association Annual Conference 2005. York, UK 21-23 Mar 2005

Sample surveys of public perceptions and opinions
Gasperoni, G., Draper, A., Hagenhoff, V., Rusanen, M. and Rusanen, T. 2005. Sample surveys of public perceptions and opinions. in: Dora, C. (ed.) Health hazards and public debate: lessons for risk communication from the BSE/CJD saga Copenhagen, Denmark WHO Regional Office for Europe.

An evaluation of participatory methods for research with hard-to-reach groups
Draper, A., Mitchell, J., Newton, P., Gustafsson, U., Green, J. and Thorogood, N. 2005. An evaluation of participatory methods for research with hard-to-reach groups. Fare Choice. 33 (2), p. 4.

Methods to access consumer views on food policy issues: an evaluation of their viability and efficacy for inclusive participation in food policy making
Draper, A., Mitchell, J., Newton, P. and Green, J. 2005. Methods to access consumer views on food policy issues: an evaluation of their viability and efficacy for inclusive participation in food policy making. London, UK University of Westminster.

Food choice, influencing factors
Draper, A. 2005. Food choice, influencing factors. in: Caballero, B., Allen, L. and Prentice, A. (ed.) Encyclopedia of human nutrition. 2nd edition Amsterdam ; London Elsevier.

The principles and application of qualitative research
Draper, A. 2004. The principles and application of qualitative research. Proceedings of the Nutrition Society. 63 (4), pp. 641-646. https://doi.org/10.1079/PNS2004397

Researching food habits: methods and problems
Draper, A. 2004. Researching food habits: methods and problems. Journal of Human Nutrition and Dietetics. 17 (5), pp. 485-486. https://doi.org/10.1111/j.1365-277X.2004.00556.x

Exploring the evidence: the challenges of searching for research on acupuncture
Pilkington, K. and Richardson, J. 2004. Exploring the evidence: the challenges of searching for research on acupuncture. Journal of Alternative and Complementary Medicine. 10 (3), pp. 587-590.

Developing CAMEO (CAM Evidence Online) for cancer
Pilkington, K., Smith, J.E. and Richardson, J. 2004. Developing CAMEO (CAM Evidence Online) for cancer. Focus on Alternative and Complementary Therapies. 9 (1), p. 39.

Engaging the hard-to-reach: an evaluation of participatory methods for research with secondary school students
Draper, A., Mitchell, J., Newton, P., Gustafsson, U., Green, J. and Thorogood, N. 2004. Engaging the hard-to-reach: an evaluation of participatory methods for research with secondary school students. Consumer and Nutrition: Challenges and Chances for Research and Society: 9th Karlsruhe Nutritional Congress. Karlsruhe, Germany 10-12 Oct 2004 pp. 163-167

Short cuts to safety: risk and 'rules of thumb' in accounts of food choice
Green, J., Draper, A. and Dowler, E. 2003. Short cuts to safety: risk and 'rules of thumb' in accounts of food choice. Health, Risk & Society. 5 (1), pp. 33-52. https://doi.org/10.1080/1369857031000065998

Evidence-based complementary (and alternative) medicine on the internet
Pilkington, K. and Richardson, J. 2003. Evidence-based complementary (and alternative) medicine on the internet. Health Information on the Internet. 34, pp. 7-9.

Food safety and consumers: constructions of choice and risk
Draper, A. and Green, J. 2003. Food safety and consumers: constructions of choice and risk. in: Dowler, E. (ed.) The welfare of food: rights and responsibilities in a changing world Oxford, UK Blackwell. pp. 54-69

Food safety and consumers: constructions of choice and risk
Draper, A. and Green, J. 2002. Food safety and consumers: constructions of choice and risk. Social Policy and Administration. 36 (6), pp. 610-625. https://doi.org/10.1111/1467-9515.00307

Community development to improve diet and nutrition
Hewitt, G., Draper, A. and Dowler, E. 2002. Community development to improve diet and nutrition. London, UK University of Westminster.

Under-nutrition
Gandy, J. and Draper, A. 2002. Under-nutrition. in: Millstone, E. and Lang, T. (ed.) The atlas of food: who eats what, where and why London, UK Earthscan. pp. 22-23

Changing diets
Gandy, J. and Draper, A. 2002. Changing diets. in: Millstone, E. and Lang, T. (ed.) The atlas of food: who eats what, where and why London, UK Earthscan. pp. 80-91

Complementary therapies: what is the evidence for their use?
Richardson, J., Jones, C. and Pilkington, K. 2001. Complementary therapies: what is the evidence for their use? Professional Nurse. 17 (2), pp. 96-99.

Lay perceptions of risk in relation to food safety and BSE in the UK: preliminary findings
Draper, A., Dowler, E. and Green, J. 2001. Lay perceptions of risk in relation to food safety and BSE in the UK: preliminary findings. Annals of Nutrition and Metabolism. 45 (supplement 1), p. 544.

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