Nurses' knowledge and attitudes toward complementary therapies for cancer: A review of the literature
2016; Medknow; Volume: 3; Issue: 3 Linguagem: Inglês
10.4103/2347-5625.189816
ISSN2349-6673
AutoresJuliana Christina, Wendy Abigail, Lesley Cuthbertson,
Tópico(s)Cancer survivorship and care
ResumoComplementary therapies (CTs) are nonconventional supportive therapies, which are used by the patients with cancer. The use of CTs has been known to alleviate symptoms as a result of chemotherapy and to improve quality of life. However, if CTs are inappropriately used, there may be adverse reactions or no effect resulting in poor support of the cancer treatment. Nurses play an important role in supporting patients with cancer who often seek information regarding CTs. Within their scope of practice, it is expected that nurses have sufficient knowledge about the safety and effective use of CTs, and positive attitudes toward supporting patients who wish to use CTs. This review aims to examine existing literature regarding nurses' knowledge and attitudes toward CTs for patients with cancer. English language articles obtained from recognized nursing and midwifery databases such as CINAHL, Google Scholar, Medline, ProQuest Central, and Scopus for the period between 2002 and 2015 were searched. A total of 96 articles were retrieved using the search terms with only 13 eligible articles meeting the inclusion criteria. Three major themes were identified by the thematic analysis of reviewed studies: nurses' knowledge about CTs, nurses' attitudes toward CTs, and sources information about CTs. The majority of studies investigating nurses' knowledge and attitudes toward the use of CTs for oncology was conducted in developed countries. Overall, it was identified that nurses need to improve their knowledge and skills about CTs so that they were more confident to assist patients in integrating conventional treatment and CTs for cancer management. Complementary therapies (CTs) are nonconventional supportive therapies, which are used by the patients with cancer. The use of CTs has been known to alleviate symptoms as a result of chemotherapy and to improve quality of life. However, if CTs are inappropriately used, there may be adverse reactions or no effect resulting in poor support of the cancer treatment. Nurses play an important role in supporting patients with cancer who often seek information regarding CTs. Within their scope of practice, it is expected that nurses have sufficient knowledge about the safety and effective use of CTs, and positive attitudes toward supporting patients who wish to use CTs. This review aims to examine existing literature regarding nurses' knowledge and attitudes toward CTs for patients with cancer. English language articles obtained from recognized nursing and midwifery databases such as CINAHL, Google Scholar, Medline, ProQuest Central, and Scopus for the period between 2002 and 2015 were searched. A total of 96 articles were retrieved using the search terms with only 13 eligible articles meeting the inclusion criteria. Three major themes were identified by the thematic analysis of reviewed studies: nurses' knowledge about CTs, nurses' attitudes toward CTs, and sources information about CTs. The majority of studies investigating nurses' knowledge and attitudes toward the use of CTs for oncology was conducted in developed countries. Overall, it was identified that nurses need to improve their knowledge and skills about CTs so that they were more confident to assist patients in integrating conventional treatment and CTs for cancer management. IntroductionConventional treatments such as surgery, chemotherapy, radiotherapy, and hormonal therapy are provided to manage cancers.1National Cancer Institute Complementary and Alternative Medicine in Cancer Treatment.http://wwwcancergov/cancertopics/pdq/cam/cam-cancer/patient/viewedDate: 2012Google Scholar, 2World Health Organization (WHO) Traditional Medicine in Republic of Indonesia.http://wwwsearowho/int/entity/medicines/topics/traditionalmedicineDate: 2013Google Scholar In addition, complementary therapies (CTs) have also been used among patients with cancer after diagnosis, during or after chemotherapy.3Vapilawa, N, Mick, R, Hampshire, MK, Metz, JM & DeNittis, AS. Patient initiation of Complementary and Alternative medical therapies (CAM) following cancer diagnosis. The cancer Journal 467–474.Google Scholar CTs encompass a wide range of nonmedical healthcare practices, therapies, procedures, and devices that can be used alongside conventional medicines. These include natural products, mind and body medicine, manipulative therapies and body-based practices, and other CTs and alternative medical systems.4National Centre of Complementary and Alternative Medicine (NCCAM) What is complementary and alternative medicine, NCCAM website.http://wwwnccamnihgov/health/what is CAM/viewedDate: 2010Google Scholar There is a significant interest in the use of CTs among patients with cancer since this treatment could improve physical and emotional well-being, boost immunity, reduce the side effects of chemotherapy, and improve the quality of life (QoL).5Cancer Australia Complementary and alternatives therapies. /viewed>Date: 2010Google Scholar, 6Gage H Storey L McDowell C Maguire G Williams P Faithfull S Thomas H & Poole K Integrated care: Utilisation of complementary and alternative medicine within a conventional cancer treatment centre.Complementary Therapies in Medicine. 2009; 17: 84-91Crossref PubMed Scopus (27) Google Scholar, 7Barnes PM Bloom B & Nahin RL Complementary and Alternative Medicine Use Among Adults and Children: United States: National Health Statistics Reports.http://wwwncbinlmnihgov/pubmed/19361005Date: 2007Google Scholar The use of CTs for cancer management in developed countries is very popular.8American Cancer Society Complementary and Alternative Methods for Cancer Management. /viewedDate: 2011Google Scholar, 9Koithan M Let's talk about complementary and alternative therapies: The journal for Nurse Practitioners- JNP.http://wwwnpjjournalorg/viewedDate: 2009Google Scholar, 10Molassiotis A Ortega PF Pud D Ozden G Platin N Hummerston S et al.Complementary and Alternative Medicine use in colorectal cancer patients in seven European countries.Complementary and Alternative Medicine. 2005; 23: 251-257Google Scholar In developing countries, such as Asia, Africa, Latin America, and the Middle East, 80% of the population used CTs as primary healthcare and as treatments for cancer. 11Ezeome ER, Anarado AN. Use of complementary and alternative medicine by cancer patients at the University of Nigeria teaching hospital, Enugu, Nigeria.BMC complementary and alternative medicine. &# 28.Google Scholar, 12Yildirim Y. Patterns of the use of complementary and alternative medicine in women with metastatic cancer. Cancer Nurs 194–200.Google Scholar, 13Yang LL Effectiveness of Taiwanese traditional herbal diet for pain management in terminal cancer patients Asia Pacific journal of clinical nutrition".Asia Pac J Clin Nutr. 2008; 17: 17-22Google ScholarHowever, in some cases, the integration of conventional medicine and CTs for cancer treatment may be ineffective and/or harmful.14Weiger WA, Smith M, Boon H, Richardson M, Kaptchuk TJ, Eisenberg DM. Advising patient who seek complementary and alternative medical therapies for cancer. Ann Intern Med 889–903.Google Scholar It is necessary that healthcare providers, including nurses, can provide appropriate information about CTs to patients who are interested in using them as part of their cancer management. A review of literature has been conducted to explore what is known and what the gaps in knowledge are for nurses in relation to the use of CTs among adult cancer patients.MethodsSearch strategiesThe articles in this literature review were obtained from recognized nursing and midwifery databases including CINAHL, Google Scholar, Medline, ProQuest Central, and Scopus. The search was limited to these databases, due to this study being focused in the nursing field. The search strategy employed synonyms and Boolean operation where keywords were combined with "and" and "or." The keywords included "complementary therapy," "adult patients," "cancer treatment," "nurses' attitudes," "nurses' knowledge," and "nurses' perceptions about complementary therapies."Inclusion and exclusion criteriaOnly English language publication articles were included in this review. Studies were focused on nurses' knowledge and attitude toward the use of CTs for adult patients with cancer. Articles that related to CTs for infant and children with cancer were excluded from the study as they were not the focus in this review.ResultsIn total, 96 articles published between 2002 and 2015 were retrieved from the databases. After reviewing the titles and abstracts, 54 citations were removed due to irrelevance to the topic. From the 42 remaining articles, only 17 articles were found to be focused on nurses' knowledge and attitudes about CTs. Finally, 13 eligible articles that met the inclusion criteria were included in this review Figure 1.Study characteristicsThe majority of the reviewed studies were conducted in developed countries including Australia (n = 3), Hong Kong (n = 1), Italy (n = 1), South Korea (n = 2), and the USA (n = 6). Ten of the studies used quantitative methodology,15Young-Hee Y, Lee KE. A comparison of the knowledge of, experience with and attitudes towards complementary and alternative medicine between nurses and patients in Korea. J Clin Nurs 2565–72.Google Scholar, 16Rojas-Cooley MT, Grant M. Complementary and alternative medicine: oncology nurses' knowledge and attitudes. Oncol Nurs Forum 217–24.Google Scholar, 17Holroyd E, Zhang AL, Suen LK, Xue CC. Beliefs and attitudes towards complementary medicine among registered nurses in Hong Kong.Int J Nurs Stud. 1660–6.Google Scholar, 18Sohn OM, Loveland Cook CA. Nurse practitioner knowledge of complementary therapy health care: foundation for practice. J Adv Nurs 9–16.Google Scholar, 19Trail-mahan T, Mao CL, Bawel-Brinkley K. Complementary and alternative medicine: nurses attitudes and knowledge. Pain Manag Nurs 277–86.Google Scholar, 20Zanini A, Quattrin R, Frassinelli B, Panariti M, Carpanelli I, et al. Italian oncology nurses' knowledge of complementary and alternative therapies: national survey. J Adv Nurs 451–6.Google Scholar, 21Kreitzer MJ, Mitten D, Harris, Shanderling J. Attitudes toward CAM among medical, nursing, and pharmacy faculty and students: A comparative analysis. Altern Ther Health Med 44.Google Scholar, 22Halcon LL, Chlan LL, Kreitzer MJ, Leonard BJ. Complementary therapies and healing practices: faculty/students belief and attitudes and the implications for nursing education. J Prof Nurs 387–97.Google Scholar, 23Booth-Laforce C, Scott CS, Heitkemper MM, Cornman BJ, Lan MC, Bond EF, et al. Complementary and Alternative Medicine (CAM) competencies of nursing students and faculty: Results of integrating CAM into the nursing curriculum. J Prof Nurs 293–300.Google Scholar, 24Kim SS, Erlen JA, Kim KB, Sok SR. Nursing students and faculty members' knowledge of, experience with, and attitude toward complementary and alternative therapies. J Nurs Educ 375–8.Google Scholar two studies were qualitative studies,25Broom A, Adams J. Oncology clinician's accounts of discussing complementary and alternative medicine with their patients. Health (London) 317–36.Google Scholar, 26Wang SY, Yates P. Nurses' responses to people with cancer who use complementary and alternative medicine. Inter J Nurs Prac 288–94.Google Scholar and one article utilized a mixed methods approach.27Shorofi SA, Arbon P. Nurses' knowledge, attitudes, and professional use of complementary and alternative medicine (CAM): A survey at five metropolitan hospitals in Adelaide. Complement Ther Clin Pract 229–34.Google Scholar The majority of the quantitative study designs was cross-sectional surveys including survey series and self-administered questionnaire surveys. One study used an electronically delivered survey and another used a conventional mailed survey. Semi-structured in-depth interviews were used to collect the data in all the qualitative studies.Participants' characteristicsThe majority of participants included in the reviewed studies was registered nurses (n = 6), nursing faculties and students (n = 4), and oncology nurses (n = 3). The sample size of the reviewed articles ranged from 4 to 850 participants. The detailed information regarding the sample is shown in Table 1:, Table 2:, Table 3:.Table 1:Oncology nurses' knowledge, attitudes and source of information about CTsNoAuthor and DateAim and ObjectiveSettings and ParticipantsStudy designResultsStrengths and Weakness1Broom and Adams 2009To examine oncology clinicians' approaches to CAM and the potential implications for patients, team dynamics and professional educationAustralia (Developed country)13 oncologists and 12 oncology nurses in two main hospitals in AustraliaQualitative, Interpretive tradition. In-depth interview.Data analysis: Charmaz' approachNurses appeared severely lacking in knowledge of different CAM and potential benefits and side-effectsThere was no information about data collection process, no inclusion and exclusion criteria of participants2Rojas-Cooley and Grant2009To describe oncology nurses' experiences with patients communicating interest in or use of CAM therapies along with oncology nurses' CAM resources and educational interestUSA (Developed country) 850 oncology nurses of Oncology NursingSociety (ONS) in the United StatesQuantitativeNational mailed survey, random sampleThe most commonly used CTs was PrayerNurses learned aboutCTs from patients (15%), books (13%) and journals (12%), formal training (2%)Advertisement (2%), psychologist (1%)Nurses were interested in developing their knowledge in naturopathy medicine (49%), TCM (44%), Ayurveda (41%)Used a newly developed survey tool which there was information about validation of the toolThe dependence on self-report of respondents3Zanini et al. 2008To investigate the knowledge of Italian oncology nurses in relation to CAM therapiesItaly (Developed country) 270 oncology nurses in ItalyQuantitativeSurvey- Self-administered questionnaires60.6% of the nurses had knowledge about CTs69.7% of the nurses had attended training regardingCTsSources of information:60.6% were books, other health workers (50%), the internet (48%), workshops and seminars (29.8%), formal nursing education (17.0%) and only 5.3% from professional journalsConducted developed countryThe result could not be generalisedCAM: Complementary and Alternative Medicines, CTs: Complementary Therapies, TCM: Traditional Chinese Medicines Open table in a new tab Table 2:Registered nurses' knowledge, attitudes and source of information about CTsNoAuthor and DateAim and ObjectiveSettings and ParticipantsStudy designResultsStrengths and Weakness1Holroyd, Zhang, Suen & Xue 2008To investigate the beliefs and attitudes CAM in a population of Hong Kong registered nursesHong Kong (Developed country)187 registered nursesQuantitativeCross- sectional survey71.9% of nurses the nurses agreed that CTs should be integrated into western medicine85% of them agreed that CTs could benefit for patients89.9% of the participants disagreed that CTs should be taken when using western medicine92% considered that CTs could alleviate the symptoms of illness93.6% wanted to learn more about CTs Source of CTs information: 64.2% from newspaper and magazines, 57.2% from friends, 43% from books, 24.1% from the internet, 21.4% from familySmall sample sizeThe result could not be generalised2Shorofi & Arbon 2010To determine nurses knowledge, attitude and personal use of CAM.Australia (Developed country)Surgical ward nurses in five metropolitan hospitals in AdelaideMixed methods (Quantitative and Qualitative)Self-administered questionnaire (adopted from NCCAM).Descriptive and non-parametric statistic used SPSS50% of nurses using CAM for patients59% of nurses were positive about CAM60% of them had very little knowledge about CAMThere were no sample size informationNumber of CAM therapies not listedConducted in a developed countryThere result could no be generalised3Sohn & Loveland 2002To investigate the level and source of nurse practitioner knowledge of CTsUSA (Developed country)152 from random sample of 400 registered nurses in Missouri and OregonQuantitativeA cross-sectional descriptive design.Nurses in this study had moderate level of knowledge about CTs67% of the participants learned CTs from their own experience61.6% obtained information from professional journals and 64.4% from journals54.8% received information from workshop and seminars, 54.1% from continuing education opportunitiesOnly 24.0% reported that formal education was a source of knowledge about CTs54.0% reported receiving training in CTs outside their NP programme.60% was interested in future education about herbal therapy 83% (n-122) had recommended CTs to their patientsNo information about pilot study, content validityGood sample sizeConducted over than ten years agoThe result was not generalizable4Trail-Mahan, Mao, Bawel-Brikley 2011To explore hospital-based nurses' knowledge and attitudes regarding CAMUSA (Developed country)152 registered nurses in CaliforniaQuantitativeDescriptive study47% of nurses could correctly define CTsOnly 33% of the respondents were able to define CTsOnly 1 of the participants strongly agreed with the use of CTs and 7 participants strongly disagreed with CTsEven though they had limited knowledge of CTs some of them agreed that patients use CTsLess than 50% of them familiar with CTs due to CTs have recently begun to beaded in nursing curricula where surveyed practicing >6 years education nursing program that may not have CTs curriculumLow response rate (18%)The result could not be generalisedConducted in developed country5Wang & Yates 2006To describe how nurses' respond to people with cancer who use CAM and the factors which might contribute to these different responsesAustralia(Developed country)Four nurses in BrisbaneA qualitative grounded theory approach with Semi-structured in-depth interviewsExperiences with CAM appeared to influence their attitude toward Cam and respond to patientsNurses who had positive experience with using CAM often described more positive attitudeNurses' attitudes were also affected by their beliefs about the evidence in support of CAMSmall sample size Cannot be generalized Conducted in a developed country6Young-Hee & Lee 2008To compare nurses' and patients' knowledge and attitudes toward CTsKorea (Developed country)485 nurses367 patientsQuantitativeA cross-sectional survey81.7% nurses heard about CTs but only 2.3% of nurses had sufficient knowledge about CTs27% of nurses had received training or education regarding CTs27% of nurses recommended CTs to their patientsNurses had more positive attitudes toward CTs than patientsLimited sampleThe result could not be generalisedThe study was conducted in developed countryCAM: Complementary and Alternative Medicines, CTs: Complementary Therapies, NCCAM: National Centre for Complementary and Alternative Medicines, SPSS: Statistical Package for the Social Sciences, NP: Nursing Practice Open table in a new tab Table 3:Faculties and nursing students' knowledge, attitudes and source of information about CTsNoAuthor and DateAim and ObjectiveSettings and ParticipantsStudy designResultsStrengths and Weakness1Booth-Laforce, Scott, Heitkemper et al. 2010To evaluate the impact of the faculty development program on CTS attitude and competencies, nursing faculty and students completed a series of surveys regarding CTs competencies, attitudes and perceptionsUSA (Developed country)Nursing faculty members (n = 27)Undergraduate, masters and doctoral students (n = 184) at University of Washington School of Nursing (UW SON)Quantitative A survey series that focused on CTs competencies, attitudes and perceptionsFaculty:49% of faculty responded indicated that they had incorporated CTs content into their courses in the last 3 years56% of the nursing faculty members increased their knowledge about CTs54% of faculty increased in enthusiasm for information about CTsStudents:80% of the students indicated their courses contained CTs topicsSmall sample sizeMinimal information how the questionnaire developed (there was no information about questioner validation)Unclear ethical considerationCannot be generalised2Halcon, Chlan, Kreitzer et al. 2003To describe the knowledge and attitudes of nursing faculty and students (BSN and MSN) regarding CTs and their integration into nursing practiceUSA (Developed country)The University of Minnesota School of Nursing.Students: n = 170 (BSN)n = 73 (MSN)n = 47 (PhD)Faculty: n = 50Quantitative A cross sectional survey60% of both students and faculty reported that their spiritual or religious beliefs influenced their attitudes toward CTsOver 95% of all groups agreed that CTs should be integrated into conventional medicineSource of information:Peer professional: Faculty (94%), BN (84%), Graduate (80)Professional journals:Faculty (90%), BN (75%), Graduate (82%)Mass media: Faculty (55%), BN (66%), Graduate (70%)Formal training: Faculty (62%), BN (54%), Graduate (77%)Internet: Faculty (41%), BN (62%), Graduate (40%).Good informationNo ethic informationConducted 10 years agoConducted in developed countryThe result could not be generalised3Kim, Erlen, Kim &w Sok 2006To examine the differences in knowledge of and experience with Complementary Alternative Therapy (CAT) among undergraduate students, graduate students and faculty membersSouth Korea (Developed country)41 undergraduate students57 graduate students55 faculty membersQuantitative Survey with questionnaire, analysed using SPSSAll groups reported having general knowledge regardingCTs91% believed patient should have CATThe participants had positive attitude regarding CTsMore than 50% had no personal experience with CAT85.7% agreed that nurses should have CAM education and trainingSmall sample sizeMinimal description of statistical reportThe result could not be generalised4Kreitzer, Mitten, Harris, Sahndeling 2002To assess the attitudes of faculty and staff toward CAM in medicine, nursing and pharmacy within an academic healthcare system.USA (Developed country) 627 faculty and students employed or enrolled at the University of MinnesotaQuantitative A survey90% of faculty and students believed that clinical care should integrate CAM/CTs and conventional treatment88% of faculty and 84% of students indicated that CAM should be included in their curriculumMost nursing students had more positive attitudes than pharmacy students More than 35% of nursing faculty felt prepared to advise patients regarding hypnosis, massage, music, prayer/spiritual healing and meditation55% of the participant had sufficient knowledge to advice patients to use CTs50% of the participants wanted more training regarding CTs75% of pharmacy students were interested in receiving training in herbal medicine.Training was related to positive attitudes toward CTs for both students and faculty (P <.05)The training and use CTs was limitedSignificant barrier to the use of CTs was lack of scientific supportFaculty and students indicated a high degree of interest in acquiring more training in CTs modalitiesGood sample sizeResults were not representative of all nurses in the USAConducted in developed countryConducted 11 years agoBN: Bachelor Nursing, BSN: Bachelor Science in Nursing, MSN: Master Science in Nursing, PhD: Philosophy of Doctoral, CTs: Complementary Therapies, CAM: Complementary and Alternative Medicines, CAT: Complementary Alternative Therapy, SPSS: Statistical Package for the Social Sciences Open table in a new tab FindingsQualitative and quantitative articles in this review were appraised using the ten questions from the Critical Appraisal Skills Programme (CASP 2006a, 2006b) that help make sense of randomized controlled trials and qualitative research. Rigor, relevance, and credibility are the main aspects considered in this tool. Overall, the critique showed the use of appropriate approaches and methods with findings significant and relevant to this review. Table 1 shows the summary of appraisal details displaying authors, year, location, aims, setting, sample, methodology and methods, major findings, limitations, rigor and validity, and significance to the issues.To discuss the findings of this review, topic headings were defined based on the thematic analysis of articles reviewed. Thematic analysis was used to identify themes, essence, and patterns within the articles.28Taylor B, Kermode S, Roberts K. Research in nursing and health care : Evidence for practice, 3rd Edn, Thomson, Australia.Google Scholar Each article was read carefully, grouped, coded, and analyzed to obtain maximum understanding. Analysis of the reviewed articles identified three themes: "nurses" knowledge about CTs, "nurses" attitudes toward CTs,' and "sources of information about CTs."Nurses' knowledge about complementary therapiesCTs are a group of nonconventional treatments that are used together with Western medicine to support the healing process.29Clarke SJ, Mclachlan AJ. Interaction between complementary and alternative medicine with conventional anti-cancer medicine. Cancer Forum 18–23.Google Scholar Studies reported that CTs including natural products, mind and body medicine, manipulative therapies and body-based practices, and other CTs and alternative medical systems have been used in managing symptoms of chemotherapy and improving QoL.29Clarke SJ, Mclachlan AJ. Interaction between complementary and alternative medicine with conventional anti-cancer medicine. Cancer Forum 18–23.Google Scholar However, in some cases, CTs may interfere with the reaction of the cancer medical treatment if they are used inappropriately. Interference in medical oncologic therapy can lead to reactions that may impair cancer-healing processes and worsen a patient's health condition; thus, it is essential that CTs should be used appropriately.29Clarke SJ, Mclachlan AJ. Interaction between complementary and alternative medicine with conventional anti-cancer medicine. Cancer Forum 18–23.Google ScholarIn general, patients obtain information about CTs from less credible information sources such as their family and friends, Internet, radio, television, and/or magazines.30Christina J. Nurses' knowledge and attitudes towards complementary therapy for adult patients with cancer: Thesis 2014; Flinders University.Google Scholar Although the information obtained may be suitable, it is important that patients receive trusted information, based on evidence from qualified professional healthcare providers.30Christina J. Nurses' knowledge and attitudes towards complementary therapy for adult patients with cancer: Thesis 2014; Flinders University.Google Scholar Nurses are one of the largest groups of healthcare providers who have regular contact with patients who have cancer.31Forsberg A, Fagevik Olsén M. Perceptions of complementary therapies among Swedish registered professions in surgical care. Complement Ther Clin Pract 44–9.Google Scholar They play an important role in assisting patients with cancer and could be a credible information source to provide trusted advice for patients who seek information and are interested in the use of CTs. Nurses' recommendations regarding the efficacy and safety of CTs could impact on the decisions made by patients with cancer, on whether they use or do not to use CTs. This, in turn, may have significant impact on patients' cancer treatment.31Forsberg A, Fagevik Olsén M. Perceptions of complementary therapies among Swedish registered professions in surgical care. Complement Ther Clin Pract 44–9.Google Scholar Therefore, nurses should be well informed and have sufficient understanding and knowledge about CTs.Nurses' understanding and knowledge of CTs could be reflected in their approach toward CTs. Studies indicated that nurses who have sufficient knowledge about CTs are more confident informing their patients about these therapies.15Young-Hee Y, Lee KE. A comparison of the knowledge of, experience with and attitudes towards complementary and alternative medicine between nurses and patients in Korea. J Clin Nurs 2565–72.Google Scholar, 16Rojas-Cooley MT, Grant M. Complementary and alternative medicine: oncology nurses' knowledge and attitudes. Oncol Nurs Forum 217–24.Google Scholar The studies also showed that positive stances by nurses to open discussion with patients who used CTs for cancer management was important.17Holroyd E, Zhang AL, Suen LK, Xue CC. Beliefs and attitudes towards complementary medicine among registered nurses in Hong Kong.Int J Nurs Stud. 1660–6.Google Scholar In contrast, nurses who lacked knowledge about CTs were reluctant to communicate about CTs.18Sohn OM, Loveland Cook CA. Nurse practitioner knowledge of complementary therapy health care: foundation for practice. J Adv Nurs 9–16.Google Scholar According to Sohn et al., nurses who lack an understanding of CTs are not able to adequately perform an appropriate nursing assessment regarding the use of CTs for patients who have cancer.18Sohn OM, Loveland Cook CA. Nurse practitioner knowledge of complementary therapy health care: foundation for practice. J Adv Nurs 9–16.Google Scholar Formal and informal education could help nurses develop their knowledge about CTs, which contribute to better quality of care for oncology patients.Several studies indicated that education regarding CTs was expanding particularly in developed countries. A survey conducted by Sohn et al. in 2002 in the USA investigated the level of knowledge of 152 nurses in Miss
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