A survey on the knowledge, attitudes and prescribing behaviour of Medical oncologist on the use of herbal medicine in cancer patients.
Background context and scope of the study
Describe the aim of the study
Provide rational for the study. You must provide at least 3 references for your study
Generate and list 3 keys objectives/research questions
List research hypotheses if applicable.
Aim:
A cross sectional survey on the knowledge, attitudes and prescribing behaviours of Medical Oncologists in cancer patients.
Rationale:
Herbal medicine are plant-derived materials and preparations consumed for their presumed therapeutic or other health benefits. An estimated 70-80% of the world’s population use non-Western medicine in the form of herbal preparations for their primary health care (MacLennan 2006). The proportion of the Australian population using herbal products has increased from 48% in 1996 to 69% in 2005 with spending on complimentary medicine increasing by more than 100% between 1996 and 2004 (MacLennan 2006). As many as 65% of Australian people with cancer in 2010 used some form of complementary medicine, more than half of whom did so in combination with conventional therapy (Richardson 2000). In certain recent studies overseas, the use of complementary and alternative medicine is considerably higher with some studies reporting rates of 70.2% in a sample of 365 patients suffering from cancer (Hyodo 2005). Despite, the paradigm shift with innumerable newer targeted non cytotoxic therapies that are significantly lengthening survival, there has been an increase in herbal medicine consumption in these patients. Documented figures of up to 60% of these patients do not disclose their herbal usage to the doctors, and the most cited reason was that their doctors did not ask them (Hyodo 2005) These findings have highlighted the lack of awareness of herbal medicine usage among health care professionals. This could have important oncologic implications due to potential drug-herb interactions.
Richardson et al reported negative perceptions on complementary medicine by clinical oncologists and Hyodo et al reported discrepant view on complementary medicine between oncologist and cancer patients. However, there has been little research addressing Medical Oncologist’s knowledge, beliefs and attitude towards herbal medicine in Australia. This survey will aim to answer questions with regards to Medical Oncologist’s knowledge, beliefs and attitudes towards herbal medicine. Furthermore, assess factors that could contribute to Oncologists’s beliefs and attitudes towards herbal medicine.
Objectives
Assess Medical Oncologists’ knowledge in use of herbal medicine in cancer patients
Assess Medical Oncologists’ beliefs and attitudes in use of herbal medicine in cancer patients.
Determine factors associated with Medical Oncologists’ behaviour in prescribing herbal medicine to cancer patients.
Hypothesis
Medical Oncologists have minimal knowledge in herbal medicine
Medical Oncologists have negative beliefs and attitudes towards use of herbal medicine in cancer patients
Previous negative experiences and lack of safety data causing consequences of poorer outcomes cause limitations in prescribing herbal medicine.
Target population.
The target population for this survey was Medical Oncologists practising in Australia. Royal Australian College of Physicians of Medical Oncology (RACP) would be used as a sampling frame for target population. All Medical Oncologist are required to be accredited to RACP in order to practice medical oncology and each doctor’s details require updates every 6-12 months. The membership records of the College are not prone to duplicate. A yearly update is required in order for Medical Oncologist to practice medicine. These two sources together would provide a strong sampling frame for my target population. Oncologists who were characterised as “administrative”,”research”, “medical teaching” or “inactive” or designated as “do not contact” were excluded.
In 2015, there were 448 Medical Oncologist in Australia (AIHW 2015). Availability sampling would be the method of choice. As any probability sampling method would lead to a sample too small for meaningful analysis. However given this study is exploratory, hypothesis generating and at a preliminary stage of research, non-random samples are satisfactory. In this research, we not concerned with generalising from a sample to the population and instead, we are interested in looking at data patterns and gathering a general idea of range of responses medical oncologists have. Therefore, in this study, it is acceptable to have availability sampling as we are not concerned about the representative population from the sample selected.
Suitable sample size required the application of a finite population correction. This calculation was accessed via select statistical services. At 5% margin of error, with 95% confidence level and 50% sample proportion, the recommended sample size was 208 participants. Given that there is only approximately 450 Medical Oncologist in Australia, all medical oncologists were contacted via email. This decision was made in order to minimise unacceptable reduction of sample size.
To further minimise and enable adjustments of bias, we can obtain information of non responders from sampling frames. RACP can provide characteristics of non responders (ethical background, religion, public/private service, age, gender). We can also minimise bias by comparing characteristics of the sample with those of the population. Any differences between the groups could indicate the area of bias. The extent of the differences would indicate the degree of bias.
It is expected that education background or socioeconomic status would largely differ as Medical Oncologists are considered a homogenous group.
Data collection
Email based survey with the it containing a link to a web survey address on SurveyMonkey would be the best method for this project. This was chosen because Medical Oncologists have a busy schedule and often quite difficult to contact. The email survey allows doctors to complete survey in their own time. The other advantage is that it is also an inexpensive data collection method and there is a short turn around period for data. The email addresses obtained from the sampling frame will be accurate and doctors check email regularly due to their work.
Any interviewer requiring surveys such as face-to-face interviews and telephone interviews would difficult. This is due to their long hour shifts and unpredictable timetable, interviews tailored to each Medical Oncologist would be quite time-consuming, inconvenient and expensive method. Postal surveys was not chosen as the time taken to answer would be longer and there could be lower response rates. Hand delivering questionnaires could have been a possibility but in this case, it will be difficult to track down a Medical Oncologist in hospital as they are rarely stationary at one place.
Questionnaire
Attribute questions
Questions 1,4,5 and 6 are attribute questions. These questions will allow us to understand the background of each Medical Oncologist to assess if certain factors were more or less likely to share similar behaviours and attitudes towards herbal medicine. A survey by Hilal & Hilal 2016 revealed that female physicians were more likely to use herbal medicines. However, this did not translate to more herbal medicine prescription. This question will further evaluate if there is a gender specific belief and attitude ultimately leads to different prescribing behaviour. Age will be an interesting attribute to look into. As there is wider use of herbal medicine throughout the decade, it will be interesting to see if this results in wider knowledge of herbal medicine in the younger generation. It will also be interesting to observe if herbal medicine beliefs, attitudes and prescription differs in private hospital and public hospital settings.
Belief questions
Questions 7 and 10 are belief questions. Question 7 is assessing Medical Oncologists’s belief in whether herbal medicine harmful or beneficial. These are critical questions which answer the research objectives in the survey. Previous similar questions based in Qatar found that 67% of Oncologists believed that complementary therapy was safe (Hassan 2015). In the same study, 87% of Medical Oncologists believed that complementary therapy would help in improving patients psychological/emotional well being and give hope. It will be interesting to see if Australian Medical Oncologists have similar beliefs. As a similar study in United States (Richardson et al 2000) had found negative perceptions towards herbal medicine.
Behavioural questions
Question 2,8,and 11 are behavioural questions. Assessing familiarity with herbal medicine is important in assessing Oncologists’s attitudes. Those that are not familiar with herbal medicine may not recommend herbal therapy and therefore not prescribe it. Question 8 elicits if doctors who have previous bad experiences. A previous bad experience with herbal medicine could be a potential reason that contributes to Medical Oncologists’ belief and attitude towards herbal medicine and thus alter their prescription of herbal medicine. This question will help delineate if previous bad experiences are potential reasons to having a negative belief, attitude and hence lower prescription rates of herbal medicine. Question 11 assesses if doctors are willing to offer herbal therapy. This enables to assess whether Medical Oncologists are willing to offer herbal therapy. For those that are not willing to prescribe herbal medicine, it will provide information if they had negative experiences, negative values and beliefs. On the other hand, for those that are willing to prescribe, it will be interesting to review their values and beliefs. As previous study (Hassan 2015) have found that 15% Qatar Doctors will recommend complementary therapy. Question 12 relates to the study objective in further assessing Medical Oncologist’s involvement in studying herbal use. This is important, especially in the context of increasing usage of herbal medicine in Australia.
Knowledge Question
Question 3 is a knowledge question. This knowledge question was to further probe Oncologist’s familiarity of herbal medicine. In a previous study, when asked about their knowledge on CAM, the majority of health care professionals thought they did not have adequate knowledge (58.8%). Up to 80% were unsure of roles of the complimentary practices in cancer related scenarios, thereby not being able to advise patients regarding the benefits, limitations and even potential harms (Chang et al 2011). Lack of knowledge in herbal medicine may also be associated to lower rates of herbal medicine prescription.
Attitude question
Question 9 is to assess the attitude of Medical Oncologists. This question directly addresses the research objective of the attitudes of Medical oncologists
References
Al-Windi, A. (2004). Determinants of complementary alternative medicine (CAM) use. Complementary Therapies in Medicine, 12(2-3), 99-111. doi:10.1016/j.ctim.2004.09.007Xue CC, Zhang AL, Lin V, et al. Complementary and alternative medicine use in Australia: a national population-based survey. J Altern Complement Med 2007; 13: 643-650.
Clinical Oncology Society of Australia Position statement. The use of complementary and alternative medicine by cancer patients (2013). Retrieved October 18, 2013, fromhttps://www.cosa.org.au/media133/cosa_cam-position-statement_final_new-logo.pdf
Richardson, M. A., Sanders, T., Palmer, J. L., Greisinger, A., & Singletary, S. E. (2000). Complementary/Alternative Medicine Use in a Comprehensive Cancer Center and the Implications for Oncology. Journal of Clinical Oncology, 18(13), 2505-2514. doi:10.1200/jco.2000.18.13.2505
Hyodo, I., Amano, N., Eguchi, K., Narabayashi, M., Imanishi, J., Hirai, M., . . . Takashima, S. (2005). Nationwide Survey on Complementary and Alternative Medicine in Cancer Patients in Japan. Journal of Clinical Oncology, 23(12), 2645-2654. doi:10.1200/jco.2005.04.126
Australia Institute of Health and Welfare. (2016, August 24). Medical practitioners workforce 2015. Retrieved from https://www.aihw.gov.au/reports/workforce/medical-practitioners-workforc-2015.
Hassan, A. A. (2015). Knowledge and Attitude of Oncology Practitioners towards Complementary and Alternative Medicine for Cancer Care in Qatar. Journal of Anesthesia & Clinical Research, 06(09). doi:10.4172/2155-6148.1000561
Chang, K. H., Brodie, R., Choong, M. A., Sweeney, K. J., & Kerin, M. J. (2011). Complementary and alternative medicine use in oncology: A questionnaire survey of patients and health care professionals. BMC Cancer, 11(1). doi:10.1186/1471-2407-11-196
Statement of what the scale measures;
The scale assesses psychometric properties of fame masculinity; specifically it assesses muscularity attitudes and behaviours among young women. It is a two factor structure that includes five item attitude sub scale and five item behaviour sub scale which provides a new female muscularity scale.
All items in scale are phrased in a positive direction. Each item scored on a 5 point scale ranging from 1 (Never) to 5 (Always). A high score in attitudes scale represents a woman who desires a muscular appearnce. a high score on the Behaviours sub scale represents a woman who is engaged in behaviours to alter physical appearance.
Justification for the scale (advantages over the existing measures);
Socially promoted physical appearance ideals for women promote importance in muscularity. Society has promoted these ideals for women and emphasised beauty with extreme thinness. This can be reflected upon with recent phenomenon of “fitspiration” online, where the fitspiration images have shown bodies that are toned and thin along with positive feedback fro thin and defined muscles.
Currently, there no scales developed developed in producing a useful tool for assessing muscularity concerns and associated behaviours among women. Previously scales developed for men were adapted to women and it appeared to have limited success as demonstrated by the absence of association with more general measurements of body image which may result from gender differences in the social ideals in terms of muscularity.
Hence, Female muscularity sale was developed to specifically asses women’s attitudes and behaviours related to female muscularity and to evaluate its psychometric properties.
Reliability of the scale (comment on internal consistency and test-retest reliability statistics);
Te test reliability and validity of scales samples of female, undergraduate student at least 18 years old were recruited through advertisements, flyers and social media platforms. A total sample of 235 women from a large university in the Northeast of United states were used.
Internal consistency was very high in both Attitudes ( α = 0.93) and Behaviours ( α = 0.90). Test-retest reliability, assessed 2 weeks apart (n = 148) was acceptable for both of FMS subscales, with for Attitudes sub scale (r = 0.79) and for Behaviours sub scale (r = 0.76) and for entire scale (r = 0.82).
Validity of the scale. Is there evidence to verify the scale measures what it purports to measure? (e.g., correlations with similar tests etc.)
Body Shape Questionnaire (BSQ; Cooper et al. 1987)
Drive for Thinness sub scale from the eating Disorder Inventory-2 (EDI-DT; Garner 1991)
Exercise behaviours
The BSQ (Cooper et al. 1987) was used to test convergent validity. Drive for Thinness was used to test divergent validity. The Attitudes sub scale demonstrated a large correlation with the BSQ ( r = 0.55) and moderate correlation with EDI-DT (r = 0.44). There was a weaker association with Attitudes and exercise behaviours in keeping with distinction between attitudes and behaviours component. Behaviour scale weakly correlated to both BSQ ( r = 0.26) and Drive for thinness (r = 0.28). However, the relationship with weekly engagement in exercise was moderate-to-large indicating good convergent validity.
Overall conclusion; authors’ suggestions for future research and your suggestions for future research regarding the validation of the scale.
Conclusion
Overall, Female Muscularity Scale (FMS) is a valid and reliable tool for assessing both attitudinal and behavioural components of muscularity and muscle tone concerns among women. FMS was reliable with two main components – firstly Attitudes sub scale which assessed the desire for a muscular appearance and secondly Behaviour sub scale which assessed engagement in behaviours aiming to modify physical appearance and increase muscularity. The two FMS subscalezs demonstrated good reliability and concurrent validity supporting its usefulness as a research instrument that can be used overall or with each subscale.
Authors’ suggestion for future research
Given that this study comprised on a college sample, the author has suggested further research in examining the properties of FMS among more diverse sample, as well as across ages and engagement in different types of exercises to further clarify FMS usefulness.
Author has also suggested that evaluating how useful the scale is for detecting at risk individuals displaying excessive exercise behaviours and disordered eating patients could be also a useful.
My suggestions for future research regarding the validation of the scale.
The author suggesting a more diverse sample with a wider age group. This study had 68% Caucasians, 17% Asian, 5% Hispanic and 3% Black. As western society have their own expectations of beauty and muscularity, It will be interesting validating this scale with a variety of ethnic groups.