Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU North), Faculty of Health Sciences, UiT The Arctic University of Norway, 9037, Tromsø, Norway.
The National Research Center in Complementary and Alternative Medicine (NAFKAM), Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, 9037, Tromsø, Norway.
BMC Complement Altern Med. 2019 Apr 30;19(1):93. doi: 10.1186/s12906-019-2499-3.
Complementary and alternative medicine (CAM) is a rather novel issue within public healthcare and health policy-making. CAM use in Europe is widespread, patient-initiated, and patient-evaluated, and the regulation across countries has been evaluated as disharmonized. CAM users are left in an uncertain position, and patient safety may be threatened. How "risk" is understood by individuals in health policy-making and clinical encounters involving the use of CAM has not yet been much debated. The aim of this article is to explore and discuss the existence and possible consequences of differing risk understandings among stakeholders maneuvering in the complex landscape of CAM practice and CAM regulation contextualized by European public healthcare systems.
Qualitative data were derived from two studies on CAM in European healthcare contexts. Findings from the EU project CAMbrella on legislation and regulation of CAM were mixed with data from an interview study exploring risk understandings, communication, and decision-making among Scandinavian CAM users and their doctors. In a secondary content analysis, we constructed the case Sara as a typology to demonstrate important findings with regard to risk understandings and patient safety involving European citizens' use of CAM in differing contexts.
By combining and comparing individual and structural perspectives on risk and CAM use, we revealed underexplored gaps in risk understandings among individuals involved in European CAM regulation and legislation, and between CAM users and their medical doctors. This may cause health risks and uncertainties associated with CAM use and regulation. It may also negatively influence doctor-CAM user communication and CAM users' trust in and use of public healthcare.
Acknowledging implications of stakeholders' differing risk understandings related to CAM use and regulation may positively influence patient safety in European healthcare. Definitions of the concept of risk should include the factors uncertainty and subjectivity to grasp the full picture of possible risks associated with the use of CAM. To transform the findings of this study into practical settings, we introduce sets of questions relevant to operationalize the important question "What is risk?" in health policy-making, clinical encounters and risk research involving European patients' use of CAM.
补充和替代医学（CAM）在公共医疗保健和卫生政策制定中是一个相当新颖的问题。欧洲广泛使用 CAM，由患者发起并由患者评估，各国的监管被评估为不协调。CAM 用户处于不确定的地位，患者安全可能受到威胁。在涉及使用 CAM 的卫生政策制定和临床接触中，个人对“风险”的理解如何，尚未进行过多的讨论。本文的目的是探讨和讨论在欧洲公共医疗保健系统背景下，在 CAM 实践和 CAM 监管的复杂环境中运作的利益相关者之间存在的和可能存在的不同风险理解，以及这些理解可能带来的后果。
定性数据来自于两项关于欧洲医疗保健背景下 CAM 的研究。欧盟项目 CAMbrella 关于 CAM 的立法和监管的研究结果与一项探索风险理解、沟通和决策的访谈研究结果相结合，该研究涉及斯堪的纳维亚 CAM 用户及其医生。在二次内容分析中，我们构建了 Sara 案例，以展示与欧洲公民在不同背景下使用 CAM 相关的风险理解和患者安全的重要发现。
通过结合和比较个体和结构视角下的风险和 CAM 使用，我们揭示了欧洲 CAM 监管和立法中涉及的个人之间以及个人与结构之间对风险理解的未被充分探索的差距，以及 CAM 用户及其医生之间的差距。这可能会给 CAM 使用和监管带来健康风险和不确定性。这也可能对医患沟通以及 CAM 用户对公共医疗保健的信任和使用产生负面影响。
承认与 CAM 使用和监管相关的利益相关者不同风险理解的影响，可能会积极影响欧洲医疗保健中的患者安全。风险概念的定义应包括不确定性和主观性因素，以全面了解与使用 CAM 相关的可能风险。为了将本研究的发现转化为实际情况，我们引入了与欧洲患者使用 CAM 相关的卫生政策制定、临床接触和风险研究中的重要问题“什么是风险？”相关的问题集，以使其操作化。
