Integration of Alternative and Complementary Medicine into Palliative Care

Patients and their families may be subject to strong pressures to utilize "ethnomedical" practices and procedures believed to be efficacious. Recent immigrants may utilize products obtained abroad or from Mexico and Central America. Practices vary widely, including acupuncture for pain, cupping or coining, dietary prohibitions based on "hot-cold" belief systems, Chinese herbal products, Ayurvedic patent medicines, and full-blown rituals including chanting and the sacrifice of animals. A skilled practitioner creates an open environment in which the patient, family, and perhaps a ritual specialist from the community may openly discuss the appropriate blending of biomedically sanctioned medicines and procedures with ethnomedical products. Although some patent medicines and food supplements are known to be harmful and may actually contain potent pharmaceuticals, the healthcare team is unlikely to obtain a full accounting of all treatments used for a particular dying patient unless a nonjudgmental attitude is maintained. This may be a challenge when a healthcare provider must compromise his or her own "ideal" care.

The need to integrate alternative and complementary medicine into palliative care is not limited to patients from particular ethnocultural communities. Research documents that a large percentage of Americans have utilized "alternative" medicine in the recent past (Eisenberg, Davis, Ettner et al.), with prayer being the most widely utilized practice (82 percent of Americans believe in the healing power of personal prayer) (Barnes, Plotnikoff, Fox, and Pendleton).

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