CAMbrella Final Report

Work package 3:

Needs and attitudes of citizens

Leading beneficiary: University of Southern Denmark (SDU)

Objectives:
The objectives of WP3 were to identify cross-European indicators for population based needs and attitudes regarding CAM, and to identify, map and provide information on the needs of European citizens with respect to CAM, and their attitudes towards CAM.

Description of work:
A purposeful sample of stakeholders was selected, taking account of the wide geographical range (EU, regional and national) and the diversity of knowledge and/or interests (e.g. academic, non-governmental, and governmental) in CAM in Europe. These stakeholders attended a workshop (Vienna, 24-25 June 2010) which sought
a) to identify how to explore the needs and attitudes of EU citizens to CAM,
b) to share relevant sources of information about CAM, and
c) to identify how citizens' needs and attitudes to CAM can be measured and compared across the EU.
The workshop resulted in initial suggestions concerning relevant sources of information and participants identified three key issues regarding citizens’ needs and attitudes to be considered in the systematic literature search:

- independent and easily accessible information about CAM, based on the strength of available evidence to support informed decision making,
- quality of care that comprises CAM services, providers and products, and
- equal access to CAM services.

Based on these three central issues WP3 then carried out a systematic review of literature concerning EU citizens' needs and attitudes using the search terms mentioned above in the main relevant databases (PubMed, Web of Science, CINHAL, AMED, PsycINFO/Articles). These searches identified a broad range of quantitative and qualitative literature, and the reporting quality of the identified articles was assessed using acknowledged quality assessment.

Findings:
It was only possible to research the attitudes and needs of citizens in Europe concerning CAM in 18 of 39 European countries; substantial research based knowledge is only available from the UK. Nevertheless, the following tendencies can be reported:

a) Citizens in the EU wish to have access to increased and diverse CAM provision: Studies indicate that citizens wish CAM to be available as part of their options for health care, for example in hospital and general practice care. They also wish CAM provision to be delivered not only by medical doctors and/or doctors trained in CAM specialities, nurses or other conventional health care providers, but also by CAM providers with therapy specific training. There is a wish for more CAM provision offering the broad spectrum of different therapies.

b) Barriers in the access to CAM: EU citizens seem to meet considerable barriers in the access to CAM: CAM treatments are predominantly paid for privately and are difficult to access due to lack of availability and limited accessibility.

c) Citizens express a wish for more support and acknowledgement regarding their CAM use: CAM use is often not disclosed by patients in other treatments because of the assumed or known hostile attitude of the medical professionals towards CAM treatments.

d) Citizens need easily accessible and trustworthy information: European citizens wish to have access to reliable and trustworthy information that can support an informed decision about treatment options.

e) Citizens require transparent regulation of CAM practice and training: Citizens’ confidence in the provision of CAM would be supported by public frameworks regulating the practice of CAM and by CAM being provided by members of professional CAM organisations that ensure educational as well as ethical standards.

Methodology and findings of the literature review are described in detail in a published article (Nissen N et al. What attitudes and needs do citizens in Europe have in relation to Complementary and Alternative Medicine? Forsch Komplementmed 2012;19(suppl 2):9-17) (78). Another article is focussing on findings of the literature review with implications on ethics in public health providing CAM.

This article (Nissen N et al. Public health ethics for Complementary and Alternative Medicine. Europ J of Integr Med. 2012, doi:10.1016/j.eujim.2012.11.003)79 is drawing on theoretical considerations of public health ethics to examine some of the ethical issues which arise from pertinent findings from this previously published review. Public health ethics is concerned with social justice and ekvity in health, the need to respect individual autonomy, and the obligation to prevent harm. The explorations presented draw attention to multiple dilemmas and tensions concerning the public health ethics of CAM.

Summarizing, one can state that many citizens in Europe have positive attitudes to CAM although their attitudes and needs have not been consistently researched across Europe. In addition they wish to have access to increased and diverse CAM provision, they need easily accessible and trustworthy information regarding CAM, and they demand for transparent regulation of CAM and the training of those who practise CAM.