OLDER PATIENT-PHYSICIAN-ALTERNATIVE HEALER RELATIONSHIPS

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Older patients are increasingly likely to be under the care of both physicians and alternative practitioners, often for treatment of the same condition. In the vast majority of cases, however, alternative care is not integrated with biomedical care; indeed, most patients do not inform their physicians of their concurrent use of complementary and alternative medicine (CAM). This is a critical juncture at which to study health-care relationships in which the patient is treated by practitioners from different medical systems who are usually not in contact with, and often not aware of, one another. The objective of this four-year qualitative, anthropological study is to describe and examine the ways in which emerging health-care relationship configurations are approached and understood by older women diagnosed with breast cancer, their physicians, and their CAM practitioners. This will be an ethnographic investigation of the mediating effects of individuals' age, ethnocultural background, and expectations of aging, based on the collection of data through in-depth individual interviews. The 150 study participants will be comprised of linked triads of women with breast cancer, ages 55- 84, who use biomedicine and CAM; their main physicians; and their main CAM practitioners. The patients will include African-, Chinese-, European-, and Hispanic American women. The project will (1) investigate the health beliefs and healing strategies involved in older breast cancer patients' seeking care concurrently from physicians and CAM practitioners; (2) examine patient participants' understandings of and reactions to their relationships with physicians and CAM practitioners; and (3) examine physicians' and CAM practitioners' understandings of and reactions to their relationships with older breast cancer patients. This study will reveal older breast cancer patients' integrative healing approaches, elucidate benefits and deficiencies of biomedical and CAM systems with regard to addressing older breast cancer patients' needs, and suggest future strategies for strengthening emerging health-care relationships.