Academic journal article Health Sociology Review

Cancer Self-Health Programmes: An Ethos for Negotiating Multiplicities of Healthcare

Academic journal article Health Sociology Review

Cancer Self-Health Programmes: An Ethos for Negotiating Multiplicities of Healthcare

Article excerpt

A prominent part of healthcare policy in the UK, North America, and Australia in the last decade has been to increase choice of mainstream healthcare providers (Tritter, Koivusalo, Ollila, & Dorfman, 2009). Related to this area of growth in the health economy is an increased interest and focus upon personal health, which is popularly understood as the individual taking responsibility for their well-being in an environment frequently framed as a healthcare market (Illouz, 2008). Understood like this, one choice up to 40% of people with cancer will exercise is to include some form of complementary and/ or alternative medicine (CAM) in their healthcare (Horneber et al., 2012).

Developing and promoting this interest are cancer support centres, which have become an increasingly acceptable healthcare provider for many people with cancer (Seers et al., 2009; Shneerson, Taskila, Gale, Greenfield, & Chen, 2013). These centres emphasise programmes of self-health and have become 'a key informative and pragmatic resource in the provision of CAM services to patients' (Chatwin & Tovey, 2004, p. 210). Formed as charities, third sector or private organisations they frequently have financial revenues into the millions, funded through donations and commercial activities (CANCERactive, 2012; PBCC, 2012). They therefore have been able to grow outside the institutional reach of mainstream healthcare and mitigate some of the factors that could be used to marginalise them (cf Coulter, Khorsan, Crawford, & Hsiao, 2010; Wahlberg, 2007).

While significant consideration has been given to the experiences of various CAM modalities by people with cancer (Broom, 2009a, 2009b; Chatwin & Tovey, 2004; Horneber et al., 2012; McClean, 2005; Shneerson et al., 2013; Smithson, Paterson, Britten, Evans, & Lewith, 2010; Stacey, 1997) and differing CAM modalities relationship with biomedicine (Bendelow, 2009; Broom & Adams, 2009; Cant & Sharma, 1998; Coulter, 2004; Coulter et al., 2010; Gale, 2014; Kuhlmann, 2009; Possamai-Inesedy & Cochrane, 2013; Saks, 2003; Seers et al., 2009), there has been less consideration of the specific self-health programmes provided by the centres themselves. The first aim of this article is therefore to explore how the cancer self-health programmes are able to draw together divergent treatments, therapies and practices in a way that they assert users will find useful. The second aim is to explore how the programmes cancer support centres offer might provide novel understandings of cancer healthcare provision in contexts where there are multiple providers.

Complex negotiations: bringing CAM and biomedicine together

CAM can refer heterogeneous field of practices, treatments and therapies including the psychological, nutritional, body-work, psychic and spiritual, as well as 'alternative' healing systems (Bendelow, 2009). Within this diverse range of modalities are 'whole system' approaches like homeopathy and 'less ideological' practices like reiki (Broom & Tovey, 2008, p. 8). What frequently characterises a CAM modality is, first, a lack of integration into the biomedical or 'Western' healthcare model; and, second, it is frequently an approach that includes some degree of physical and metaphysical elements (Broom & Tovey, 2008). Therefore, given the range of different modalities available, the coming together of CAM with biomedicine - itself a diverse field with a range (and history) of approaches to the body, health, and care (Mol & Berg, 1998) - is a relationship characterised by a complex array of problems epistemologically, systemically and at the level of individual healthcare.

Most notably, the relationship between CAM and biomedicine has been defined by a long history of mutual distrust and conflict (Saks, 2003) and has frequently been viewed through simplified binary oppositions (Gale, 2014) (e.g. scientific/quack; reductionist/holistic; cure/care etc.). …

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