Therapeutic pluralism and the politics of disclosure: breast cancer patients' experiences in public healthcare

BACKGROUND: Despite the widespread utilisation of complementary and or alternative medicine (CAM) by breast cancer patients in low-and-middle-income countries, few disclose CAM use to their physicians. OBJECTIVE: This study examines disclosure CAM use among a small sample of women attending a breast cancer clinic in a public health hospital in the Western Cape, South Africa. METHODS: An Interpretative Phenomenological Analysis (IPA) approach was utilised in this study. Semi-structured in-depth interviews were conducted with a convenience sample of 17 women attending a breast clinic in a public hospital. RESULTS: Non-disclosure of CAM use was attributed to minimal time for patient-doctor interactions due to resource constraints in public health facilities and the superior status accorded to biomedical doctors' superior knowledge, associated with paternalism, leading to patients' fear of reproach for using CAM. Consequently, disclosure of CAM only occurred in instances where it was deemed an absolute necessity. CONCLUSION: Considering the reality of an overstretched public healthcare system, what may be possible is an active attempt to communicate to patients that doctors are aware that patients may use a range of resources (such as CAM), which is their right, and further, recommend patient disclosure of CAM use to their doctors, because of the possibility of drug interactions and other potentially negative effects.