Integrative Care
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Swedish surgeons want to learn more about CAM

17 September, 2012 by David Finer

A national Swedish survey shows for the first time that a majority of surgeons want to learn more about CAM, Complementary and Alternative Medicine.

The study was carried out in 2010-2011 by Kristofer Bjerså, RN and collaborators at the Sahlgrenska Academy, Gothenburg University and is published in the journal BMC Complementary and Alternative Medicine.

The survey was sent to 1 757 individuals at surgical clinics at the seven university hospitals in Sweden (response rate 42 percent – 737 surveys – of which 78 percent were women, most of them nurses).

Before and after surgery
Previous studies from various countries, i.a. Sweden, have demonstrated an increased CAM use in the general population and among health care providers. Patients commonly employ CAM modalities before and after surgery.

Recent international studies have shown that providers of conventional health care do not know very much about CAM, but the situation in Sweden has been unknown.

The Gothenburg researchers wanted to study the state of CAM knowledge among Swedish surgical staff. A qualitative interview study published earlier with 16 participants demonstrated ignorance but interest. Now they were keen to test these results by way of a larger quantitative study.

Wanted to know more
The participating health care providers were asked to define what they themselves understood by the terms complementary, alternative and integrative methods, respectively.

Among complementary methods, they mentioned massage, manual therapies, yoga and acupuncture. As alternative methods they delineated herbals, nutrition supplements, homeopathy and healing. They did not define any methods as being integrative.

Almost all the respondents (96 percent) admitted to having little or no knowledge of CAM, whereas 69 percent had a desire to learn more and 81 percent termed such knowledge important. These responses represent a strong attitudinal shift in just a few decades. In 1979, 52 percent of health care staff when questioned said that kind of knowledge was unimportant, according to study in social psychiatry by Nils-Olof Jacobson.

Requested more research
CAM research deserves more funding according to 61 percent of the surveyed surgical staff, while 73 percent were interested in reading about such research, and 28 percent were willing to participate themselves.

Patient-provider communication around CAM is uncommon, the respondents said.

Study weaknesses
The authors discuss several methodological weaknesses of the study, i.a. the relatively low response rate, lack of clarity regarding the terms used to designate treatment modalities, and possibly responder bias, in that those who answered may have been more emotionally involved, hence more positive, than non-responders.

With these reservations the researchers conclude that the first study of the attitudes of Swedish registered health care providers towards CAM demonstrates a definite thirst for knowledge.

David Finer


Bjerså K, Stener Victorin E, Fagevik Olsén M. Knowledge about complementary, alternative and integrative medicine (CAM) among registered health care providers in Swedish surgical care: a national survey among university hospitals. BMC Complementary and Alternative Medicine 2012; 12:42.


Jacobson NO: Naturläkemedel och okonventionella behandlingsmetoder: en socialpsykiatrisk undersökning av erfarenheter och attityder hos läkare och allmänhet/Naturopathic medicines and unconventional methods of treatment. Stockholm: Karolinska institutet; 1979.

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