Using a mixed methods research design to investigate complementary alternative medicine (CAM) use among women with breast cancer in Ireland Patricia Fox a, * , Michelle Butler a , Barbara Coughlan a , Mary Murray b , Noreen Boland c , Terry Hanan d , Hilary Murphy d , Pauline Forrester d , Marie O’ Brien b , Nollaig O’ Sullivan d a UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Dublin, Ireland b St Vincent’s University Hospital, Ireland c St James’s Hospital, Ireland d Adelaide, Meath & National Children’s Hospital, Ireland Keywords: Mixed methods Breast cancer Complementary alternative medicine Ireland Complementary therapies abstract Aim: To investigate complementary and alternative medicine (CAM) use among women with breast cancer in Ireland using a mixed methods modified sequential explanatory design. Methods: Semi-structured interviews were conducted with oncology professionals (n ¼ 20) and CAM practitioners (n ¼ 20) and this was followed by a survey of 406 women with breast cancer using the ‘Use of Complementary and Alternative Therapies Survey’ questionnaire (UCATS) (Lengacher et al., 2003). Follow up interviews were subsequently undertaken with a subset of this survey sample (n ¼ 31). Results: Over half of those surveyed (55.7%, n ¼ 226) used some form of CAM since diagnosis. The most frequently used therapies were massage, herbal supplements (including herbs with oestrogenic prop- erties), antioxidants, relaxation, counselling, health supplements, reflexology, reiki and support groups. Dietary interventions were used primarily to reduce symptoms and/or side effects while reduction of psychological stress was the primary reason for use of stress-reducing therapies. Most respondents re- ported that the CAM therapies they had used were helpful. The qualitative data elaborated on and provided clarification of the survey results. Conclusions: Similar to international studies, CAM is popular among women with breast cancer in Ireland. As such, the challenge for Irish oncology professionals is to identify low risk CAM therapies that are likely to benefit patients while educating patients and themselves on therapies which may be of concern. This study clearly illustrates the benefits of using a mixed methods approach to enhance our understanding of a complex clinical issue and thus we recommend that this method should be the method of choice when planning health services research. Ó 2012 Elsevier Ltd. All rights reserved. Introduction Evidence from the literature (Chow et al., 2010; Molassiotis et al., 2005; Tarhan et al., 2009), anecdotal evidence, and personal experience all suggest considerable interest in, and use of complementary and alternative medicine (CAM) by patients with cancer. Patients with breast cancer have a greater tendency to utilize CAM than other cancer patients (Gage et al., 2009; Lafferty et al., 2008; Yates et al., 2005) or the general population (Kufel et al., 2004; VandeCreek et al., 1999) although considerable vari- ability in the frequency of CAM use has also been noted in this cohort. This variability is most likely a reflection of varying defi- nitions of CAM being used (Lengacher et al., 2002; Nagel et al., 2004), small sample sizes (Lengacher et al., 2002), and also use at different time-points whereby patients may be asked if they have used CAM ever in their lifetime, in the past year, or since diagnosis. A number of authors (Buettner et al., 2006; Chen et al., 2008; Greenlee et al., 2009; Molassiotis et al., 2006; Pedersen et al., 2009) have highlighted the popularity of CAM (40% uptake) among women with breast cancer in Europe, the US and Asia. Many studies have also identified the type of CAM used, the characteristics asso- ciated with CAM users and the reasons for use. Biologically based therapies (vitamins/minerals/health supplements, herbal medicines, special diets), prayer and/or spiritual therapies, relaxation/medita- tion (Greenlee et al., 2009; Hann et al., 2005; Henderson and * Corresponding author. þ353 (0) 877516708. E-mail address: patricia.fox@ucd.ie (P. Fox). Contents lists available at SciVerse ScienceDirect European Journal of Oncology Nursing journal homepage: www.elsevier.com/locate/ejon 1462-3889/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ejon.2012.10.008 European Journal of Oncology Nursing 17 (2013) 490e497