Complementary and Integrative Medicine Use: A National Survey

Abstract

Objective:

This large-scale survey aimed to investigate the use of Complementary and Integrative Medicine (CIM) across France.

Design:

Observation multicentric study.

Setting:

This survey study was conducted from October 10, 2022 to October 28, 2022 in medical, surgical, and obstetric clinics across France. Self-administered questionnaires specifically designed for the study were used to collect data related to subjects’ prior use of CIM (type of therapy used, reasons for use, cost, duration, who recommended the therapy) and patient demographic data. The questionnaires were made available at the admissions office, secretary’s office, or waiting rooms of clinics.

Results:

A total of 1178 questionnaires collected in 26 multipurpose clinics were analyzed. Two-thirds of patients (65%) reported having used at least one CIM, with a mean of four therapies used per patient. Osteopathy, massage, homeopathy, acupuncture, and psychotherapy were the most frequently reported therapies. More women than men declared using these therapies, and users were significantly younger than nonusers. Therapies were used for a variety of health conditions, but were most commonly used to treat pain (32%), anxiety (11%), cancer (9%), well-being (8%), and stress (7%). Patients mainly discussed use with family members (53%), doctors (52%), and/or partners (45%). Friends (29%), doctors (26%), or family members (18%) most commonly recommended therapies. Patients estimated spending a median of €330 over a median duration of 24 months. Depending on the therapy, 71%–92% of patients would recommend CIM to others.

Conclusions:

A substantial number of patients seen in French multipurpose clinics, particularly female and young adults, report using CIM. Patients have a positive opinion of these therapies, report using them long term, and devote a significant budget to them.

Introduction

Conventional, or Western, medicine is constantly progressing because of scientific research and development and has drastically improved the treatment of acute and life-threatening illnesses, as well as the management of chronic diseases, leading to increased survival rates. In addition to conventional medicine, there exists a category of health care practices known as Complementary and Integrative Medicine (CIM), which includes practices outside of the scope of Western medicine. The National Center for Complementary and Integrative Health defines five major domains within CIM: integrative medical systems, mind–body interventions, biologically-based treatments, manipulative and body-based methods, and energy therapies. CIM encompasses a variety of practices, some with ancient origins and others contemporary, often passed down orally, and lacking clinical studies and guidelines, which has created a barrier to their integration into evidence-based medicine.¹ Nevertheless, CIM is widely used around the world, with varying prevalence rates ranging from 9.8% to 76% globally,² and between 0.3% and 86% in Europe,³ depending on the country and the specific pathology.⁴ The primary motivation for the utilization of CIM in Europe is the perceived limitation of Western medicine to treat all health conditions effectively.³ A German study indicated that CIM is rarely used as a stand-alone treatment, but mainly used as a complement or in combination with conventional medicine.⁵

France’s health system can be described as a single public payer model that provides universal coverage. Medical care delivered by biomedically trained clinicians is typically covered and reimbursed by the national health system. CIM occupies a complex legal space in France. Although the law indicates that therapeutic care should be delivered by biomedically qualified professionals, CIM practitioners operate widely and openly. Their activities and qualifications are often organized collectively, with little to no state intervention.⁶

In France, CIM utilization has mainly been studied in targeted populations, such as patients with cancer,^7–10 in palliative care,¹¹ or with cardiac diseases¹² or in specific departments of a tertiary hospital.¹³ To our knowledge, no large-scale multicenter studies have been conducted in the general population. To address this gap, we conducted a large-scale survey in multidisciplinary clinics across France to explore the utilization of CIM among a diverse population with varying health profiles. The study aimed to examine the types of therapies used, the reasons for their use, their duration and associated costs, with whom patients communicate about these therapies, and patients’ perceptions of the therapies they used.

Patients and Methods

Patient inclusion

The SCERI healthcare cooperation consortium (Santé Cité Enseignement-Recherche-Innovation) set up a national survey on the use of CIM. The study was approved by the Institutional Review Board (IRB) of Montpellier University Hospital (IRB-MTP_2022_06_202201152) and conducted over a 2-week period in partnership with multidisciplinary clinics (medical, surgery, and obstetrics) across France. The authors specifically designed the questionnaire to describe CIM use in France. Questions were related to the patients’ characteristics, the types of therapies they used, the reasons for use, the costs, and the duration of use, as well as who recommended the therapy. The questionnaire was pilot-tested among the research team. Patients were informed of the objectives of the study, the procedures for processing their data, as well as their related rights. All French-speaking patients who were 18 years and older and consulting in participating clinics were eligible to participate in the study. Those who wished to participate responded anonymously to the questionnaire, which was made available by the admissions office, the secretary’s office, or in the waiting rooms of the establishments.

Data collection

Anonymized data provided in the questionnaires were hosted in each clinic and then centralized for analysis. Data included patients’ age, sex assigned at birth, and information on their use of CIM. Patients who declared having never used CIM were asked to indicate the reasons why. Patients reporting CIM use were asked who they talked to about it and which therapies they used. They could select therapies from a list, including osteopathy, massage, homeopathy, acupuncture, psychotherapy, hypnosis, magnetism, sophrology, reflexology, Chinese medicine, phytotherapy, meditation, naturopathy, chiropractic, kinesiology, aromatherapy, micronutrition, Ayurveda, shamanism, and bioenergy, or write in a response. For each therapy, patients were asked to indicate who had recommended the therapy to them, the health conditions concerned, the duration, and the cost, and whether they would recommend it to others.

Statistical analysis

A descriptive analysis was performed using the SAS® Enterprise Guide 8.2 software (SAS Institute Inc. 2019, Cary, NC, USA) and R version 4.3.1. Descriptive results are presented in terms of mean, standard deviation, median, lower (Q1) and upper (Q3) quartiles, minimum and maximum values for quantitative data, and in terms of number and proportion for qualitative data. For exploratory analyses, comparison of variables of interest was performed using χ² tests for categorical variables or Fisher’s exact tests and Wilcoxon Mann–Whitney or Student’s t-test for quantitative variables, according to the normality of the distribution, assessed with the Shapiro–Wilk test.

Results

Patient characteristics and CIM use

Between October 10 and 28, 2022, a total of 1183 completed questionnaires were collected in 26 multipurpose clinics in 10 regions of France (9 in mainland France and 1 overseas). Five questionnaires completed by minors were excluded. Therefore, in total, 1178 questionnaires completed by adult patients were included in the analysis.

The patients who responded to the questionnaire had a median age of 54 years (range: 18–92), and the sex ratio was 2.5 (72% were female, Table 1). Two-thirds of patients (N = 768; 65%) reported having used at least one CIM, and one-third (N = 410; 35%) reported having never used CIM. Those who reported using CIM were significantly younger (median age = 50 years) than nonusers (median age = 61 years) (p < 0.01, Table 1), and when considering age in quartiles, rates of CIM use were higher among patients under the age of 54 compared with those over the age of 54 (Fig. 1). A significant sex difference was also found, with a sex ratio of 3.6 (78% female) and 1.5 (60% female) among declared CIM users and nonusers, respectively (p < 0.01, Table 1).

FIG. 1.

Percentage of adults who have used CIM at least one time in their life. Patients were divided into age groups according to quartiles of population age: [18; 39], [39; 54], [54; 67], and [67; 92]. The proportion of patients reporting CIM use was higher among younger patients. CIM, Complementary and Integrative Medicine.

Table 1.

Characteristics of Patients Who Reported Using CIM at Least One Time Compared With Patients Who Reported Never Using CIM

	Total(N = 1178)	Use of ≥1 CIM(N = 768)	Never used CIM(N = 410)	p-Value
Age				<0.01
N	1159	757	402
Mean (±SD)	53.09 (±16.97)	51.03 (±16.28)	56.98 (±17.57)
Median	54.00	50.00	61.00
Interquartile range [Q1–Q3]	[39.00–67.00]	[38.00–63.00]	[43.00–71.00]
[Min–Max]	[18.00–92.00]	[18.00–92.00]	[18.00–89.00]
Sex
N	1175	765	410	<0.01
Male (%)	331 (28.17)	168 (21.96)	163 (39.76)
Female (%)	844 (71.83)	597 (78.04)	247 (60.24)

CIM, Complementary and Integrative Medicine; SD, standard deviation.

The use of 20 therapies was reported, with a mean of 4 therapies used per patient (median: 3.00; range: 1–18). The most commonly reported therapy was osteopathy (73% of cases) (Table 2), followed by massage (49%), homeopathy (36%), acupuncture (33%), psychotherapy (24%), hypnosis (20%), magnetism (19%), sophrology (17%), reflexology (17%), Chinese medicine (15%), phytotherapy (14%), meditation (13%), and naturopathy (11%). Other therapies were used by less than 10% of patients, including chiropractic, kinesiology, aromatherapy, micronutrition, Ayurveda, shamanism, and bioenergy.

Table 2.

Reported Used Therapies

Used therapies	n (%)^a
Osteopathy	562 (73)
Massage	374 (49)
Homeopathy	273 (36)
Acupuncture	250 (33)
Psychotherapy	186 (24)
Hypnosis	157 (20)
Magnetism	149 (19)
Sophrology	129 (17)
Reflexology	128 (17)
Chinese medicine	115 (15)
Phytotherapy	105 (14)
Meditation	96 (13)
Naturopathy	86 (11)
Other (unspecified)	69 (9)
Chiropractic	65 (9)
Kinesiology	65 (9)
Aromatherapy	60 (8)
Micronutrition	47 (6)
Ayurveda	30 (4)
Shamanism	22 (3)
Bioenergy	20 (3)
Total CIM use cases	2919

The % is expressed in relation to the total number of declared CIM users (N = 768).

CIM, Complementary and Integrative Medicine.

The primary reason why patients did not use CIM was that they did not think about them (44%). More rarely, patients reported that they did not use CIM because they did not believe in them (19%), because of their cost (11%), and/or because they did not know which therapy or therapist to consult (11%). A minority of patients reported never needing (7%) or being unaware of CIM (2%).

Reasons for CIM use

Patients were asked to explain why they used each therapy they mentioned. Pain was the most frequently reported reason for consulting CIM (32%) (Table 3), followed by anxiety (11%), cancer (9%), physical or mental well-being (8%), and stress (7%). In less than 5% of cases, other reasons such as endometriosis, addiction, fatigue, or health prevention were reported.

Table 3.

Reasons for CIM Use

Reason for therapy use	N	(%; n = 2919)^a
Pain	923	31.6
Anxiety	307	10.5
Cancer	257	8.8
Well-being (physical or mental)	233	8.0
Stress	198	6.8
Endometriosis	132	4.5
Addiction	87	3.0
Fatigue	60	2.1
Health prevention	54	1.8
Traumatic injury	54	1.8
Sleep troubles	52	1.8
Pregnancy	43	1.5
Infection	42	1.4
Dermatologic disorders	40	1.4
Pre- or postsurgery	38	1.3
Arthrosis	29	1.0
Eating disorders	27	0.9
Blocking	25	0.9
Fibromyalgia	24	0.8
Respiratory disorders	21	0.7
Blood flow disorders	20	0.7
Digestive disorders	16	0.5
Fertility disorders	16	0.5
Neurological disorders	12	0.4
Drainage	8	0.3

The frequency of each reason is expressed in % of the total number of reported CIM use cases (n = 2919).

Duration and budget dedicated to CIM

Patients were asked to estimate how long they used and the budget they spent on each therapy. Estimated therapy durations varied from less than 2 weeks to decades depending on the therapies and the patients (Table 4). The median durations of use for each therapy ranged from 4.5 (hypnosis) to 18.5 (aromatherapy) months, with a median duration of 12.0 months reported for 14 of the 20 therapies. The median duration of use of all of the therapies, considered together, was 24 months. The estimated median budget for each therapy ranged from €10 (meditation) to €300 (psychotherapy). The estimated median budget for all therapies, considered together, was €330 (Q1: 120; Q3: 900).

Table 4.

Patient Experience of CIM

	Duration^a (months)		Budget^a (euros)				Recommendation to others^b
	Median [Min–Max]	n	Median [Min–Max]	Q1	Q3	n	YES	NO	No answer
Therapy n (%)
Osteopathy	12.0 [0.3–324.0]	362	150.0 [0.0–4000.0]	96.0	300.0	385	517 (92.0)	14 (2.5)	31 (5.5)
Massage	12.0 [0.5–420.0]	206	100.0 [0.0–5000.0]	40.0	300.0	181	333 (89.0)	7 (1.9)	34 (9.1)
Homeopathy	12.0 [0.3–516.0]	103	50.0 [0.0–6000.0]	25.0	180.0	85	214 (78.4)	27 (9.9)	32 (11.7)
Acupuncture	12.0 [0.3–480.0]	146	115.0 [0.0–6000.0]	0.0	300.0	130	189 (75.6)	44 (17.6)	17 (6.8)
Psychotherapy	12.0 [0.3–360.0]	149	300.0 [0.0–20000.0]	60.0	700.0	110	160 (86.0)	11 (5.9)	15 (8.1)
Hypnosis	4.5 [0.3–120.0]	98	100.0 [0.00–1000.0]	60.0	225.0	108	117 (74.5)	26 (16.6)	14 (8.9)
Magnetism	6.0 [0.5–180.0]	90	85.0 [0.0–3600.0]	45.0	200.0	100	130 (87.2)	10 (6.7)	9 (6.0)
Sophrology	6.0 [1.0–120.0]	85	100.0 [0.0–2000.0]	0.0	250.0	78	101 (78.3)	10 (7.8)	18 (14.0)
Reflexology	9.0 [1.0–240.0]	66	60.0 [0.0–1400.0]	0.0	150.0	75	108 (84.4)	5 (3.9)	15 (11.7)
Chinese medicine	12.0 [0.5–324.0]	65	120.0 [0.0–11250.0]	50.0	400.0	67	96 (83.5)	7 (6.1)	12 (10.0)
Phytotherapy	12.0 [0.3–360.0]	51	150.0 [0.0–3600.0]	60.0	300.0	42	89 (84.8)	3 (2.9)	13 (12.4)
Meditation	12.0 [1.0–420.0]	55	10.0 [0.0–7950.0]	0.0	260.0	50	89 (92.7)	2 (2.1)	5 (5.2)
Naturopathy	12.0 [1.0–360.0]	43	170.0 [0.0–2000.0]	90.0	300.0	50	69 (80.2)	5 (5.8)	12 (14.0)
Other (unspecified)	6.0 [1.0–420.0]	53	150.0 [0.0–5400.0]	0.0	360.0	42	64 (90.1)	1 (1.4)	6 (8.5)
Chiropractic	12.0 [0.5–228.0]	44	160.0 [0.0–1125.0]	80.0	300.0	45	55 (84.6)	7 (10.8)	3 (4.6)
Kinesiology	12.0 [1.0–240.0]	43	150.0 [0.0–1000.0]	60.0	240.0	30	46 (70.8)	10 (15.4)	9 (13.8)
Aromatherapy	18.5 [1.0–360.0]	26	150.0 [0.0–600.0]	60.0	200.0	26	49 (81.7)	0 (0.0)	11 (18.3)
Micronutrition	12.0 [2.0–360.0]	32	285.0 [0.0–1400.0]	100.0	500.0	26	40 (85.1)	2 (4.3)	5 (10.6)
Ayurveda	12.0 [0.5–48.0]	11	150.0 [60.0–1500.0]	100.0	570.0	24	22 (73.3)	2 (6.7)	6 (20.0)
Shamanism	12.0 [0.5–144.0]	9	80.0 [0.0–5000.0]	0.0	150.0	17	16 (72.7)	1 (4.5)	5 (22.7)
Bioenergy	8.5 [1.0–120.0]	14	200.0 [0.0–500.0]	150.0	400.0	9	16 (80.0)	3 (15.0)	1 (5.0)
Total	24.0 [0.3–2232.0]	581	330.0 [0.0–26250.0]	120.0	900.0	575	—	—	—

Patients were asked to estimate how long they had each therapy and the budget they spent on it. The total duration and budget were calculated considering all the therapies followed by the patient.

For each therapy they used, patients were asked whether they would recommend it to others. The % of the answer (YES, NO, or No answer) is expressed in relation to the total number of declared CIM users (N = 768).

Patient opinion and communication about CIM

Depending on the therapy, 71%–92% of patients would recommend CIM to others (Table 4). The most highly recommended CIM was osteopathy (92%), then massage (89%), psychotherapy (86%), homeopathy (78%), and acupuncture (76%). In general, CIM users reported discussing therapies with their family members (53%, Table 5), doctors (52%), and/or partners (45%). When patients were asked who advised them to use each therapy, friends (29% of the therapy use cases), doctors (26%), or family members (18%) were most frequently cited.

Table 5.

Patient Communication About CIM

	n (%)
Patients who reported using at least one CIM discussed their therapy with^a
Family	409 (53)
Doctor	396 (52)
Partner	344 (45)
Friends	86 (11)
Nobody	42 (5)
Others^b	30 (4)
Patients were advised to use CIM by^c
Friends (%)	838 (29)
Doctor (%)	772 (26)
Family (%)	536 (18)
Internet (%)	59 (2)
Others^d	484 (17)

The % is expressed in relation to the total number of declared CIM users (N = 768).

Other responses to the open question included other people in the patient’s entourage, other health professionals, health centers, or associations. Each response accounted for ≤1% proportion of patients.

For each therapy they used, patients were asked to indicate on whose advice they had used it. The % of each answer is expressed in relation to the total number of reported CIM use cases (N = 2919).

Other responses to the open question included CIM practitioner, pharmacist, other health professionals, health centers or associations, colleagues, literature, and so on. Each response accounted for ≤1% proportion of patients.

Discussion

The objective of this survey was to investigate the types of CIM therapies used, the reasons for their use, the duration of their use, and the associated costs in a large population of patients with varied health profiles. Among the 1178 patients who responded to the questionnaire, 65% reported that they had used at least one CIM. Prior national surveys in France have reported similarly high rates of CIM use, ranging from 56% to 89%.^14–16 Previous studies focusing on CIM use in specific health conditions, or for targeted health services, reported widely varying rates of use, ranging from 21% to 91%.^{7–9,11–13} Our survey included patients consulting multiple medical specialties offered by multidomain clinics. The reported reasons for CIM use encompassed a wide variety of health conditions, with pain being the most common, followed by anxiety, cancer, and well-being.

Patients who reported using CIM were significantly more likely to be female and younger than nonusers. Data from previous studies suggest that sociodemographic factors are associated with CIM use. In particular, people who use CIM tend to be middle aged, college educated, and female.¹⁷ The higher prevalence of CIM use among females has been widely observed nationally and internationally.^{3,5,9,15,18,19} Studies found that females frequently use CIM for typically female health conditions, such as pregnancy²⁰ or endometriosis.²¹ However, too few patients in our study reported using CIM for such reasons to explain the sex ratio differences observed between groups. However, sociocultural reasons may contribute to lower use among men, as they are generally less likely to seek help from health care professionals.²² Reasons for CIM use may be multifactorial and dependent on the type of CIM.²³ Other factors such as difficulty accessing care (e.g., geographical limitation), limited time spent with patients, difficulty managing chronic pathologies, and easy access to different sources of health information via the media and the internet could also encourage the use of these practices.¹⁶ A previous study identified social media as the main source for the introduction to and promotion of CIM.²⁴ All of these factors could also explain the simultaneous use of CIM observed in our study and in previous studies.^12,25

Osteopathy, massage, homeopathy, acupuncture, and psychotherapy were the most commonly reported therapies. Although the first four therapies have come up extensively in previous studies, psychotherapy has rarely been cited.^3,7,11,26 The classification and definition of psychotherapy are ambiguous, encompassing several schools and techniques such as eye movement desensitization and reprocessing or systemic therapy. This subject is still debated among professionals,²⁷ and several terms can be associated with psychotherapy, including hypnosis and sophrology.¹⁰

CIM is generally used as a complement to conventional medicine,⁵ particularly in cancer where their use is primarily aimed at reducing side effects and improving physical and mental well-being.^7,8,26 In some cases, CIM is integrated into lifestyle practices, rather than for therapeutic purposes, particularly when used regularly and over long periods. Our results identified several long-term therapies, some spanning decades. Further studies should aim to improve our understanding of patient use patterns of CIM, including frequency and duration, and consider different health conditions and therapies.

Patients estimated spending a median of €330 over a median therapy duration of 24 months. According to French surveys, one of the obstacles to using CIM is its cost.^14,15 However, a 2023 poll found that the average annual expenditure was €173, with 41% of responders spending between €100 and €499.¹⁶ In Europe, maximum expenditures reached €4,140/month in 2005.²⁵ Such expenditures have also been observed in the United States, even among low-income patients.²⁸ Patient expenses can be reduced through coverage by mutual and insurance companies.^29,30 Recently in France, some insurers have offered flat-rate coverage for CIM consultations, which may explain the €0 budgets reported in our survey. In contrast, long therapy durations and multiple CIM use may lead to substantial expenses.

Patients generally have a favorable opinion of CIM.^9,12,14,15 This was confirmed in our survey, with 71%–92% of patients stating that they would recommend the therapy, depending on the modality. CIM users mainly discussed their use with their family, doctor, and/or partner. In total, 52% of patients reported discussing their CIM use with doctors, which was on par with the percentage of individuals who discussed their therapy with their family (53%). Nevertheless, almost half of the patients had not informed their doctor of their CIM, thus preventing proper monitoring of their care. Furthermore, the use of CIM was advised by the doctor in only 26% of cases. On the contrary, the main reason patients reported not using CIM was that they did not think about it. There is a need to improve patient–doctor communication and raise doctors’ awareness of CIM.^31,32 Increased knowledge of CIM would help doctors make decisions, advise patients, coordinate, and monitor their overall care, thereby improving treatment and outcomes.³³ A Canadian study found that doctors show interest in receiving additional training on CIM, which would allow them to monitor possible interactions with conventional treatments, compliance, or even abandonment of the treatment.³⁴ In terms of public health, this would limit costs with less use of medications and shorter hospital stays.³⁵ As health care moves toward preventive medicine, integrative practices are becoming essential,³⁶ and the World Health Organization encourages considering both traditional and complementary health care.³⁷ Supportive care is developing particularly in oncology, with training programs for caregivers.^38–40 In France, a standardized framework for evaluating CIM has been created to facilitate their integration into medical practice.⁴¹

Our study has limitations. The first lies in the methodology based on a self-reported questionnaire rather than on actual use. Due to recall bias, the subjects could remember information incorrectly, overestimate or underestimate their use, or be influenced by personal biases. Furthermore, surveying individuals consulting in clinics may have introduced a selection bias as these individuals may have different health resource use behaviors compared with the general population. These individuals may also have better access to care, due to either their geographical location or their financial situation. In addition, data from the questionnaire did not enable us to link patients’ symptoms to CIM use or determine when multiple CIM therapies were used to treat the same symptoms. Nevertheless, this observational study will facilitate the development of future studies targeting the health conditions identified in the present study (wellness, pain, anxiety, cancer) and CIM use. Furthermore, representativeness of the sample was not ensured. However, the results from over 1000 patients in a total of 26 clinics spread over 10 regions of France provide an overview of CIM use across the country, patients’ behaviors, and communication related to CIM.

Conclusion

In conclusion, this large-scale survey highlights the substantial use of CIM in France, particularly among females and young adults. Osteopathy, massage, homeopathy, acupuncture, and psychotherapy were the most commonly used modalities. CIM is used for a wide variety of health conditions, but are most commonly used for pain, anxiety, cancer, and well-being. The patients have a positive opinion of CIM, report using the therapies long term, and devote a significant budget to them. The study encourages health care professionals to communicate to their patients about these therapies. Further studies should provide a better understanding of both patients’ behaviors and doctors’ approach to CIM use.

Footnotes

Acknowledgments

The authors would like to thank the SCERI health-care cooperation consortium for promoting and sponsoring the study through their established network, François Roux, pharmacist in Plaisance du Touch, France, for his contribution to the project conception, and Sylvie Poulette, PhD, Bordeaux, France, for her contribution as a medical writer of this article. The authors would also like to acknowledge the Clinique Tivoli Ducos, Hopital Privé de Provence, Clinique Médipôle Garonne, Clinique St-Vincent, Clinique Ste-Clotilde, Clinique Charcot, Clinique de la Mitterie, Clinique Victor Pauchet, Clinique du Trocadéro, Polyclinique St-Côme, Clinique St-Joseph, Clinique Saint-Exupéry, CMC Bizet, Clinique Rive Gauche, Polyclinique Longues Allées, Polyclinique de la Reine Blanche, Centre Cardiologique du Nord, Centre Cardiologique du Nord Porte de Paris, Clinique Ste-Isabelle, SAS Cardiologie Urgences, Cliniques Ste-Geneviève, Clinique du Louvre, Clinique des Cèdres, Clinique Saint-Hilaire, Clinique de St-Joseph, and Polyclinique du Contentin for patient recruitment.

Authors’ Contributions

C.R. and I.P. contributed to the conceptualization. L.C. participated in funding acquisition and project administration. J.V. conducted the investigation. N.M. was responsible for methodology and formal analysis. G.N. conducted the validation. All coauthors contributed to writing and reviewing of the article.

Author Disclosure Statement

The authors have no conflicts of interest to declare for the present study.

Funding Information

This research did not receive any external funding or support from agencies in the public, commercial, or not-for-profit sectors.

Abbreviations Used

References

Tabish

. Complementary and alternative healthcare: Is it evidence-based? Int J Health Sci (Qassim), 2008; 2(1):V–VIX.

Harris

, Cooper

, Relton

, et al. Prevalence of complementary and alternative medicine (CAM) use by the general population: A systematic review and update: CAM use by general population. Int J Clin Pract, 2012; 66(10):924–939.

Eardley

, Bishop

, Prescott

, et al. A systematic literature review of complementary and alternative medicine prevalence in EU. Forsch Komplementmed, 2012; 19(Suppl 2):18–28.

Abdullah

, Borhanuddin

, Patah

AEA

, et al. Utilization of complementary and alternative medicine in multiethnic population: The Malaysian cohort study. J Evid Based Integr Med, 2018; 23:2515690X18765945.

Jeitler

, Ortiz

, Brinkhaus

, et al. Use and acceptance of traditional, complementary and integrative medicine in Germany-an online representative cross-sectional study. Front Med (Lausanne), 2024; 11:1372924.

Cloatre

. Regulating alternative healing in France, and the problem of ‘non-medicine’. Med Law Rev, 2019; 27(2):189–214.

Gras

, Vallard

, Brosse

, et al. Use of complementary and alternative medicines among cancer patients: A single-center study. Oncology, 2019; 97(1):18–25.

Sarradon-Eck

, Rey

, Touzani

, et al. Use of non-conventional medicine and lifestyle change among cancer survivors: Evidence from the national VICAN survey. J Cancer Surviv, 2020; 14(6):779–789.

Dupin

, Arsène-Henry

, Charleux

, et al. Prevalence and expectations of ‘alternative and complementary medicine’ use during radiotherapy in 2016: A prospective study. Cancer Radiother J Soc Francaise Radiother Oncol, 2018; 22:682–687.

10.

Lognos

, Carbonnel

, Boulze Launay

, et al. Complementary and alternative medicine in patients with breast cancer: Exploratory study of social network forum data. JMIR Cancer, 2019; 5(2):e12536.

11.

Filbet

, Schloss

, Maret

J-B

, et al. The use of complementary medicine in palliative care in France: An observational cross-sectional study. Support Care Cancer, 2020; 28(9):4405–4412.

12.

Dalmayrac

, Quignon

, Baufreton

. Complementary and alternative medicine in cardiac surgery: Prevalence and modality of use. Heart Lung Circ, 2016; 25(7):712–718.

13.

Michel-Cherqui

, Had-Bujon

, Mongereau

, et al. Knowledge and use of complementary therapies in a tertiary care hospital in France: A preliminary study. Medicine (Baltimore), 2020; 99(45):e23081.

14.

Harris Interactive. Observatoire des parcours de soins des Français. Thème 3 : Les Français et les médecines douces. 2019. Une étude Harris Interactive pour Santéclair. Available from: https://harris-interactive.fr/opinion_polls/observatoire-des-parcours-de-soins-des-francais-theme-3-les-francais-et-les-medecines-douces/

15.

Médoucine, Harris Interactive. Enquête sur la santé des Français et leurs relations aux médecines douces en période de COVID. 2021. Etude Harris Interactive pour Médoucine. Available from: https://www.medoucine.com/blog/wp-content/uploads/2021/04/Enqu%C3%AAte-sur-la-sant%C3%A9-des-Fran%C3%A7ais-et-leurs-relations-aux-m%C3%A9decines-douces-en-p%C3%A9riode-de-COVID_Medoucine-Harris-Interactive-Mars-2021-.pdf

16.

Odoxa. Les Français et les thérapies alternatives. Sondage réalisé pour l’Union Nationale des Associations de Défense des familles et de l’Individu victimes de sectes (UNADFI), avec le soutien de la Mission Interministérielle de vigilance et de lutte contre les dérives sectaires (Miviludes). 2023. Available from: https://www.odoxa.fr/sondage/les-francais-et-les-therapies-alternatives/

17.

Bishop

, Lewith

. Who Uses CAM? A narrative review of demographic characteristics and health factors associated with CAM Use. Evid Based Complement Alternat Med, 2010; 7(1):11–28.

18.

Peltzer

, Pengpid

. Prevalence and determinants of traditional, complementary and alternative medicine provider use among adults from 32 countries. Chin J Integr Med, 2018; 24(8):584–590.

19.

Guillaud

, Darbois

, Allenet

, et al. Predictive factors of complementary and alternative medicine use in the general population in Europe: A systematic review. Complement Ther Med, 2019; 42:347–354.

20.

Bowman

, Davis

, Ferguson

, et al. Women’s motivation, perception and experience of complementary and alternative medicine in pregnancy: A meta-synthesis. Midwifery, 2018; 59:81–87.

21.

Adamietz

, Boosz

, Mueller

, et al. Complementary and alternative medicine (CAM) in women with endometriosis. Eur J Obstet Gynecol Reprod Biol, 2021; 262:7–12.

22.

Galdas

, Cheater

, Marshall

. Men and health help-seeking behaviour: Literature review. J Adv Nurs, 2005; 49(6):616–623.

23.

Perlman

, Lontok

, Huhmann

, et al. Prevalence and correlates of postdiagnosis initiation of complementary and alternative medicine among patients at a comprehensive cancer center. J Oncol Pract, 2013; 9(1):34–41.

24.

Youn

B-Y

, Moon

, Mok

, et al. Use of traditional, complementary and alternative medicine in nine countries: A cross-sectional multinational survey. Complement Ther Med, 2022; 71:102889.

25.

Molassiotis

, Fernández-Ortega

, Pud

, et al. Use of complementary and alternative medicine in cancer patients: A European survey. Ann Oncol, 2005; 16(4):655–663.

26.

Rossi

, Vita

, Baccetti

, et al. Complementary and alternative medicine for cancer patients: Results of the EPAAC survey on integrative oncology centres in Europe. Support Care Cancer, 2015; 23(6):1795–1806.

27.

Thurin

J-M

. De l’évaluation des psychothérapies à la recherche en psychothérapie et en psychanalyse. Res Psychoanal, 2017; N° 23(1):55a–68a.

28.

Foster

, Phillips

, Hamel

, et al. Alternative medicine use in older Americans. J Am Geriatr Soc, 2000; 48(12):1560–1565.

29.

Pelletier

, Astin

. Integration and reimbursement of complementary and alternative medicine by managed care and insurance providers: 2000 update and cohort analysis. Altern Ther Health Med, 2002; 8(1):38–39, 42, 44 passim.

30.

Steyer

, Freed

, Lantz

. Medicaid reimbursement for alternative therapies. Altern Ther Health Med, 2002; 8(6):84–88.

31.

Stub

, Quandt

, Arcury

, et al. Complementary and conventional providers in cancer care: Experience of communication with patients and steps to improve communication with other providers. BMC Complement Altern Med, 2017; 17(1):301.

32.

Aizuddin

, Zamzuri

M’IA

, Mansor

, et al. Perception of integrating complementary and alternative medicine practice in patient’s treatment among the healthcare practitioners: A systematic review. Pan Afr Med J, 2022; 43:19.

33.

Berretta

, Rinaldi

, Taibi

, et al. Physician attitudes and perceptions of Complementary and Alternative Medicine (CAM): A multicentre Italian study. Front Oncol, 2020; 10:594.

34.

Gaboury

, Johnson

, Robin

, et al. Médecines alternatives et complémentaires: Les médecins se considèrent-ils en mesure de répondre aux exigences du Collège des médecins du Québec? Can Fam Physician Med Fam Can, 2016; 62:e767–e771.

35.

Kooreman

, Baars

. Patients whose GP knows complementary medicine tend to have lower costs and live longer. Eur J Health Econ, 2012; 13(6):769–776.

36.

Hood

, Flores

. A personal view on systems medicine and the emergence of proactive P4 medicine: Predictive, preventive, personalized and participatory. N Biotechnol, 2012; 29(6):613–624.

37.

von Schoen-Angerer

, Manchanda

, Lloyd

, et al. Traditional, complementary and integrative healthcare: Global stakeholder perspective on WHO’s current and future strategy. BMJ Glob Health, 2023; 8(12):e013150.

38.

Witt

. Training oncology physicians to advise their patients on complementary and integrative medicine. J Altern Complement Med, 2018; 24(9–10):1016–1017.

39.

Lyman

, Greenlee

, Bohlke

, et al. Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. J Clin Oncol, 2018; 36(25):2647–2655.

40.

Fink

, Burns

, Perez Moreno

, et al. A quality brief of an oncological multisite massage and acupuncture therapy program to improve cancer-related outcomes. J Altern Complement Med N Y N, 2020; 26:820–824.

41.

Ninot

, Descamps

, Achalid

, et al. NPI Model: Standardised Framework for Evaluating Non-Pharmacological Interventions in the French Health Context Authors. 2023. Available from: https://hal.science/hal-04360550 [Last accessed: April 9, 2024].