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Yorgancı A, Öztürk UK, Evliyaoğlu Bozkurt Ö, Akyol M, Pay RE, Engin-Ustun Y. Complementary and Alternative Medicine Attitudes of Gynecologic Patients: Experience in a Tertiary Clinic. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:853-861. [PMID: 34872144 PMCID: PMC10183933 DOI: 10.1055/s-0041-1739462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To evaluate the knowledge, attitudes, and behaviors regarding complementary and alternative medicine methods of patients who were admitted to gynecology outpatient clinics. METHODS In the present survey, a questionnaire on complementary and alternative medicine practices was applied on 1,000 women (ages between 18 and 83 years old) who were admitted to the gynecology outpatient clinic of a tertiary maternity hospital. Demographic features and knowledge, attitudes, and behaviors about these methods were inquired in face-to-face interviews. RESULTS While 80.7% of the total participants thought that complementary and alternative medicine was beneficial, only 37.5% of them had used these methods previously. The rate of prior knowledge on this subject was of 59.7% and the source of information was physicians for 8.5% of the patients. However, 72.4% of all participants wanted to obtain information on these methods and 93.7% wanted to be informed by physicians. In the decision tree model, having knowledge about complementary and alternative medicine was the most effective factor determining its use (p < 0.001). Phytotherapy was found to be the most used method, with 91.4%. The most preferred plant was onion (18.9%), and the most common reasons for herbal use were stress (15.4%) and fatigue (15.2%). CONCLUSION More than one-third of the patients who applied to the gynecology outpatient clinics used one of the complementary and alternative medicine methods at least once. As gynecologists and obstetricians, we need to be more knowledgeable about these methods to provide correct guidance to our patients for accessing accurate and effective information.
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Affiliation(s)
- Ayçağ Yorgancı
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Uğur Kemal Öztürk
- Department of Obstetrics and Gynecology, İstanbul Zeynep Kamil Women and Child Diseases Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Özlem Evliyaoğlu Bozkurt
- Department of Obstetrics and Gynecology, Ankara Gülhane Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mesut Akyol
- Department of Biostatistics and Medical Informatics, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Ramazan Erda Pay
- Department of Obstetrics and Gynecology, Ankara Gülhane Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Yaprak Engin-Ustun
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Women's Health Education and Research Hospital, University of Health Sciences, Ankara, Turkey
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The Use of Complementary and Alternative Medicine in Thai Gynecologic Oncology Patients: Influencing Factors. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:1322390. [PMID: 34804172 PMCID: PMC8598354 DOI: 10.1155/2021/1322390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/26/2021] [Indexed: 01/22/2023]
Abstract
Background To determine the factors influencing the use of complementary and alternative medicine (CAM) in gynecologic cancer patients and the prevalence and pattern of CAM use. Methods This was a cross-sectional study of 370 gynecologic cancer patients conducted at the outpatient clinic, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. After obtaining informed consent, participants were asked to complete a standardized questionnaire including sociodemographic and clinical characteristics, detail of CAM use, attitude of CAM use, and quality of life using EORTC-QLQ-C30. Results The prevalence of CAM use was 25.13%. The most common type was herbal medicine (55.90%). The participants who resided or had a birthplace in rural areas presented with a higher proportion of CAM use than those in urban areas (P=0.470 and P=0.004, respectively). Participants who received multiple modalities of cancer treatment reported a significantly higher proportion of CAM use (P=0.024). Most CAM users agreed that the CAM could be used in combination with standard treatment, and some rather disagreed that CAM could interrupt the treatment effect of the conventional treatment. CAM users had significantly higher role functioning in quality-of-life scores. Conclusion Factors influencing CAM use in gynecologic cancer patients were rural area birthplace or residency, receiving multiple modalities of cancer treatment, having positive attitude toward CAM use. CAM users had better performance in role functioning in the quality-of-life score. Therefore, gynecologic oncologists should pay attention to these factors in order to communicate with gynecologic cancer patients about CAM use.
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Greenfield G, Shmueli L, Harvey A, Quezada-Yamamoto H, Davidovitch N, Pliskin JS, Rawaf S, Majeed A, Hayhoe B. Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. BMJ Open 2021; 11:e044033. [PMID: 34561250 PMCID: PMC8475134 DOI: 10.1136/bmjopen-2020-044033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To review the characteristics and motivations of patients seeking second opinions, and the impact of such opinions on patient management, satisfaction and cost effectiveness. DATA SOURCES Embase, Medline, PsycINFO and Health Management Information Consortium (HMIC) databases. STUDY DESIGN A systematic literature search was performed for terms related to second opinion and patient characteristics. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. DATA COLLECTION/EXTRACTION METHODS We included articles focused on patient-initiated second opinions, which provided quantitative data on their impact on diagnosis, treatment, prognosis or patient satisfaction, described the characteristics or motivating factors of patients who initiated a second opinion, or the cost-effectiveness of patient-initiated second opinions. PRINCIPAL FINDINGS Thirty-three articles were included in the review. 29 studies considered patient characteristics, 19 patient motivating factors, 10 patient satisfaction and 17 clinical agreement between the first and second opinion. Seeking a second opinion was more common in women, middle-age patients, more educated patients; and in people having a chronic condition, with higher income or socioeconomic status or living in central urban areas. Patients seeking a second opinion sought to gain more information or reassurance about their diagnosis or treatment. While many second opinions confirm the original diagnosis or treatment, discrepancies in opinions had a potential major impact on patient outcomes in up to 58% of cases. No studies reported on the cost effectiveness of patient initiated second opinions. CONCLUSIONS This review identified several demographic factors associated with seeking a second opinion, including age, gender, health status, and socioeconomic status. Differences in opinion received, and in the impact of change in opinion, varies significantly between medical specialties. More research is needed to understand the cost effectiveness of second opinions and identify patient groups most likely to benefit from second opinions.
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Affiliation(s)
- Geva Greenfield
- Primary Care and Public Health, School of Public Health, Imperial College London Department of Life Sciences, London, UK
| | - Liora Shmueli
- Department of Management, Bar-Ilan University, Ramat-Gan, Israel
| | - Amy Harvey
- Primary Care and Public Health, School of Public Health, Imperial College London Department of Life Sciences, London, UK
| | - Harumi Quezada-Yamamoto
- Primary Care and Public Health, School of Public Health, Imperial College London Department of Life Sciences, London, UK
| | - Nadav Davidovitch
- Health Policy and Management, School of Public Health, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Joseph S Pliskin
- Health Policy and Management, School of Public Health, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Salman Rawaf
- Primary Care and Public Health, School of Public Health, Imperial College London Department of Life Sciences, London, UK
| | - Azeem Majeed
- Primary Care and Public Health, School of Public Health, Imperial College London Department of Life Sciences, London, UK
| | - Benedict Hayhoe
- Primary Care and Public Health, School of Public Health, Imperial College London Department of Life Sciences, London, UK
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Second medical opinion in oncological setting. Crit Rev Oncol Hematol 2021; 160:103282. [PMID: 33675905 DOI: 10.1016/j.critrevonc.2021.103282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 01/23/2021] [Accepted: 02/27/2021] [Indexed: 11/20/2022] Open
Abstract
Oncological patients increasingly require second medical opinions to feel more likely confident with their oncologists and treatments, although this could lead to wrong opinions and delay in the start of treatments. Second opinions can be required also by physicians to obtain advices, especially in case of rare tumors. The request of new opinions is documented in radiology and pathology settings too, with not negligible discrepancy rate. Conversely, the role in general medical/surgical conditions has not been well established. Literature is poor of studies relative to second opinions or they are more focused on patient's motivations. For these reasons, AIOM (Italian Association of Medical Oncology) and AIOM Foundation faced this topic during the 7th Annual Meeting on Ethics in Oncology (Ragusa, 4-5 t h May 2018). In this position paper we report reasons, limits, advantages and outcomes of second medical opinion and the respective Decalogue in the oncological setting.
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Lehmann V, Smets EMA, de Jong M, de Vos FYF, Kenter GG, Stouthard JM, Hillen MA. Reducing uncertainty: motivations and consequences of seeking a second opinion in oncology. Acta Oncol 2020; 59:1512-1519. [PMID: 32702254 DOI: 10.1080/0284186x.2020.1794036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cancer patients increasingly seek second opinion (SO) consultations, but there is scarce empirical evidence to substantiate medical and psychological benefits for patients. This is the first study to examine patient- and oncologist-reported (1) motivations and expectations of patients to seek a SO, (2) the perceived medical outcome, and (3) psychological consequences of SOs over time (i.e. patients' uncertainty and anxiety). MATERIAL AND METHODS This multi-informant longitudinal cohort study (SO-COM) included consecutive cancer patients referred for a SO (N = 70; age 28-85), as well as their referring and consulting oncologists. Outcome measures were completed at three time points: Patients and referring oncologists reported motivations and expectations before the SO (T0), patients and consulting oncologists reported the medical outcome of the SO (i.e. discrepancy between first and second opinion) immediately following the SO (T1), and patients reported their uncertainty and anxiety at T0, T1, and two months following the SO (T2). RESULTS Cancer patients most frequently reported wanting expert advice, exhausting all options, and/or needing more information as motivations for SOs. Referring oncologists rather accurately anticipated these motivations, except most did not recognize patients' information needs. The vast majority of patients (90.0%) received a medical advice similar to the first opinion, although 65.7% had expected to receive a different opinion. Patients' uncertainty (F = 6.82, p=.002; η2 =.22), but not anxiety (F = 3.074, p=.055, η2 =.11) was significantly reduced after the SO. CONCLUSIONS SOs can yield psychological benefits by reducing patients' uncertainty, but the added medical value remains debatable. Referring oncologists may not be fully aware of their patients' information needs. Patients should be better informed about goals and benefits of SOs to better manage their expectations. More cost-effective ways of optimally providing medically and psychologically valuable SOs need to be explored.
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Affiliation(s)
- Vicky Lehmann
- Department of Medical Psychology, Amsterdam UMC, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Ellen M. A. Smets
- Department of Medical Psychology, Amsterdam UMC, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Maxime de Jong
- Department of Medical Psychology, Amsterdam UMC, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Filip Y. F. de Vos
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gemma G. Kenter
- Department of Gynaecologic Oncology, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Center for Gynaecologic Oncology Amsterdam, Department of Gynaecology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Marij A. Hillen
- Department of Medical Psychology, Amsterdam UMC, Amsterdam Public Health, Amsterdam, The Netherlands
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After encounters: revealing patients’ unseen work through their pathways to care. INTERNATIONAL JOURNAL OF MIGRATION HEALTH AND SOCIAL CARE 2020. [DOI: 10.1108/ijmhsc-07-2019-0066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Research has long focused on the notion of access and the trajectory towards a healthcare encounter but has neglected what happens to patients after these initial encounters. This paper focuses attention on what happens after an initial healthcare encounter leading to a more nuanced understanding of how patients from a diverse range of backgrounds make sense of medical advice, how they mix this knowledge with other forms of information and how they make decisions about what to do next.
Design/methodology/approach
Drawing on 160 in-depth interviews across four European countries the paper problematizes the notion of access; expands the definition of “decision partners”; and reframes the medical encounter as a journey, where one encounter leads to and informs the next.
Findings
This approach reveals the significant unseen, unrecognised and unacknowledged work that patients undertake to solve their health concerns.
Originality/value
De-centring the professional from the healthcare encounter allows us to understand why patients take particular pathways to care and how resources might be more appropriately leveraged to support both patients and professionals along this journey.
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Shmueli L, Shmueli E, Pliskin JS, Balicer RD, Davidovitch N, Hekselman I, Greenfield G. Second opinion utilization by healthcare insurance type in a mixed private-public healthcare system: a population-based study. BMJ Open 2019; 9:e025673. [PMID: 31352409 PMCID: PMC6661653 DOI: 10.1136/bmjopen-2018-025673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To evaluate the utilisation (overall and by specialty) and the characteristics of second-opinion seekers by insurance type (either health fund or supplementary insurance) in a mixed private-public healthcare. DESIGN An observational study. SETTING Secondary care visits provided by a large public health fund and a large supplementary health insurance in Israel. PARTICIPANTS The entire sample included 1 392 907 patients aged 21 years and above who visited at least one specialist over an 18 months period, either in the secondary care or privately via the supplementary insurance. OUTCOMES MEASURES An algorithm was developed to identify potential second-opinion instances in the dataset using visits and claims data. Multivariate logistic regression was used to identify characteristics of second-opinion seekers by the type of insurance they used. RESULTS 143 371 (13%) out of 1 080 892 patients who had supplementary insurance sought a single second opinion, mostly from orthopaedic surgeons. Relatively to patients who sought second opinion via the supplementary insurance, second-opinion seekers via the health fund tended to be females (OR=1.2, 95% CI 1.17 to 1.23), of age 40-59 years (OR=1.36, 95% CI 1.31 to 1.42) and with chronic conditions (OR=1.13, 95% CI 1.08 to 1.18). In contrast, second-opinion seekers via the supplementary insurance tended to be native-born and established immigrants (OR=0.79, 95% CI 0.76 to 0.84), in a high socioeconomic level (OR=0.39, 95% CI 0.37 to 0. 4) and living in central areas (OR=0.88, 95% CI 0.85 to 0.9). CONCLUSIONS Certain patient profiles tended to seek second opinions via the supplementary insurance more than others. People from the centre of the country and with a high socioeconomic status tended to do so, as medical specialists tend to reside in central urban areas. Further research is recommended to examine the availability of medical specialists by specialty and residence.
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Affiliation(s)
- Liora Shmueli
- Department of Management, Bar Ilan University, Ramat Gan, Israel
| | - Erez Shmueli
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Joseph S Pliskin
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ran D Balicer
- Epidemiology, Ben-Gurion University, Tel Aviv, Israel
- Clalit Research Institute, Tel Aviv, Israel
| | - Nadav Davidovitch
- Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Igal Hekselman
- Clalit Mushlam Health Insurance, Bnei Brak, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Geva Greenfield
- Department of Primary Care & Public Health, Imperial College London, London, UK
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Shmueli L, Davidovitch N, Pliskin JS, Hekselman I, Balicer RD, Greenfield G. Reasons, perceived outcomes and characteristics of second-opinion seekers: are there differences in private vs. public settings? BMC Health Serv Res 2019; 19:238. [PMID: 31014323 PMCID: PMC6480844 DOI: 10.1186/s12913-019-4067-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/05/2019] [Indexed: 01/29/2023] Open
Abstract
Background In most countries, patients can get a second opinion (SO) through public or private healthcare systems. There is lack of data on SO utilization in private vs. public settings. We aim to evaluate the characteristics of people seeking SOs in private vs. public settings, to evaluate their reasons for seeking a SO from a private physician and to compare the perceived outcomes of SOs given in a private system vs. a public system. Methods A cross-sectional national telephone survey, using representative sample of the general Israeli population (n = 848, response rate = 62%). SO utilization was defined as seeking an additional clinical opinion from a specialist within the same specialty, on the same medical concern. We modeled SO utilization in a public system vs. a private system by patient characteristics using a multivariate logistic regression model. Results 214 of 339 respondents who obtained a SO during the study period, did so in a private practice (63.1%). The main reason for seeking a SO from a private physician rather than a physician in the public system was the assumption that private physicians are more professional (45.7%). However, respondents who obtained a private SO were neither more satisfied from the SO (p = 0.45), nor felt improvement in their perceived clinical outcomes after the SO (p = 0.37). Low self-reported income group, immigrants (immigrated to Israel after 1989) and religious people tended to seek SOs from the public system more than others. Conclusions The main reason for seeking a SO from private physicians was the assumption that they are more professional. However, there were no differences in satisfaction from the SO nor perceived clinical improvement. As most of SOs are sought in the private system, patient misconceptions about the private market superiority may lead to ineffective resource usage and increase inequalities in access to SOs. Ways to improve public services should be considered to reduce health inequalities.
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Affiliation(s)
- Liora Shmueli
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel
| | - Nadav Davidovitch
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel
| | - Joseph S Pliskin
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel.,Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel
| | - Igal Hekselman
- Clalit Mushlam Health Insurance Systems, Clalit Health Services, 1 Ben Gurion, 5120149, Bnei Brak, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, 101 Arlozorov, 62098, Tel-Aviv, Israel
| | - Geva Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St. Dunstan's Road, London, W6 8RP, UK.
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Shmueli L, Davidovitch N, Pliskin JS, Balicer RD, Hekselman I, Greenfield G. Seeking a second medical opinion: composition, reasons and perceived outcomes in Israel. Isr J Health Policy Res 2017; 6:67. [PMID: 29221461 PMCID: PMC5721599 DOI: 10.1186/s13584-017-0191-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 11/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Seeking a second-opinion (SO) is a common clinical practice that can optimize treatment and reduce unnecessary procedures and risks. We aim to characterize the composition of the population of SO seekers, their reasons for seeking a SO and choosing a specific physician, and their perceived outcomes following the SO. Methods A cross-sectional national telephone survey, using a representative sample of the general Israeli population (n = 848, response rate = 62%). SO utilization was defined as seeking an additional clinical opinion from a specialist within the same specialty, for the same medical concern. We describe the characteristics of respondents who obtained SOs, their reasons for doing so and their perceived outcomes: (1) Satisfaction with the SO; (2) Experiencing health improvement after receiving a SO; (3) A difference in the diagnosis or treatment suggested in the first opinions and the second opinions; (4) Preference of the SO over the first one. Results Most of the respondents who sought a SO (n = 344) were above 60 years old, secular, living with a partner, perceived their income to be above average and their health status to be not so good. For the patients who utilized SOs, orthopedic surgeons were sought out more than any other medical professional.Reasons for seeking a SO included doubts about diagnosis or treatment (38%), search for a sub-specialty expert (19%) and dissatisfaction with communication (19%). SO seekers most frequently chose a specific specialist based on a recommendation from a friend or a relative (33%). About half of the SO seekers also searched for information on the internet. Most of the respondents who sought a SO mentioned that they were satisfied with it (84%), felt health improvement (77%), mentioned that there was a difference between the diagnosis or treatment between the first opinion and the SO (56%) and preferred the SO over the first one (91%). Conclusions Clinical uncertainty or dissatisfaction with patient-physician communication were the main reasons for seeking a SO. Policy makers should be aware that many patients choose a physician for a SO based on recommendations made outside the medical system. We recommend creating mechanisms that help patients in the complicated process of seeking a SO, suggest specialists who are suitable for the specific medical problem of the patient, and provide tools to reconcile discrepant opinions. Electronic supplementary material The online version of this article (10.1186/s13584-017-0191-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liora Shmueli
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel.
| | - Nadav Davidovitch
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel
| | - Joseph S Pliskin
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel.,Department of Industrial Engineering and Management Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel
| | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, 101 Arlozorov, 62098, Tel-Aviv, Israel
| | - Igal Hekselman
- Clalit Mushlam Health Insurance Systems, Clalit Health Services, 1 Ben Gurion, 5120149, Bnei Brak, Israel
| | - Geva Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St. Dunstan's Road, London, W6 8RP, UK
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Groß SE, Hillen MA, Pfaff H, Scholten N. Second opinion in medical encounters - A study among breast cancer patients. PATIENT EDUCATION AND COUNSELING 2017; 100:1990-1995. [PMID: 28601261 DOI: 10.1016/j.pec.2017.05.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine the association between whether physicians discuss the possibility of seeking a second opinion (SO) with patients and the patients' decision to seek an SO. We also investigated the impact of seeking such an opinion on patients' trust in physicians. METHODS Newly diagnosed breast cancer patients were surveyed postoperatively with a mail survey. A patient survey is carried out annually to evaluate the breast cancer centers in North Rhine-Westphalia, Germany. In 2016, survey data from 4517 patients in 87 hospitals were analyzed. RESULTS Physicians were more likely to inform patients under the age of 75 years with higher education levels about the possibility of seeking an SO. Our results indicate that requesting another opinion is associated with less trust in the physician. CONCLUSION Our results indicate that physicians may selectively inform only a subset of patients about the possibility of seeking an SO. Patients who were informed about such a possibility are more likely to do so. PRACTICE IMPLICATIONS Physicians may need to be careful to avoid inequalities based on the age and education of patients regarding giving information about the possibility of an SO. Moreover, breast cancer centers could provide material to patients regarding seeking an SO.
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Affiliation(s)
- Sophie E Groß
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Faculty of Human Sciences and Faculty of Medicine (IMVR), University of Cologne, Eupener Straße 129, 50933 Cologne, Germany.
| | - Marij A Hillen
- Department of Medical Psychology, Academic Medical Center - University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Faculty of Human Sciences and Faculty of Medicine (IMVR), University of Cologne, Eupener Straße 129, 50933 Cologne, Germany
| | - Nadine Scholten
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Faculty of Human Sciences and Faculty of Medicine (IMVR), University of Cologne, Eupener Straße 129, 50933 Cologne, Germany
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Hillen MA, Medendorp NM, Daams JG, Smets EMA. Patient-Driven Second Opinions in Oncology: A Systematic Review. Oncologist 2017; 22:1197-1211. [PMID: 28606972 PMCID: PMC5634767 DOI: 10.1634/theoncologist.2016-0429] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 04/27/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although patient-driven second opinions are increasingly sought in oncology, the desirability of this trend remains unknown. Therefore, this systematic review assesses evidence on the motivation for and frequency of requests for second opinions and examines how they evolve and their consequences for oncological practice. MATERIALS AND METHODS Relevant databases were sought using the terms "cancer," "second opinion," and "self-initiated." Included were peer-reviewed articles that reported on patient-initiated second opinions within oncology. Selection, data extraction, and quality assessment were performed and discussed by two researchers. RESULTS Of the 25 included studies, the methodological designs were qualitative (n = 4), mixed (n = 1), or quantitative (n = 20). Study quality was rated high for 10 studies, moderate for eight, and low for seven studies. Reported rates of second opinion seeking ranged from 1%-88%. Higher education was most consistently related to seeking a second opinion. Patients' primary motivations were a perceived need for certainty or confirmation, a lack of trust, dissatisfaction with communication, and/or a need for more (personalized) information. Reported rates of diagnostic or therapeutic discrepancies between the first and second opinions ranged from 2%-51%. DISCUSSION Additional studies are required to further examine the medical, practical, and psychological consequences of second opinions for patients and oncologists. Future studies could compare the potential advantages and disadvantages of second opinion seeking, and might offer guidance to patients and physicians to better facilitate the second opinion process. Some practical recommendations are provided for oncologists to optimally discuss and conduct second opinions with their patients. The Oncologist 2017;22:1197-1211 IMPLICATIONS FOR PRACTICE: Although cancer patients increasingly seek a second opinion, the benefits of this process remain unclear. Results of this systematic review suggest that the available studies on this topic are highly variable in both methodology and quality. Moreover, reported rates for a second opinion (1%-88%) as well as for disagreement between the first and second opinion (2%-51%) range widely. The primary motivations of patients are a need for certainty, lack of trust, dissatisfaction with communication, and/or a need for more (personalized) information. Additional research should evaluate how unnecessary second opinions might be avoided. Practical suggestions are provided for oncologists to optimize second opinions.
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Affiliation(s)
- Marij A Hillen
- Department of Medical Psychology, Amsterdam, The Netherlands
| | | | - Joost G Daams
- Medical Library, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam, The Netherlands
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Lu T, Xu YC, Wallace S. Internet usage and patient's trust in physician during diagnoses: A knowledge power perspective. J Assoc Inf Sci Technol 2017. [DOI: 10.1002/asi.23920] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Tian Lu
- School of Management; Fudan University; 670, Guoshun Road, Shanghai 200433 China
| | - Yunjie Calvin Xu
- School of Management; Fudan University; 670, Guoshun Road, Shanghai 200433 China
| | - Scott Wallace
- The Geisel School of Medicine at Dartmouth; 37 Dewey Field Road, HB 7253, Hanover NH 03755 USA
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13
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14
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Second Medical Opinion: Utilization Rates and Characteristics of Seekers in a General Population. Med Care 2017; 54:921-8. [PMID: 27213545 DOI: 10.1097/mlr.0000000000000567] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Second opinion (SO) is common in medical practice and can reduce unnecessary risks and costs. To date, there is no population-based estimation of how many people seek SOs and what the characteristics of second-opinion seekers are. OBJECTIVES To estimate how many people seek SOs, and what the characteristics of second-opinion seekers are. METHODS We conducted both a medical records analysis (n=1,392,907) and a cross-sectional national telephone survey with a representative sample of the general Israeli population (n=848, response rate=62%). In the medical records analysis, we linked consultations with specialists at community secondary care and private consultations using claims data. We developed a time-sensitive algorithm that identified potential SO instances. In both methods, we predicted the characteristics of second-opinion seekers using multivariate logistic regressions. RESULTS The medical records analysis and the survey findings were highly consistent, and showed that about sixth (14.9% in the medical records vs. 17.2% in the survey) of a general population sought a SO, mostly from orthopedic surgeons. Women, native-born, and established immigrants, people living in central urban areas or close to central urban areas, people with chronic conditions, and those who perceived their health status as not very good, were more likely to seek SOs than others. CONCLUSIONS A considerable amount of people sought a SO. Certain patient profiles tended to seek SOs more than others. Such utilization patterns are important to devise policy regarding SOs, due to their implications on expenditure, policy, clinical outcomes, and patient satisfaction.
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Akpunar D, Bebis H, Yavan T. Use of Complementary and Alternative Medicine in Patients with Gynecologic Cancer: a Systematic Review. Asian Pac J Cancer Prev 2016; 16:7847-52. [PMID: 26625809 DOI: 10.7314/apjcp.2015.16.17.7847] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Research carried out with gynecologic cancer patients using CAM was reviewed to provide a source for discussing which CAM method is used for which purpose, patients' perceptions on the effects/side effects occurred during/after using CAM and their sources of information regarding CAM. MATERIALS AND METHODS This literature review was carried out for the period between January 2000 and March 2015 using Scopus, Dynamed, Med-Line, Science Direct, Ulakbim, Research Starters, Ebscohost, Cinahl Complete, Academic Onefile, Directory of Open Access Journals, BMJ Online Journals (2007-2009), Ovid, Oxford Journal, Proquest Hospital Collection, Springer-Kluwer Link, Taylor and Francis, Up To Date, Web Of Science (Citation Index), Wiley Cochrane-Evidence Base, Wiley Online Library, and Pub-Med search databases with "complementary and alternative medicine, gynecologic cancer" as keywords. After searching through these results, a total of 12 full length papers in English were included. RESULTS CAM use in gynecologic cancer patients was discussed in 8 studies and CAM use in breast and gynecologic cancer patients in 4. It was determined that the frequency of CAM use varies between 40.3% and 94.7%. As the CAM method, herbal medicines, vitamins/minerals were used most frequently in 8 of the studies. When the reasons why gynecologic cancer patients use CAM are examined, it is determined that they generally use to strengthen the immune system, reduce the side effects of cancer treatment and for physical and psychological relaxation. In this review, most of the gynecologic cancer patients perceived use of CAM as beneficial. CONCLUSIONS In order that the patients obtain adequate reliable information about CAM and avoid practices which may harm the efficiency of medical treatment, it is recommended that "Healthcare Professionals" develop a common language.
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Affiliation(s)
- Dercan Akpunar
- Public Health Nursing Department, Gulhane Military Medical Academy, Health Sciences Institution, Ankara, Turkey E-mail :
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16
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Is there evidence for a better health care for cancer patients after a second opinion? A systematic review. J Cancer Res Clin Oncol 2015; 142:1521-8. [DOI: 10.1007/s00432-015-2099-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/11/2015] [Indexed: 11/25/2022]
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Abstract
OBJECTIVES The goal of this study was to identify second opinion consultations by physicians and to determine patient and family factors that appeared to contribute to a second opinion being sought. METHODS One hundred and fifty consecutive parents of children with cancer recently treated in our Department of Pediatric Hematology Oncology were interviewed by telephone. The questionnaire included epidemiological data, details about the disease, timing of the second opinion consultation, reasons for seeking a second opinion, and the outcome of the consultation. RESULTS Thirty-seven (24.7%) parents sought a second opinion. Advice was sought from other physicians in the hospital or at other clinics. There was a correlation to a higher socioeconomic status (P = .003) and to the number of educational years (P = .001). Most of the parents sought a second opinion because they wanted confirmation about the treatment protocol and the professional level of the hematologist oncologist/surgeon and the institution. CONCLUSIONS Second opinion consultations were not uncommon and were mainly secondary to the desire for reassurance. Pediatric oncologists should ensure that patients and their families feel comfortable requesting a second opinion consultation.
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Affiliation(s)
- Oz Mordechai
- Department of Pediatric Hematology Oncology, Rambam Health Care Campus , Haifa , Israel
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Payne VL, Singh H, Meyer AND, Levy L, Harrison D, Graber ML. Patient-initiated second opinions: systematic review of characteristics and impact on diagnosis, treatment, and satisfaction. Mayo Clin Proc 2014; 89:687-96. [PMID: 24797646 DOI: 10.1016/j.mayocp.2014.02.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/13/2014] [Accepted: 02/26/2014] [Indexed: 11/30/2022]
Abstract
The impact of second opinions on diagnosis in radiology and pathology is well documented; however, the value of patient-initiated second opinions for diagnosis and treatment in general medical practice is unknown. We conducted a systematic review of patient-initiated second opinions to assess their impact on clinical outcomes and patient satisfaction and to determine characteristics and motivating factors of patients who seek a second opinion. We searched PubMed, EMBASE, Cochrane, and Academic OneFile databases using Medical Subject Headings (MeSH) indexes and keyword searches. Search terms included referral and consultation, patient-initiated, patient preference, patient participation, second opinion, second review, and diagnosis. Multiple reviewers screened abstracts and articles to determine eligibility and extract data. We assessed risk of bias using the Cochrane Risk of Bias Tool and rated study quality using Cochrane's GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. We screened 1342 abstracts and reviewed full text of 41 articles, identifying 7 articles that reported clinical agreement data and 10 that discussed patient characteristics, motivation, and satisfaction. We found that a second opinion typically confirms the original diagnosis or treatment regimen but that 90% of patients with poorly defined conditions remain undiagnosed. However, 10% to 62% of second opinions yield a major change in the diagnosis, treatment, or prognosis. A larger fraction of patients receive different advice on treatment than on diagnosis. Factors motivating a second opinion include diagnosis or treatment confirmation, dissatisfaction with a consultation, desire for more information, persistent symptoms, or treatment complications. Patients generally believed that second opinions were valuable. Second opinions can result in diagnostic and treatment differences. The literature on patient-initiated second opinions is limited, and the accuracy of the second opinion through follow-up is generally unknown. Standardized methods and outcome measures are needed to determine the value of second opinions, and the potential of second opinions to reduce diagnostic errors merits more rigorous evaluation.
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Affiliation(s)
- Velma L Payne
- Houston Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, and Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Hardeep Singh
- Houston Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, and Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Ashley N D Meyer
- Houston Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, and Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
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Hsieh CI, Chung KP, Yang MC, Li TC. Association of treatment and outcomes of doctor-shopping behavior in patients with hepatocellular carcinoma. Patient Prefer Adherence 2013; 7:693-701. [PMID: 23874090 PMCID: PMC3713999 DOI: 10.2147/ppa.s43631] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A variety of unfulfilled needs may trigger doctor-shopping behavior (DSB) in patients. In oncology, treatment results usually cause patients the most concern. This study investigated the association of DSB with active treatments received by patients with hepatocellular carcinoma (HCC) and outcomes. METHODS With approval from the institutional review board, all patients registered in the cancer database of a teaching hospital and diagnosed as having HCC by self-referral from outside hospitals or by in-house diagnosis were retrospectively identified. Patient data were then reviewed and analyzed via electronic medical records. RESULTS Hepatitis B carriers were significantly more likely than noncarriers to show first-time DSB. Recurrent disease was less likely to result in DSB than predicted. Patients from outside hospitals not receiving upfront first treatment after diagnosis were significantly more likely to show more frequent DSB than those receiving it. Male patients eligible for salvage treatment were less likely to have frequent occurrences of DSB than their female counterparts. Receiving first salvage treatment was not associated with more frequent DSB. Treatment recommendations offered in the study hospital did not influence patients' decisions to leave or stay. Only elderly patients (>70 years) were less likely to show DSB. CONCLUSION DSB can occur throughout the entire course of treatment for HCC for a variety of reasons. Active treatments, disease status, and patient characteristics all exerted an influence on DSB.
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Affiliation(s)
- Cheng-I Hsieh
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei
- Correspondence: Kuo-Piao Chung Room 635, 17 Suchow Rd, Taipei, Taiwan 10052, People’s Republic of China, Tel +886 2 33668065, Fax 886 2 23581541, Email
| | - Ming-Chin Yang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Public Health, China Medical University
- Graduate Institute of Chinese Medicine Science, College of Chinese Medicine, China Medical University
- Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
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Greenfield G, Pliskin JS, Wientroub S, Davidovitch N. Orthopedic surgeons' and neurologists' attitudes towards second opinions in the Israeli healthcare system: a qualitative study. Isr J Health Policy Res 2012; 1:30. [PMID: 22913507 PMCID: PMC3441381 DOI: 10.1186/2045-4015-1-30] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 06/18/2012] [Indexed: 11/15/2022] Open
Abstract
Background Second opinion is a treatment ratification tool that may critically influence diagnosis, treatment, and prognosis. Second opinions constitute one of the largest expenditures of the supplementary health insurance programs provided by the Israeli health funds. The scarcity of data on physicians’ attitudes toward second opinion motivated this study to explore those attitudes within the Israeli healthcare system. Methods We interviewed 35 orthopedic surgeons and neurologists in Israel and qualitatively analyzed the data using the Grounded Theory approach. Results As a common tool, second opinion reflects the broader context of the Israeli healthcare system, specifically tensions associated with health inequalities. We identified four issues: (1) inequalities between central and peripheral regions of Israel; (2) inequalities between private and public settings; (3) implementation gap between the right to a second opinion and whether it is covered by the National Health Insurance Law; and (4) tension between the authorities of physicians and religious leaders. The physicians mentioned that better mechanisms should be implemented for guiding patients to an appropriate consultant for a second opinion and for making an informed choice between the two opinions. Conclusions While all the physicians agreed on the importance of the second opinion as a tool, they raised concerns about the way it is provided and utilized. To be optimally implemented, second opinion should be institutionalized and regulated. The National Health Insurance Law should strive to provide the mechanisms to access second opinion as stipulated in the Patient’s Rights Law. Further studies are needed to assess the patients' perspectives.
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Affiliation(s)
- Geva Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstans Road, London, W6 8RP, UK.
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21
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Carmady B, Smith CA. Use of Chinese medicine by cancer patients: a review of surveys. Chin Med 2011; 6:22. [PMID: 21651825 PMCID: PMC3148205 DOI: 10.1186/1749-8546-6-22] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 06/09/2011] [Indexed: 11/24/2022] Open
Abstract
Chinese medicine has been used to treat a variety of cancer-related conditions. This study aims to examine the prevalence and patterns of Chinese medicine usage by cancer patients. We reviewed articles written in English and found only the Chinese medicine usage from the studies on complementary and alternative medicine (CAM). Seventy four (74) out of 81 articles reported rates of CAM usage ranging from 2.6 to 100%. Acupuncture was reported in 71 out of 81 studies. Other less commonly reported modalities included Qigong (n = 17), Chinese herbal medicine (n = 11), Taichi (n = 10), acupressure (n = 6), moxibustion (n = 2), Chinese dietary therapy (n = 1), Chinese massage (n = 1), cupping (n = 1) and other Chinese medicine modalities (n = 19). This review also found important limitations of the English language articles on CAM usage in cancer patients. Our results show that Chinese medicine, in particular Chinese herbal medicine, is commonly used by cancer patients. Further research is warranted to include studies not written in English.
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Affiliation(s)
- Bridget Carmady
- Centre for Complementary Medicine Research, University of Western Sydney, Locked Bag 1797, Penrith South DC 2751, New South Wales, Australia.
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Philip J, Gold M, Schwarz M, Komesaroff P. Second medical opinions: the views of oncology patients and their physicians. Support Care Cancer 2009; 18:1199-205. [DOI: 10.1007/s00520-009-0742-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 09/10/2009] [Indexed: 11/28/2022]
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Shankland WE. Patients seeking treatment for craniofacial pain: a retrospective study of 300 patients. Cranio 2008; 26:241-5. [PMID: 19004304 DOI: 10.1179/crn.2008.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Those engaged in any type of pain practice will encounter patients who have seen many practitioners. This is especially true for clinicians who treat craniofacial pain and temporomandibular disorders. In this retrospective study of 300 patients seeking treatment for various types of craniofacial pain, the average age was 43.05 years. A mean average of 3.92 clinicians was consulted with the range of practitioners being one to 26. The average time of pain was 4.15 years. Most of the subjects (210) were in the age groups 21 years to 60 years old. Females comprised 85.30% of the subjects with a mean average age of 43.43 years; 14.70% were male with a mean average age of 41.02 years.
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Affiliation(s)
- Wesley E Shankland
- TMJ and Facial Pain Center 158 A Commerce Park Dr. Westerville, OH 43082, USA.
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