Use of complementary and alternative medicine by Brazilian oncologists

Acceptance and use of complementary and alternative medicine among medical specialists: a 15-year systematic review and data synthesis

BACKGROUND

Complementary and Alternative Medicine (CAM) has gained popularity among the general population, but its acceptance and use among medical specialists have been inconclusive. This systematic review aimed to identify relevant studies and synthesize survey data on the acceptance and use of CAM among medical specialists.

METHODS

We conducted a systematic literature search in PubMed and Scopus databases for the acceptance and use of CAM among medical specialists. Each article was assessed by two screeners. Only survey studies relevant to the acceptance and use of CAM among medical specialists were reviewed. The pooled prevalence estimates were calculated using random-effects meta-analyses. This review followed both PRISMA and SWiM guidelines.

RESULTS

Of 5628 articles published between 2002 and 2017, 25 fulfilled the selection criteria. Ten medical specialties were included: Internal Medicine (11 studies), Pediatrics (6 studies), Obstetrics and Gynecology (6 studies), Anesthesiology (4 studies), Surgery (3 studies), Family Medicine (3 studies), Physical Medicine and Rehabilitation (3 studies), Psychiatry and Neurology (2 studies), Otolaryngology (1 study), and Neurological Surgery (1 study). The overall acceptance of CAM was 52% (95%CI, 42-62%). Family Medicine reported the highest acceptance, followed by Psychiatry and Neurology, Neurological Surgery, Obstetrics and Gynecology, Pediatrics, Anesthesiology, Physical Medicine and Rehabilitation, Internal Medicine, and Surgery. The overall use of CAM was 45% (95% CI, 37-54%). The highest use of CAM was by the Obstetrics and Gynecology, followed by Family Medicine, Psychiatry and Neurology, Pediatrics, Otolaryngology, Anesthesiology, Internal Medicine, Physical Medicine and Rehabilitation, and Surgery. Based on the studies, meta-regression showed no statistically significant difference across geographic regions, economic levels of the country, or sampling methods.

CONCLUSION

Acceptance and use of CAM varied across medical specialists. CAM was accepted and used the most by Family Medicine but the least by Surgery. Findings from this systematic review could be useful for strategic harmonization of CAM and conventional medicine practice.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019125628.

National survey of China's oncologists' knowledge, attitudes, and clinical practice patterns on complementary and alternative medicine

It is common for cancer patients to use complementary and alternative medicine (CAM). This study was designed to explore China's oncologists’ knowledge, attitudes and clinical practices regarding CAM use by their patients. An online survey was conducted of China's oncologists. Among 11,270 participants who completed the online survey, 6,007 (53.3%) were identified as oncologists. Most were men (75.2%), with a mean age of 33.4 (standard deviation: 6.5) years. The 6,007 oncologists discussed with 36.5% of their patients about CAM. Most of them (75.6%) did not want to initiate discussions due to lack of knowledge on CAM. Oncologists estimated that 40.0% of their patients used CAM treatments. Oncologists reported that 28.7% of their patients underwent anticancer therapy with the concurrent use of CAM. Four out of five of the responding oncologists self-reported inadequate knowledge and only 22.0% reported receiving professional education on CAM. Nearly half (44.9%) of the oncologists believed CAM treatment was effective for symptoms and treatment of cancer. Physician factors associated with initiating discussions with patients about CAM use included sex, age (≥ 33 years), medical license for traditional Chinese medicine, enough knowledge and professional education experience. China's oncologists infrequently discussed with their patients about CAM due to lack of knowledge. Most of the oncologists did not encourage CAM use.

A preliminary survey on the religious profile of Brazilian psychiatrists and their approach to patients' religiosity in clinical practice

BACKGROUND

Although there is evidence of a relationship between religion/spirituality and mental health, it remains unclear how Brazilian psychiatrists deal with the religion/spirituality of their patients.

AIMS

To explore whether Brazilian psychiatrists enquire about religion/spirituality in their practice and whether their own beliefs influence their work.

METHOD

Four hundred and eighty-four Brazilian psychiatrists completed a cross-sectional survey on religion/spirituality and clinical practice.

RESULTS

Most psychiatrists had a religious affiliation (67.4%) but more than half of the 484 participants (55.5%) did not usually enquire about patients' religion/spirituality. The most common reasons for not assessing patients' religion/spirituality were 'being afraid of exceeding the role of a doctor' (30.2%) and 'lack of training' (22.3%).

CONCLUSIONS

Very religious/spiritual psychiatrists were the most likely to ask about their patients' religion/spirituality. Training in how to deal with a patient's religiosity might help psychiatrists to develop better patient rapport and may contribute to the patient's quicker recovery.

DECLARATION OF INTEREST

None.

COPYRIGHT AND USAGE

© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Mental and Physical Health and Spiritual Healing: An Evaluation of Complementary Religious Therapies Provided by Spiritist Centers in the City of São Paulo, Brazil

The present study aims to describe the characteristics of the complementary religious treatment conducted by Spiritist centers in the city of São Paulo (Brazil), to understand how physical and mental health problems are addressed and how the directors of these centers differentiate between persons with spiritual experiences from those with psychiatric disorders. From 365 Spiritist centers, which received the questionnaire, 55 (15.1 %) were included in the final analysis. There were on average 261 people per week attending spiritual sessions in each center, totalizing approximately 15,000 attendees per week in all 55 centers. The most common treatment performed in these centers was disobsession (Spirit release therapy) (92.7 %); the least common was the 'spiritual surgery', present in only 5.5 %. The most frequent health problems reported by attendees were depression (45.1 %), cancer (43.1 %) and diseases in general (33.3 %). Concerning the directors' awareness to differentiate between spiritual experiences and psychiatric disorders, we found some remarkable divergent opinions. In conclusion, the Spiritist centers are an important health related support system for the city of São Paulo, responsible for a significant share of the city's total health consultations. The most common conditions the patients suffer from were depression and cancer.

An exploratory typology of provider responses that encourage and discourage conversation about complementary and integrative medicine during routine oncology visits

OBJECTIVE

To characterize how providers respond to patient mentions of complementary and integrative medicine (CIM) during routine oncology visits.

METHODS

Ethnographic methods were used over a two and a half year period with 82 advanced cancer patients and their providers across four oncology clinics. Participant observation fieldnotes were analyzed using Discourse Analysis.

RESULTS

CIM was mentioned in 78/229 (34%) of the total observed visits. Patients initiated talk about CIM (76%) more than providers (24%). Patients mentioning CIM may indicate a preference for or interest in non-pharmacological adjunctive treatment options. Providers' responses inhibited further talk in 44% of observations and promoted talk in 56% of observations.

CONCLUSION

How providers respond may indicate their willingness to discuss a range of treatment options and to collaboratively engage in treatment decision-making. Provider responses that inhibited CIM conversation passed on the opportunity to discuss patient preferences, and responses that promoted further conversation helped counsel patients about appropriate CIM use. Promoting discussion did not require additional time or extensive knowledge about CIM.

PRACTICE IMPLICATIONS

Providers can facilitate high quality communication without endorsing CIM to help patients make treatment decisions and to evaluate CIM appropriateness in response to patient values and preferences.

Perceptions and attitudes of rehabilitation medicine physicians on complementary and alternative medicine in Australia

BACKGROUND

The growing demand for complementary and alternative medicine (CAM) is undeniable. We report a first study about the attitudes and behaviour of Australian rehabilitation physicians to CAM.

METHODS

A prospective cross-sectional survey was undertaken to document the prevalence of, knowledge about and referrals to CAM therapies and their perceived effectiveness, by a sample of Australian rehabilitation physicians.

RESULTS

Thirty-six out of 94 actively practising rehabilitation physicians from the Australasian Faculty of Rehabilitation Medicine, the Royal Australasian College of Physicians, replied to the survey, a response rate of 38%, and 85% reported familiarity with CAM, the most familiar therapies being acupuncture (80%), yoga (74%) and Tai-Chi (72%). CAM referral was reported in 84%, 38% personally used CAM, 94% of patients enquired about CAM therapies, 32% of respondents routinely enquired about CAM use. Age, sex and year of Fellowship were not associated with familiarity, personal use or frequency of patient enquiry about CAM. Those who reported to be very familiar with CAM were more likely to routinely enquire about CAM use (P = 0.028) and be more confident in prescribing certain CAM therapies (P < 0.05).

CONCLUSION

Australian rehabilitation physicians report similar CAM referral rates to Canadian physiatrists and Australian general practitioners. The most commonly prescribed therapies were acupuncture, yoga and Tai-Chi. Almost all patients use CAM therapies, but only a minority of rehabilitation physicians enquires about CAM use on a regular basis. The latter may avoid potentially harmful drug interactions, as well as improve the quality of the physician-patient relationship.

Futile medication use in terminally ill cancer patients

BACKGROUND

Cancer patients usually take many medications. The proportion of patients with advanced cancer who are taking futile drugs is unknown.

MATERIALS AND METHODS

We retrospectively reviewed the charts of all consecutive ambulatory patients with advanced cancer and who were receiving supportive care exclusively at palliative care clinics, Princess Margaret Hospital, to gather information on futile medications used by them. Futile medications were defined as unnecessary (when no short-term benefit to patients with respect to survival, quality of life, or symptom control was anticipated) or duplicate (two or more drugs from the same pharmacological class). Summary statistics were used to describe the results.

RESULTS

From November 2005 to July 2006, 82 (22%) of 372 patients were taking at least one futile medication before consultation; after initial consultation, this proportion dropped to 20% (78): 70 patients were taking unnecessary medications, while eight were on duplicate medications. The most frequent unnecessary medications used by patients were statins (56%). The most common duplicate medication involved the use of two different benzodiazepines (seven patients).

CONCLUSION

About one fifth of cancer outpatients at the end of life take futile medications, most commonly statins. Prospective and population-based studies are warranted to further evaluate the magnitude and consequences of futile medication use in oncology.

Perception and use of complementary and alternative medicine among gynecologic oncology care providers

OBJECTIVE

To determine general attitudes and approaches to complementary and alternative medicine (CAM) among physicians who care for gynecologic oncology patients.

METHODS

Surveys were mailed to members of the Society of Gynecologic Oncologists and the Michigan Oncology Group. Physicians were asked to rate their general attitude toward CAM.

RESULTS

Surveys were obtained from 462 physicians. Gynecologic oncologists and female physicians were more likely to have positive attitudes toward CAM, and to believe that clinical care should integrate conventional and CAM practices, compared with other oncologists and male physicians.

CONCLUSION

Discrepancies exist among oncologists regarding attitude and use of CAM in their practice. Education of physicians regarding the safety and efficacy of CAM modalities may ultimately improve patient care.

Discrepant views of Korean medical oncologists and cancer patients on complementary and alternative medicine

PURPOSE

This study was designed to evaluate the communication gap between Korean medical oncologists and cancer patients on complementary and alternative medicine (CAM).

MATERIALS AND METHODS

Cross sectional studies utilized the responses of 59 medical oncologists and 211 patients. To understand the communication gap, perceived reasons and nondisclosure of CAM use, reactions of physicians to disclosure, and expectations for CAM were analyzed. Data were compared with use of the chi-squared test.

RESULTS

Both medical oncologists and patients were in accord that CAM use would provide the patients with a feeling of hope. The medical oncologists believed more often than patients to attribute CAM use for control over medical care decisions, for the treatment of an incurable disease or as a nontoxic approach (p<0.05). Regarding reasons for nondisclosure, medical oncologists were more likely to think that physicians would not understand the use of CAM, discontinue treatment or disapprove of the use of CAM (p<0.0001). Patients attributed nondisclosure mainly to the lack of questioning about CAM. Medical oncologists were more likely to warn of the risks with CAM use and less likely to encourage the use of CAM than perceived by patients (p=0.01). Patients expected that CAM could cure disease, extend survival, relieve symptoms and improve the immune system or quality of life more often than medical oncologists (p<0.05).

CONCLUSION

Given the discrepant views of medical oncologists and patients on the use of CAM, medical oncologists should be aware of the discrepancies and attempt to resolve any differences.