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Källman M, Bergström S, Carlsson T, Järås J, Holgersson G, Nordberg JH, Nilsson J, Wode K, Bergqvist M. Use of CAM among cancer patients : Results of a regional survey in Sweden. BMC Complement Med Ther 2023; 23:51. [PMID: 36797715 PMCID: PMC9933304 DOI: 10.1186/s12906-023-03876-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND The use of complementary and alternative medicine (CAM) by patients is widespread. However, there is a lack of knowledge regarding the extent and details of patient CAM use in Sweden, especially in rural Sweden. The aim of this study was to estimate the extent and characteristics of CAM use among cancer patients in Region Gävleborg. METHODS A total of 631 questionnaires were distributed to which 376 responses were registered, yielding a response rate of 59.6%. Questionnaires were distributed to oncology patients at their first visit for curative treatment at the Department of Oncology, Gävle Hospital. Palliative patients were recruited at their first visit and during enrollment in palliative outpatient care in their own homes. The characteristics of the respondents were presented with standard descriptive statistics. A multivariable logistic model was fitted to calculate odds ratios (ORs) and identify potential predictors (Age, Gender, Education, Diagnosis) of CAM use post-cancer diagnosis. RESULTS 54% of all participants reported lifetime CAM use, 34% reported CAM use post-diagnosis. The most common CAM methods used after diagnosis are vitamins, health food preparations, herbal teas, prayer and dietary methods. The most common source of information reported is family and friends. Almost 70% of those who used CAM after their diagnosis stated that they did not discuss their use with healthcare professionals. Most patients reported that they would like some CAM modalities to be offered within conventional care regardless of their own CAM use. CONCLUSIONS The use of CAM is common among patients with cancer in the region of Gävleborg, and previous studies show a similar use in Sweden in general. Based on the widespread use of CAM and patient interest in discussing CAM use with healthcare professionals, greater attention and focus should be placed on creating a basis for this dialogue. If we, as healthcare professionals, are to emphasise our commitment to providing patient-centred care, we must acknowledge that patients use CAM and are seeking a dialogue about CAM use in their care.
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Affiliation(s)
- Mikael Källman
- Department of Radiation Sciences, Umeå University, Umeå, Sweden. .,Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden. .,Department of Oncology, Gävle Hospital, Gävle, Sweden.
| | - Stefan Bergström
- grid.12650.300000 0001 1034 3451Department of Radiation Sciences, Umeå University, Umeå, Sweden ,grid.8993.b0000 0004 1936 9457Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden ,grid.413607.70000 0004 0624 062XDepartment of Oncology, Gävle Hospital, Gävle, Sweden
| | - Tobias Carlsson
- grid.413607.70000 0004 0624 062XDepartment of Oncology, Gävle Hospital, Gävle, Sweden
| | | | - Georg Holgersson
- grid.412354.50000 0001 2351 3333Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Johanna Hök Nordberg
- Regional Cancer Centre Stockholm–Gotland, Stockholm, Sweden ,Department of NVS, Karolinska Institution, Stockholm, Sweden ,Department of Physiology & Pharmacology, Karolinska Institution, Stockholm, Sweden
| | - Jonas Nilsson
- grid.12650.300000 0001 1034 3451Department of Radiation Sciences, Umeå University, Umeå, Sweden ,grid.8993.b0000 0004 1936 9457Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Kathrin Wode
- grid.12650.300000 0001 1034 3451Department of Radiation Sciences, Umeå University, Umeå, Sweden ,Regional Cancer Centre Stockholm–Gotland, Stockholm, Sweden ,grid.12650.300000 0001 1034 3451Department of Nursing, Umeå University, Umeå, Sweden
| | - Michael Bergqvist
- grid.12650.300000 0001 1034 3451Department of Radiation Sciences, Umeå University, Umeå, Sweden
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Akeeb AA, King SM, Olaku O, White JD. Communication Between Cancer Patients and Physicians About Complementary and Alternative Medicine: A Systematic Review. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:80-98. [PMID: 36149678 PMCID: PMC10081707 DOI: 10.1089/jicm.2022.0516] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: Complementary and alternative medicine (CAM) has become increasingly popular among cancer patients and is often used concomitantly with standard cancer therapies. Nonetheless, disclosure of CAM utilization by cancer patients to physicians, along with the provision of information on CAM therapies by physicians, is poor. This review explores the literature to synthesize existing information on communication about CAM usage, reasons for nondisclosure, and the clinical implications thereof. Methods: A search of medical literature published between December 1, 2009, and October 1, 2021 (last searched on April 18, 2022), on communications between physicians and cancer patients about CAM treatments was conducted through MEDLINE and EMBASE. Results were screened for inclusion, dually reviewed, and assessed using the QualSyst quality appraisal instrument. Findings were categorized and synthesized for review. Results: A total of 30 articles were located (n = 8721 total participants), which discussed elements related to patient disclosure of CAM use (n = 16), provider experiences or perceptions related to communication about CAM (n = 3), patterns of this communication (n = 6), and recommendations for effectively discussing CAM with cancer patients (n = 5). Reports indicate that nondisclosure is common throughout the cancer care spectrum. Factors influencing nondisclosure range from patient beliefs and attitudes about their provider, demographic characteristics, disease progression, physician-patient relationship, physician noninquiry, and type of CAM used; ultimately creating a gap in care that may have serious medical implications. Discussion: Many of the studies identified are small and confined to a single-center, hospital-network, or geographic setting, thereby limiting the applicability of findings and recommendations. Nonetheless, improving patient-physician communication is essential in delivering evidence-informed, patient-centered care and crucial for achieving patient satisfaction and positive health outcomes. The lack of adequate CAM dialogue about CAM use increases the risk of adverse interactions with conventional cancer treatments and results in missed opportunities for providers and patients to engage in vital information exchange. Future research and education are necessary to further identify barriers surrounding patient-provider communication about CAM treatments.
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Affiliation(s)
- Ameenat A. Akeeb
- Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Sophia M. King
- Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Oluwadamilola Olaku
- Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Jeffrey D. White
- Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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Mentink MDC, van Vliet LM, Timmer-Bonte JANH, Noordman J, van Dulmen S. How is complementary medicine discussed in oncology? Observing real-life communication between clinicians and patients with advanced cancer. PATIENT EDUCATION AND COUNSELING 2022; 105:3235-3241. [PMID: 35989202 DOI: 10.1016/j.pec.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study aims to examine the structure of communication about complementary medicine (CM) between patients with cancer and clinicians during oncology consultations. METHODS Previously, consultations between 29 clinicians and 80 patients with advanced cancer were recorded in six hospitals in the Netherlands. The present study considers a secondary analysis. References to CM during the consultation were coded using a self-developed observational coding scheme. RESULTS At least one reference to CM was observed in 35 out of 80 consultations (44 %), with a total of 73 references. In most cases, CM was initially referred to by patients. Clinicians often did not elaborate on the subject of CM. Relevant aspects related to CM (e.g., safety, effectiveness) were infrequently discussed. Both patients and clinicians showed predominantly neutral to positive attitudes towards CM. CONCLUSIONS This study shows that patients are still the main initiators of discussions about CM and the topic is not consistently discussed in daily oncology practice. PRACTICE IMPLICATIONS If exploration of patients' interest in CM or its use became routine in oncology practice, it may relieve patients of the burden of introducing the topic, decrease potential risks of CM use and increase access to evidence-based CM for all patients with cancer.
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Affiliation(s)
- Marit D C Mentink
- Nivel, Netherlands Institute for Health Services Research, Department of Communication in Healthcare, Utrecht, Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands.
| | - Liesbeth M van Vliet
- Leiden University, Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden, Netherlands; Leiden University, Leiden Institute for Brain and Cognition, Leiden, Netherlands
| | | | - Janneke Noordman
- Nivel, Netherlands Institute for Health Services Research, Department of Communication in Healthcare, Utrecht, Netherlands
| | - Sandra van Dulmen
- Nivel, Netherlands Institute for Health Services Research, Department of Communication in Healthcare, Utrecht, Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands
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Impact of Open Dialogue about Complementary Alternative Medicine-A Phase II Randomized Controlled Trial. Cancers (Basel) 2022; 14:cancers14040952. [PMID: 35205698 PMCID: PMC8870003 DOI: 10.3390/cancers14040952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/03/2022] [Accepted: 02/09/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary A large number of patients with cancer use complementary alternative medicine (CAM), such as diet supplements, massage and acupuncture, as an adjunct to conventional cancer treatment and care. Some types of CAM reduce nausea and vomiting, pain, fear, fatigue and depression, but CAM may also cause new symptoms and side effects. Therefore, it is crucial that cancer patients receive professional guidance on how to use CAM in a safe and healthy manner. Open dialogue about CAM between patients and health professionals is, however, not an integrated part of cancer treatment and care. Therefore, the aim of our study was to assess how open dialogue, including guidance about CAM, affected patients’ safety and health when it was an integrated part of the cancer treatment and care. We found that open dialogue about CAM does not compromise patient safety and that it may improve patients’ quality of life, self-care and survival. Abstract Complementary alternative medicine (CAM) may reduce the symptom burden of side effects to antineoplastic treatment but also cause new side effects and non-adherence to conventional treatment. The aim of this RCT was to investigate the impact of open dialogue about complementary alternative medicine (OD-CAM) on cancer patients’ safety, health and quality of life (QoL). Patients undergoing antineoplastic treatment were randomly assigned to standard care (SC) plus OD-CAM or SC alone. The primary endpoint was frequency of grade 3–4 adverse events (AE) eight weeks after enrollment. Secondary endpoints were frequency of grade 1–4 AE, QoL, psychological distress, perceived information, attitude towards and use of CAM 12 and 24 weeks after enrollment. Survival was analyzed post hoc. Fifty-seven patients were randomized to the OD-CAM group and fifty-five to the SC group. No significant difference in frequency of grade 3–4 AEs was shown. The same applied to grade 1–4 AEs and QoL, psychological distress and perceived information. A tendency towards better QoL, improved survival and a lower level of anxiety was found in the OD-CAM group. OD-CAM is not superior to SC in reducing the frequency of AEs in patients undergoing antineoplastic treatment. OD-CAM does not compromise patient safety; it may reduce psychological stress and improve QoL and overall survival.
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Mentink M, Noordman J, Busch M, van Vliet L, Timmer-Bonte JA, van Dulmen S. Towards an open and effective dialogue on complementary medicine in oncology: protocol of patient participatory study 'COMMON'. BMJ Open 2021; 11:e053005. [PMID: 34670766 PMCID: PMC8529983 DOI: 10.1136/bmjopen-2021-053005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Approximately half of patients with cancer use some form of complementary medicine alongside conventional cancer treatment. The topic of complementary medicine often remains undiscussed in consultations between patients with cancer and their healthcare providers. This results in increased risks for adverse or interaction effects and decreased access to the benefits of evidence-based complementary medicine for patients with cancer. This paper describes the design of patient participatory study titled 'COMMON' that aims to explore and enhance open and effective communication about complementary medicine in oncology. The study is carried out in collaboration with 12 (former) patients with breast cancer as coresearchers. METHODS AND ANALYSIS The study complies with the six steps of the intervention mapping framework. Three non-academic hospitals recruit participants (patients with cancer, oncology healthcare providers and managers) for interviews about the organisation, experiences and needs regarding complementary medicine. To assess communication about complementary medicine, recorded oncology consultations are analysed. For an overview of evidence-based complementary medicine available to patients with cancer, a review of reviews is conducted on the evidence on cancer patient-reported outcomes of complementary medicine frequently used by patients with cancer, supplemented with an online search and survey among organisations and persons providing complementary medicine to patients with cancer. Together, these steps generate input for the development of a toolbox that supports an open and effective discussion on complementary medicine in oncology. In a pilot study, acceptability and usability of the toolbox are assessed among patients with cancer and oncology healthcare providers. Dissemination of the toolbox is covered by the commitment of stakeholder parties. ETHICS AND DISSEMINATION The Medical Ethics Committee Arnhem-Nijmegen declared the study was exempted from formal approval under the Dutch Medical Research Involving Human Subjects Act. The results will be disseminated through open-access, peer-reviewed publications, stakeholder-reporting and presentations at relevant conferences.
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Affiliation(s)
- Marit Mentink
- Netherlands Institute for Health Services Research, NIVEL, Utrecht, The Netherlands
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
| | - Janneke Noordman
- Netherlands Institute for Health Services Research, NIVEL, Utrecht, The Netherlands
| | | | - Liesbeth van Vliet
- Health, Medical, and Neuropsychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | | | - Sandra van Dulmen
- Netherlands Institute for Health Services Research, NIVEL, Utrecht, The Netherlands
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
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Stie M, Jensen LH, Delmar C, Nørgaard B. Open dialogue about complementary and alternative medicine (CAM) integrated in conventional oncology care, characteristics and impact. A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:2224-2234. [PMID: 32563705 DOI: 10.1016/j.pec.2020.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To systematically review evidence on the characteristics, experiences and impact of an open dialogue about complementary and alternative medicine (CAM) integrated in oncology care. METHODS We searched MEDLINE, EMBASE, AMED, Scopus, ProQuest Dissertations and Thesis, Cochrane Central Register, clinicaltrials.gov, forskningsdatabase.dk and PROSPERO. Two reviewers screened title, abstract and full-text articles. Each study was appraised using the Critical Appraisal Skills Programme (CASP) and synthesized narratively. PROSPERO registration CRD42019112242. RESULTS We retrieved 4736 articles and included 5; 3 received 9 ½, 1 received 9, and 1 received 5 points on the CASP score. Predominately, the open dialogue was one or two individual, patient-centered, face-to-face consultations led by oncology physicians. In one study, it was a tele-phone consultation and in another it was structured counseling led by pharmacists. Integrated information and recommendations about CAM contributed to high level of satisfaction and improvement in concerns, quality of life and well-being. CONCLUSION Integration of open dialogue about CAM in oncology care including acknowledging patients' preferences, values, wishes and knowledge, and providing information about CAM expands the opportunities for improving patients' health, quality of life and well-being. PRACTICE IMPLICATIONS Open dialogue about CAM has potentials, but research on how it specifically helps patients, is needed.
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Affiliation(s)
- Mette Stie
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark; Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Lars Henrik Jensen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark; Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Charlotte Delmar
- Department of Nursing Science, Health Faculty, Aarhus University, Aarhus, Denmark
| | - Birgitte Nørgaard
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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Güthlin C, Bartsch HH, Joos S, Längler A, Lampert C, Ritter C, Schildmann J, Weis J, Wilhelm M, Witt CM, Horneber M. KOKON: A Germany-Wide Collaborative Research Project to Identify Needs, Provide Information, Foster Communication and Support Decision-Making about Complementary and Alternative Medicine in Oncology. Complement Med Res 2019; 27:105-111. [PMID: 31722354 DOI: 10.1159/000502945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/27/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The German Cancer Aid set up a priority research programme with the intention to generate high-quality information based on evidence and to make this information easily accessible for health-care professionals and advisors, researchers, patients, and the general public. SUMMARY The Kompetenznetz Komplementärmedizin in der Onkologie (KOKON) received 2 funding periods within this programme. During the first funding period, KOKON assessed patients' and health-care professionals' informational needs, developed a consulting manual for physicians, developed an education programme for self-help groups, set up a knowledge database, and developed a pilot information website for patients. Funding period 2 continues with work that allows cancer patients and health-care professionals to make informed decisions about complementary and alternative medicine (CAM). For this aim, KOKON evaluates training programmes for physicians (oncology physicians, paediatric oncologists, and general practitioners) and for self-help groups. All training programmes integrate results from an analysis of the ethical, psychological, and medical challenges of CAM in the medical encounter, and the knowledge database is being extended with issues related to CAM for supportive and palliative care. Key Message: A Germany-wide collaborative research project to identify needs, provide information, foster communication, and support decision-making about CAM in oncology is being set up.
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Affiliation(s)
- Corina Güthlin
- Institute for General Practice, Goethe University, Frankfurt, Germany,
| | - Hans-Helge Bartsch
- Klinik für Onkologische Rehabilitation, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Stefanie Joos
- Institute for General Practice, University Hospital, Tübingen, Germany
| | | | | | - Christoph Ritter
- Klinische Pharmazie, Universität Greifswald, Greifswald, Germany
| | - Jan Schildmann
- Institut für Geschichte und Ethik der Medizin, Martin-Luther-Universität, Halle-Wittenberg, Germany
| | - Joachim Weis
- Department of Cancer Self-Help Research, Comprehensive Cancer Center, Medical Center - University Clinic Center, Freiburg, Germany
| | - Martin Wilhelm
- Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Nürnberg, Germany
| | - Claudia M Witt
- Department for Epidemiology and Health Economics, Charité, Berlin, Germany
| | - Markus Horneber
- Universitätskliniken für Innere Medizin 3 und 5, Schwerpunkte Pneumologie und Onkologie/Hämatologie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Nürnberg, Germany.,Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Nürnberg, Germany
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Tilburt J, Yost KJ, Lenz HJ, Zúñiga ML, O'Byrne T, Branda ME, Leppin AL, Kimball B, Fernandez C, Jatoi A, Barwise A, Kumbamu A, Montori V, Koenig BA, Geller G, Larson S, Roter DL. A Multicenter Comparison of Complementary and Alternative Medicine (CAM) Discussions in Oncology Care: The Role of Time, Patient-Centeredness, and Practice Context. Oncologist 2019; 24:e1180-e1189. [PMID: 31101701 DOI: 10.1634/theoncologist.2019-0093] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/10/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Little is known about how complementary and alternative medicine (CAM) is discussed in cancer care across varied settings in the U.S. METHODS In two practices affiliated with one academic medical center in southern California (SoCal), and one in the upper Midwest (UM), we audio-recorded patient-clinician interactions in medical oncology outpatient practices. We counted the frequency and duration of CAM-related conversations. We coded recordings using the Roter Interaction Analysis System. We used chi-square tests for bivariate analysis of categorical variables and generalized linear models for continuous variables to examine associations between dialogue characteristics, practice setting, and population characteristics with the occurrence of CAM discussion in each setting followed by multivariate models adjusting for clinician clustering. RESULTS Sixty-one clinicians and 529 patients participated. Sixty-two of 529 (12%) interactions included CAM discussions, with significantly more observed in the SoCal university practice than in the other settings. Visits that included CAM were on average 6 minutes longer, with CAM content lasting an average of 78 seconds. In bivariate tests of association, conversations containing CAM included more psychosocial statements from both clinicians and patients, higher patient-centeredness, more positive patient and clinician affect, and greater patient engagement. In a multivariable model including significant bivariate terms, conversations containing CAM were independently associated with higher patient-centeredness, slightly longer visits, and being at the SoCal university site. CONCLUSION The frequency of CAM-related discussion in oncology varied substantially across sites. Visits that included CAM discussion were longer and more patient centered. IMPLICATIONS FOR PRACTICE The Institute of Medicine and the American Society of Clinical Oncology have called for more open discussions of complementary and alternative medicine (CAM). But little is known about the role population characteristics and care contexts may play in the frequency and nature of those discussions. The present data characterizing actual conversations in practice complements a much larger literature based on patient and clinician self-report about CAM disclosure and use. It was found that CAM discussions in academic oncology visits varied significantly by practice context, that the majority were initiated by the patient, and that they may occur more when visit time exists for lifestyle, self-care, and psychosocial concerns.
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Affiliation(s)
- Jon Tilburt
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathleen J Yost
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Heinz-Josef Lenz
- Division of Medical Oncology, Keck School of Medicine, University of Southern California, Los Angeles California, USA
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, California, USA
| | - Thomas O'Byrne
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Biostatistics, Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Megan E Branda
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Biostatistics, Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron L Leppin
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Brittany Kimball
- Departments of Internal Medicine and Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cara Fernandez
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Aminah Jatoi
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amelia Barwise
- Division of Critical Care, Mayo Clinic, Rochester, Minnesota, USA
| | - Ashok Kumbamu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor Montori
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Barbara A Koenig
- Program in Bioethics, University of California San Francisco, San Francisco, California, USA
| | - Gail Geller
- Berman Institute of Bioethics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan Larson
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Debra L Roter
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Wode K, Henriksson R, Sharp L, Stoltenberg A, Hök Nordberg J. Cancer patients' use of complementary and alternative medicine in Sweden: a cross-sectional study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:62. [PMID: 30866916 PMCID: PMC6417272 DOI: 10.1186/s12906-019-2452-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/30/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Access to and advice on Complementary and Alternative Medicine (CAM) are uncommon within Swedish conventional cancer care and little is known about cancer patients' own use of CAM. The aim of this cross-sectional study was to explore Swedish cancer patients´ patterns of CAM use, their experiences and preferences. METHODS Questionnaires were distributed consecutively to 1297 cancer patients at a university hospital's out-patient oncology units. The response rate was 58% (n = 755). Descriptive statistics were used to analyze the survey data. A logistic regression model was used to investigate the association between CAM use and gender, age and level of education. Open-ended responses were analyzed, using qualitative content analysis. RESULTS Lifetime CAM use was reported by 34% (n = 256), and 26% (n = 198) used CAM after cancer diagnosis. Being female, younger and having higher education predicted CAM use. Most commonly used methods were natural products including vitamins and minerals and relaxation. Main reasons for CAM use were improvement of physical, general and emotional wellbeing and increasing the body's ability to fight cancer. Satisfaction with CAM usage was generally high. Reported adverse effects were few and mild; 54% of users spent < 50 Euro a month on CAM. One third had discussed their CAM use with cancer care providers. More than half of all participants thought that cancer care providers should be able to discuss (58%) and to consider (54%) use of CAM modalities in cancer care. CONCLUSIONS Despite limited access and advice within conventional cancer care, one fourth of Swedish cancer patients use CAM. The insufficient patient-provider dialogue diverges with most patients' wish for professional guidance in their decisions and integration of CAM modalities in conventional cancer care. Concurrent and multimodal CAM use implies challenges and possibilities for cancer care that need to be considered.
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Helmer SM, Rogge AA, Fischer F, Pach D, Horneber M, Roll S, Witt CM. Evaluation of a blended-learning training concept to train oncology physicians to advise their patients about complementary and integrative medicine (KOKON-KTO): study protocol for a prospective, multi-center, cluster-randomized trial. Trials 2019; 20:90. [PMID: 30696465 PMCID: PMC6352447 DOI: 10.1186/s13063-019-3193-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 01/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many cancer patients are interested in complementary and integrative medicine during and after regular cancer treatment. Given the high number of users it is important that physicians and patients engage in a dialog about useful complementary and integrative medicine therapies during cancer treatment. In a prospective, multi-center, cluster-randomized evaluation study we will develop, implement and evaluate a training program for oncology physicians advising their patients on complementary and integrative medicine. The main objective of the study is to evaluate whether training physicians in a blended-learning approach (e-learning + skills-training workshop) in providing advice to their cancer patients on complementary and integrative medicine, in addition to handing out an information leaflet about reputable websites, has different effects on the outcomes of patients, physicians, and their interaction level, compared to only giving out the information leaflet. METHODS/DESIGN Forty-eight oncology physicians will be included into a cluster-randomized trial to either participate or not in the blended-learning training. Physicians will then advise 10 cancer patients each, resulting in 480 patients participating in the trial. The blended learning consists of nine units of up to 45 min of e-learning and 18 units of up to 45 min of on-site skills-training workshop focusing. Outcomes will be measured on the physician, patient, and physician-patient-interaction level. DISCUSSION A blended-learning program for oncology physicians to advise their cancer patients in a systematic way and a reasonable time frame on complementary and integrative medicine will be evaluated in depth in a large cluster-randomized trial. TRIAL REGISTRATION German Clinical Trials Register, ID: DRKS00012704 . Registered on 28 August 2017.
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Affiliation(s)
- Stefanie M Helmer
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alizé A Rogge
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Pach
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Markus Horneber
- Department of Internal Medicine, Division of Oncology and Hematology, Paracelsus Medical University, Klinikum Nuremberg, Nuremberg, Germany
| | - Stephanie Roll
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia M Witt
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. .,Institute for Complementary and Integrative Medicine, University of Zurich and UniversityHospital Zurich, Zurich, Switzerland. .,Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
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Kumbamu A, Geller G, Leppin A, Fernandez C, Tilburt J, Koenig B. Contending Worldviews in the Clinical Encounter: An Empirical Study of Complementary and Alternative Medicine Deliberations in Contemporary Medical Oncology. J Altern Complement Med 2018; 24:996-1002. [PMID: 30156425 DOI: 10.1089/acm.2018.0200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE In this article, the authors characterize the different ways patients and clinicians discuss complementary and alternative medicine (CAM) during routine cancer care. METHODS Over a period of two years, the authors audio-recorded clinical interactions between 37 medical oncology clinicians and a sample of 327 oncology patients at an academic cancer center in the Midwest United States. Recordings of conversations that included any discussion of CAM were transcribed and analyzed using a qualitative content analysis approach. RESULTS Out of 327 conversations, CAM was mentioned and/or discussed in only 31 encounters. Communication dynamics between clinician and patient involve several factors: the condition of the patient and his or her knowledge about and experience with CAM, the clinician's knowledge and values about CAM, perceived assumptions and stereotypes about CAM, and institutional response to the integration of CAM in cancer care. CONCLUSION Addressing the difficult and sensitive topic of CAM in cancer care requires hearing patients in a manner meaningful to them. In that sense, CAM can serve as an important marker and test case in the march toward shared decision-making and patient-centered communication generally.
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Affiliation(s)
- Ashok Kumbamu
- 1 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery , Mayo Clinic, Rochester, Minnesota
| | - Gail Geller
- 2 Johns Hopkins University , Baltimore, Maryland
| | | | | | - Jon Tilburt
- 4 Program in Professionalism and Bioethics, Mayo Clinic , Rochester, Minnesota
| | - Barbara Koenig
- 5 Institute for Health Aging, University of California San Francisco , San Francisco, California
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Roumeliotis GA, Dostaler G, Boyd KU. Complementary and Alternative Medicines and Patients With Breast Cancer: A Case of Mortality and Systematic Review of Patterns of Use in Patients With Breast Cancer. Plast Surg (Oakv) 2017; 25:275-283. [PMID: 29619352 DOI: 10.1177/2292550317716126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background The use of complementary and alternative medicines (CAMs) is common among women being treated for breast cancer. A recent mortality associated with CAM at our center precipitated a systematic review of the Cochrane, EMBASE, and PubMed databases to identify English manuscripts including "CAM" and "breast cancer." Methods Papers included for review were selected based on predefined inclusion and exclusion criteria. The primary outcome was the use of CAM by women with breast cancer. Secondary outcomes included timing of use along disease trajectory, attitudes toward CAM by allopathic practitioners, and patient disclosure of CAM use to treating allopathic physicians. Results Of 701 titles identified by the search strategy, 36 met the inclusion criteria. The weighted average proportion of women with breast cancer who use CAM was 40% (standard deviation: 18%). The diagnosis of breast cancer also prompts the initiation or increase of CAM use. However, up to 84% of patients do not disclose the use of CAM to their allopathic practitioners. Conclusions Although CAM is often dismissed as a harmless addition to allopathic therapy, significant complications and interactions can occur. Our review and the dramatic case example provided highlight the need for physicians to educate themselves regarding CAM and to engage with their patients regarding its use.
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Affiliation(s)
- Grayson A Roumeliotis
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Kirsty U Boyd
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
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Blödt S, Mittring N, Schützler L, Fischer F, Holmberg C, Horneber M, Stapf A, Witt CM. A consultation training program for physicians for communication about complementary medicine with breast cancer patients: a prospective, multi-center, cluster-randomized, mixed-method pilot study. BMC Cancer 2016; 16:843. [PMID: 27809814 PMCID: PMC5096286 DOI: 10.1186/s12885-016-2884-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 10/25/2016] [Indexed: 11/26/2022] Open
Abstract
Background The aim was to develop and evaluate a training program for physicians for communicating with breast cancer patients about complementary medicine (CM). Methods In a cluster-randomized pilot trial eight breast cancer centers (two physicians per center) were randomized to either a complementary communication training program (9 h e-learning + 20 h on-site skills training) or to a control group without training. Each physician was asked to consult ten patients for whom he or she is not the physician in charge. We used mixed methods: Quantitative outcomes included physicians’ assessments (empathy, complexity of consultation, knowledge transfer) and patients’ assessments (satisfaction, empathy, knowledge transfer). For qualitative analyses, 15 (eight in the training and seven in the control group) videotaped consultations were analyzed based on grounded theory, and separate focus groups with the physicians of both groups were conducted. Results A total of 137 patients were included. Although cluster-randomized, physicians in the two groups differed. Those in the training group were younger (33.4 ± 8.9 vs. 40.0 ± 8.5 years) and had less work experience (5.4 ± 8.9 vs. 11.1 ± 7.4 years). Patient satisfaction with the CM consultation was relatively high on a scale from 0 to 24 and was comparable in the two groups (training group: 19.4 ± 4.6; control group 20.5 ± 4.1). The qualitative findings showed that physicians structured majority of consultations as taught during the training. Comparing only the younger and less CM experienced physicians, those trained in CM communication felt more confident discussing CM-related topics than those without training. Conclusion A CM communication-training program might be especially beneficial for physicians with less consulting experience when communicating about CM-related issues. A larger trial using more suitable quantitative outcomes needs to confirm this. Trial registration ClinicalTrials.gov: NCT02223091, date of registration: 7 February 2014.
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Affiliation(s)
- Susanne Blödt
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstrasse 57, 10117, Berlin, Germany
| | - Nadine Mittring
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstrasse 57, 10117, Berlin, Germany
| | - Lena Schützler
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstrasse 57, 10117, Berlin, Germany
| | - Felix Fischer
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstrasse 57, 10117, Berlin, Germany.,Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christine Holmberg
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Horneber
- Department of Internal Medicine, Division of Oncology and Hematology, Paracelsus Medical University, Klinikum Nuremberg, Nuremberg, Germany
| | - Adele Stapf
- Department of Internal Medicine, Division of Oncology and Hematology, Paracelsus Medical University, Klinikum Nuremberg, Nuremberg, Germany
| | - Claudia M Witt
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstrasse 57, 10117, Berlin, Germany. .,Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
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Roter DL, Yost KJ, O'Byrne T, Branda M, Leppin A, Kimball B, Fernandez C, Jatoi A, Kumbamu A, Montori V, Koenig B, Geller G, Larson S, Tilburt J. Communication predictors and consequences of Complementary and Alternative Medicine (CAM) discussions in oncology visits. PATIENT EDUCATION AND COUNSELING 2016; 99:1519-25. [PMID: 27296081 PMCID: PMC5007180 DOI: 10.1016/j.pec.2016.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/07/2016] [Accepted: 06/02/2016] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Cancer patients use complementary and alternative medicine (CAM), but do not routinely talk about it with their clinicians. This study describes CAM discussions in oncology visits, the communication patterns that facilitate these discussions and their association with visit satisfaction. METHODS 327 patients (58% female; average age 61) and 37 clinicians were recorded during an oncology visit and completed post-visit questionnaires. All CAM discussions were tagged and the Roter Interaction Analysis System (RIAS) was used to code visit dialogue. RESULTS CAM was discussed in 36 of 327 visits; discussions were brief ( CONCLUSIONS CAM discussions do not occur at random; they take place in visits characterized by patient-centered communication and are associated with higher visit satisfaction. PRACTICE IMPLICATIONS CAM discussions are perceived positively by both patients and clinicians and are facilitated by patient-centered visit communication.
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Affiliation(s)
- Debra L Roter
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | | - Barbara Koenig
- University of California San Francisco, San Francisco, CA, USA
| | - Gail Geller
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan Larson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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15
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Complementary and integrative medicine for breast cancer patients - Evidence based practical recommendations. Breast 2016; 28:37-44. [PMID: 27203402 DOI: 10.1016/j.breast.2016.04.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/07/2016] [Accepted: 04/28/2016] [Indexed: 12/24/2022] Open
Abstract
On average half of the breast cancer patients' population uses complementary and integrative medicine (CIM) therapies and many of them would like to receive information on CIM from their conventional treatment team. However, often they don't feel comfortable in discussing CIM related questions, with their conventional treatment team, because they think they don't have enough expertise and available time to deal with this topic. Furthermore, information on the evidence of CIM is not easily accessible and the available information is not always reliable. The purpose of the current paper is to provide: 1) an overview about the CIM interventions that have shown positive effects in breast cancer patients and might be useful in supportive cancer care, 2) practical guidance on how to choose and find a qualified referral to a CIM treatment: 3) recommendations on how these interventions could be integrated into Breast Cancer Centers and which factors should be taken into consideration in this setting. This paper takes available CIM practice guidelines for cancer patients and previous research on CIM implementation models into account. There are CIM interventions that have shown a potential to reduce symptoms of cancer or cancer treatments in breast cancer patients and the vast majority uses a non-pharmacological approach and have a good potential for implementation. Nevertheless, further and more rigorous research is still needed.
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Koenig CJ, Ho EY, Trupin L, Dohan D. An exploratory typology of provider responses that encourage and discourage conversation about complementary and integrative medicine during routine oncology visits. PATIENT EDUCATION AND COUNSELING 2015; 98:857-63. [PMID: 25865412 PMCID: PMC4430387 DOI: 10.1016/j.pec.2015.02.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/24/2015] [Accepted: 02/22/2015] [Indexed: 05/27/2023]
Abstract
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.
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Affiliation(s)
- Christopher J Koenig
- Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, USA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA.
| | - Evelyn Y Ho
- Department of Communication Studies, University of San Francisco, San Francisco, USA
| | - Laura Trupin
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA
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Sullivan A, Gilbar P, Curtain C. Complementary and Alternative Medicine Use in Cancer Patients in Rural Australia. Integr Cancer Ther 2015; 14:350-8. [DOI: 10.1177/1534735415580679] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim. Numerous studies have demonstrated the high prevalence of complementary and alternative medicine (CAM) use in metropolitan cancer cohorts but few have been conducted in regional and remote populations. This study aimed to investigate the trends and regional variations in CAM use by cancer patients at a regional cancer care center in Toowoomba, South East Queensland, Australia. Methods. All English-speaking adult cancer patients attending the regional cancer care center were invited to participate. Eligible patients were provided a self-administered questionnaire that was developed based on published surveys. Ethics approval was obtained. Results. Overall 142 patients completed the questionnaire and 68% were currently or had previously used at least one form of CAM. CAM users and nonusers did not differ significantly by region, age, gender, time since diagnosis, income, town size, treatment intent, or metastases. CAM users were more likely to have a higher level of education. Concurrent CAM use with conventional treatment was reported by approximately half of respondents. The most common reason for CAM use was “to improve general physical well-being.” The most common sources of CAM information were family (31%) and friends (29%). Disclosure of CAM use to either the general practitioner or specialist was reported by 46% and 33% of patients, respectively. The most common reason for nondisclosure was “doctor never asked.” Conclusion. This study supports previous research that CAM use is as common in regional and remote areas as metropolitan areas. Nondisclosure of CAM use to health professionals was common. Future research needs to focus on strategies to improve communication between patients and health professionals about the use of CAM.
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Affiliation(s)
- Aimee Sullivan
- Toowoomba Hospital, Toowoomba, Queensland, Australia
- Prince of Wales Hospital, Sydney, New South Wales, Australia
- University of Tasmania, Hobart, Tasmania, Australia
| | - Peter Gilbar
- Toowoomba Hospital, Toowoomba, Queensland, Australia
- Department of Medicine (Rural Clinical School), The University of Queensland, Toowoomba, Queensland, Australia
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Hong G, White J, Zhong L, Carlson LE. Survey of Policies and Guidelines on Antioxidant Use for Cancer Prevention, Treatment, and Survivorship in North American Cancer Centers: What Do Institutions Perceive as Evidence? Integr Cancer Ther 2015; 14:305-17. [PMID: 25716350 DOI: 10.1177/1534735415572884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Health care policies and guidelines that are clear and consistent with research evidence are important for maximizing clinical outcomes. To determine whether cancer centers in Canada and the United States had policies and/or guidelines about antioxidant use, and whether policies were aligned with the evidence base, we reviewed current research evidence in the field, and we undertook a survey of the policies and guidelines on antioxidant use at cancer institutions across North America. METHODS A survey of policies and guidelines on antioxidant use and the development and communication of the policies and guidelines was conducted by contacting cancer institutions in North America. We also conducted a Website search for each institution to explore any online resources. RESULTS Policies and guidelines on antioxidant use were collected from 78 cancer institutions. Few cancer institutions had policies (5%) but most provided guidelines (69%). Antioxidants from diet were generally encouraged at cancer institutions, consistent with the current research evidence. In contrast, specific antioxidant supplements were generally not recommended at cancer institutions. Policies and guidelines were developed using evidence-based methods (53%), by consulting another source (35%), or through discussions/conference (26%), and communicated mainly through online resources (65%) or written handouts (42%). For cancer institutions that had no policy or guideline on antioxidants, lack of information and lack of time were the most frequently cited reasons. CONCLUSIONS Policies and guidelines on antioxidants from diet were largely consistent with the research evidence. Policies and guidelines on antioxidant supplements during treatment were generally more restrictive than the research evidence might suggest, perhaps due to the specificity of results and the inability to generalize findings across antioxidants, adding to the complexity of their optimal and safe use. Improved communication of comprehensive research evidence to cancer institutions may aid in the development of more evidence-based policies and guidelines.
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Affiliation(s)
- Gyeongyeon Hong
- Tom Baker Cancer Centre-Holy Cross Site, Calgary, Alberta, Canada
| | - Jennifer White
- Tom Baker Cancer Centre-Holy Cross Site, Calgary, Alberta, Canada
| | - Lihong Zhong
- Tom Baker Cancer Centre-Holy Cross Site, Calgary, Alberta, Canada
| | - Linda E Carlson
- Tom Baker Cancer Centre-Holy Cross Site, Calgary, Alberta, Canada University of Calgary Department of Oncology, Cumming School of Medicine, Calgary, Alberta, Canada
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In vivo and in vitro demonstration of herb-drug interference in human breast cancer cells treated with tamoxifen and trastuzumab. Menopause 2014; 20:646-54. [PMID: 23340260 DOI: 10.1097/gme.0b013e31827b2240] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE In recent trends, patients with breast cancer seek integrative medical treatment when receiving either hormonal (tamoxifen [Tam]) or target (trastuzumab) therapy. Our previous in vitro studies demonstrated that the Chinese medicine Si-Wu-Tang (SWT) stimulates MCF-7 cell growth via activation of estrogen receptor α and human epidermal growth factor receptor 2 (HER2) signaling. The present study demonstrates herb-drug interference with cell proliferation in tumor-bearing mice treated with SWT and Tam in vivo and with proliferation capacity in breast cancer cells treated with SWT and trastuzumab in vitro. METHODS To assess in vivo SWT + Tam interference, we randomly separated female MCF-7-implanted athymic nude mice into five groups, namely, vehicle (n = 11), estradiol (n = 8), SWT (n = 8), Tam (n = 11), and SWT + Tam (n = 8). All mice were killed after 21 days of treatment. Body weight, uterine weight, tumor volume, and tumor weight were measured. To assess in vitro SWT-trastuzumab interference, we cotreated BT-474 and SK-BR-3 breast cancer cells with SWT and trastuzumab. This was followed by (4,5-cimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assays and cell cycle analysis to measure cell proliferation and by Western blot analysis to analyze protein expression in growth-related signal pathways. RESULTS SWT reversed Tam-induced antiproliferative effects on tumor weight and tumor volume and increased estrogen receptor α and N-cadherin expression in the SWT + Tam-treated group compared with the Tam-treated group. Furthermore, SWT reversed trastuzumab-induced antiproliferative activity in HER2 cell lines (SK-BR-3 and BT-474) through increased phosphorylation of the cell cycle regulatory protein p27(Kip1) and possibly of the antiapoptosis protein P38. CONCLUSIONS Based on the in vivo and in vitro demonstration of herb-drug interference in breast cancer cells, we conclude that physicians should pay more attention to such interference when treating patients with receptor-positive (estrogen receptor-positive, progesterone receptor-positive, or HER2) breast cancers.
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Koenig CJ, Ho EY, Yadegar V, Tarn DM. Negotiating complementary and alternative medicine use in primary care visits with older patients. PATIENT EDUCATION AND COUNSELING 2012; 89:368-73. [PMID: 22483672 PMCID: PMC3630233 DOI: 10.1016/j.pec.2012.02.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 02/12/2012] [Accepted: 02/29/2012] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To empirically investigate the ways in which patients and providers discuss Complementary and Alternative Medicine (CAM) treatment in primary care visits. METHODS Audio recordings from visits between 256 adult patients aged 50 years and older and 28 primary care physicians were transcribed and analyzed using discourse analysis, an empirical sociolinguistic methodology focusing on how language is used to negotiate meaning. RESULTS Discussion about CAM occurred 128 times in 82 of 256 visits (32.0%). The most frequently discussed CAM modalities were non-vitamin, non-mineral supplements and massage. Three physician-patient interactions were analyzed turn-by-turn to demonstrate negotiations about CAM use. Patients raised CAM discussions to seek physician expertise about treatments, and physicians adopted a range of responses along a continuum that included encouragement, neutrality, and discouragement. Despite differential knowledge about CAM treatments, physicians helped patients assess the risks and benefits of CAM treatments and made recommendations based on patient preferences for treatment. CONCLUSION Regardless of a physician's stance or knowledge about CAM, she or he can help patients negotiate CAM treatment decisions. PRACTICE IMPLICATIONS Providers do not have to possess extensive knowledge about specific CAM treatments to have meaningful discussions with patients and to give patients a framework for evaluating CAM treatment use.
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Lo-Fo-Wong DNN, Ranchor AV, de Haes HCJM, Sprangers MAG, Henselmans I. Complementary and alternative medicine use of women with breast cancer: self-help CAM attracts other women than guided CAM therapies. PATIENT EDUCATION AND COUNSELING 2012; 89:529-536. [PMID: 22464017 DOI: 10.1016/j.pec.2012.02.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 02/27/2012] [Accepted: 02/28/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Examine stability of use of complementary and alternative medicine (CAM) of breast cancer patients, reasons for CAM use, and sociodemographic, clinical, and psychological predictors of CAM use. METHODS CAM use was assessed after adjuvant therapy and six months later. Following the CAM Healthcare Model, CAM use was divided into use of provider-directed (guided) and self-directed (self-help) CAM. Stability and reasons for CAM use were examined with McNemar's tests and descriptive statistics. Cross-sectional and longitudinal associations between predictors and CAM use were examined with univariate and multivariate logistical analyses. RESULTS Use of provider-directed and self-directed CAM was stable over time (N=176). Self-directed CAM was more often used to influence the course of cancer than provider-directed CAM. Both were used to influence well-being. Openness to experience predicted use of provider-directed CAM, while clinical distress predicted use of self-directed CAM, after adjusting for other predictors. Perceived control did not predict CAM use. CONCLUSION CAM use is stable over time. It is meaningful to distinguish provider-directed from self-directed CAM. PRACTICE IMPLICATIONS Providers are advised to plan a 'CAM-talk' before adjuvant therapy, and discuss patients' expectations about influence of CAM on the course of cancer. Distressed patients most likely need information about self-directed CAM.
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Ho EY, D'Agostino TA, Yadegar V, Burke A, Bylund CL. Teaching patients how to talk with biomedical providers about their complementary and alternative medicine use. PATIENT EDUCATION AND COUNSELING 2012; 89:405-410. [PMID: 22503146 DOI: 10.1016/j.pec.2012.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 03/09/2012] [Accepted: 03/10/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The goal was to examine the feasibility and impact of a face-to-face communication skills training intervention based on a current public health campaign to encourage patients to talk about complementary and alternative medicine (CAM) with their biomedical health providers. METHODS Current CAM users were invited to complete a survey about current/past CAM use and communication with biomedical providers before beginning a communication skills training workshop. In the 6-month period following the training, participants were asked to record information on any CAM conversations with those providers. RESULTS Of the 38 participants who received training, 32 finished the entire study. Over half of those participants reported discussing CAM in post-training visits with biomedical providers. Participants initiated the conversation in most cases, and were more likely to disclose CAM use than they were to ask questions about CAM. Participants who talked about CAM were significantly more likely to perceive CAM as relevant to their visit, compared with individuals who did not talk about CAM. CONCLUSIONS Participants positively evaluated this patient communication workshop. Consistent with previous research, most CAM conversations were patient-initiated. PRACTICE IMPLICATIONS These findings reinforce the importance of patient education interventions for improving patient-provider communication in general, and CAM communication specifically.
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Affiliation(s)
- Evelyn Y Ho
- Department of Communication Studies, University of San Francisco, San Francisco, CA 94117, USA.
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Tautz E, Momm F, Hasenburg A, Guethlin C. Use of Complementary and Alternative Medicine in breast cancer patients and their experiences: A cross-sectional study. Eur J Cancer 2012; 48:3133-9. [DOI: 10.1016/j.ejca.2012.04.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 02/13/2012] [Accepted: 04/27/2012] [Indexed: 10/28/2022]
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Beith JM, Oh B, Hale AK, Venkateswaran R. Acupuncture Use in Women with Breast Cancer. Med Acupunct 2011. [DOI: 10.1089/acu.2011.0798] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Jane M. Beith
- Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Byeongsang Oh
- Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Amanda K. Hale
- Sydney Cancer Centre, Concord Hospital, Sydney, New South Wales, Australia
| | - Ramya Venkateswaran
- Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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