Can ChatGPT Provide Quality Information on Integrative Oncology? A Brief Report

This short report evaluated the accuracy and quality of information provided by ChatGPT regarding the use of complementary and integrative medicine for cancer. Using the QUality Evaluation Scoring Tool, a panel of 12 reviewers assessed ChatGPT's responses to 8 questions. The study found that ChatGPT provided moderate-quality responses that were relatively unbiased and not misleading. However, the chatbot's inability to reference specific scientific studies was a significant limitation. Patients with cancer should not rely on ChatGPT for clinical advice until further systematic validation. Future studies should examine how patients perceive ChatGPT's information and its impact on communication with health care professionals.

The Use of Traditional, Complementary, and Integrative Medicine in Cancer: A Data-Mining Study of One-million Online Posts from Health Forums and Social Media Platforms (Preprint)

BACKGROUND

Patients with cancer are increasingly using forums and social media platforms to access health information and share their experiences, particularly in the use of traditional, complementary, and integrative medicine (TCIM). Despite the popularity of TCIM among patients with cancer, few related studies have used data from these web-based sources to explore the use of TCIM among patients with cancer.

OBJECTIVE

This study leveraged multiple forums and social media platforms to explore patients' use, interest, and perception of TCIM for cancer care.

METHODS

Posts (in English) related to TCIM were collected from Facebook, Twitter, Reddit, and 16 health forums from inception until February 2022. Both manual assessments and natural language processing were performed. Descriptive analyses were performed to explore the most commonly discussed TCIM modalities for each symptom and cancer type. Sentiment analyses were performed to measure the polarity of each post or comment, and themes were identified from posts with positive and negative sentiments. TCIM modalities that are emerging or recommended in the guidelines were identified a priori. Exploratory topic-modeling analyses with latent Dirichlet allocation were conducted to investigate the patients' perceptions of these modalities.

RESULTS

Among the 1,620,755 posts available, cancer-related symptoms, such as pain (10/10, 100% cancer types), anxiety and depression (9/10, 90%), and poor sleep (9/10, 90%), were commonly discussed. Cannabis was among the most frequently discussed TCIM modalities for pain in 7 (70%) out of 10 cancer types, as well as nausea and vomiting, loss of appetite, anxiety and depression, and poor sleep. A total of 7 positive and 7 negative themes were also identified. The positive themes included TCIM, making symptoms manageable, and reducing the need for medication and their side effects. The belief that TCIM and conventional treatments were not mutually exclusive and intolerance to conventional treatment may facilitate TCIM use. Conversely, TCIM was viewed as leading to patients' refusal of conventional treatment or delays in diagnosis and treatment. Doctors' ignorance regarding TCIM and the lack of information provided about TCIM may be barriers to its use. Exploratory analyses showed that TCIM recommendations were well discussed among patients; however, these modalities were also used for many other indications. Other notable topics included concerns about the legalization of cannabis, acupressure techniques, and positive experiences of meditation.

CONCLUSIONS

Using machine learning techniques, social media and health forums provide a valuable resource for patient-generated data regarding the pattern of use and patients' perceptions of TCIM. Such information will help clarify patients' needs and concerns and provide directions for research on integrating TCIM into cancer care. Our results also suggest that effective communication about TCIM should be achieved and that doctors should be more open-minded to actively discuss TCIM use with their patients.

A Cross-Sectional Assessment of Complementary and Alternative Medicine (CAM) Use among Patients with Chronic Diseases (CDs) in Qassim, Saudi Arabia

This study aims to investigate CAM use among CD patients from Qassim, Saudi Arabia and to compare CAM practice with different demographic and disease characteristics of the participants. A cross-sectional study was conducted among CD patients. During the three-months of data collection period, a total of 377 patients were approached and 208 patients participated in the study, giving a response rate of 55.17%. A p value of <0.05 was considered as significant. Among the study population, 94 (45.2%) patients were CAM users. Diabetes mellitus patients were the majority (48 (51.06%)) followed by hypertensive patients (34 (36.17%)). Spiritual therapies were the most common CAM followed by herbal products. Among CAM users, 41 (19.7%) patients reported disclosing CAM use to their health care providers. Among all the sociodemographic variables, gender (p = 0.029), marital status (p = 0.034) and education level (p = 0.047) were significantly associated with CAM use. In conclusion, the use of CAM among CD patients was relatively high in Qassim. Patients reported using CAM without disclosing to their health care providers which is a major health risk. It is critical to counsel CD patients regarding rational and informed CAM use in order to prevent harmful and unwanted effects.

Complementary and Integrative Approaches to Cancer: A Pilot Survey of Attitudes and Habits among Cancer Patients in Italy

Background. Cancer patients are among the main consumers of traditional, complementary, integrative, and alternative medicine (TCIM) such as natural products (herbals, integrators, etc.) and mind and body practices (yoga, acupuncture, etc.). Methods. A questionnaire on TCIM was submitted to 415 Italian cancer patients. The questionnaire consisted of three sections: (i) biographical and clinical information; (ii) use of natural substances; and (iii) use of mind-body practices. Results. 406 patients completed the questionnaire. The prevalence of TCIM use was 72.3%. Of them, 75.6% started to use TCIM after a tumor diagnosis. The main reasons for using TCIM were to mitigate side effects (65.0%), to regain physical and mental balance (35.9%), to relieve pain (18.3%), and to improve the efficacy of cancer therapy (16.0%). 44.7% of patients taking natural products used them during conventional therapies (chemotherapy, radiotherapy, etc.), and in 67.5% of cases without consulting a doctor. As a consequence, only about 50% of patients taking natural substances used these compounds appropriately, and the most common errors were related with the purpose of reducing the side effects of the therapy (52.3%) and for boosting immune system (32.1%). Conclusions. There is an impelling need to provide patients with scientifically validated information to raise awareness about the benefits and risks of using TCIM.

The role of the general practitioner in cancer care in general and with respect to complementary and alternative medicine for patients with cancer

OBJECTIVE

Cancer patients often use complementary and alternative medicine (CAM). The aim of this study was to assess the expectations of cancer patients towards their general practitioner (GP) regarding information on and offers of CAM procedures.

METHODS

A standardised anonymous questionnaire was developed and handed out to cancer patients in GP practices and oncology clinics in Germany.

RESULTS

One hundred and eighty questionnaires were evaluable. For 88.1% of the patients, it was important that their GP regularly receives information on cancer therapy. Only a minority consulted with the GP regarding diagnosis and therapy of the cancer (32.4%) or approached him about side effects of the therapy (46.9%). About one fifth of the GPs offered CAM. Before the cancer diagnosis, only 7% of the patients received a CAM offer from the GP; after the diagnosis, it was 14%. A large majority wanted the GP to offer more complementary (70.9%) and alternative (54.3%) medicine.

CONCLUSION

Our survey points to a clear mismatch of supply and demand regarding CAM for cancer patients in the primary care sector. Training for GPs on scientific evidence of as well as communication skills on CAM will be indispensable in the future to optimise the care of cancer patients by GPs.

The Impact of an Evidence-Based Education on Complementary and Alternative Medicine Usage in People with Cancer: Pilot Study

Complementary and alternative medicine (CAM) usage amongst cancer patients is high globally and in Australia. CAM use in cancer care has the ability to increase chemotherapy toxicity or cause sub-therapy due to altered metabolism as well as increase a patient's bleeding risk. Furthering these risks, people with cancer are largely obtaining their CAM use information from non-evidence-based sources. This study aimed to determine whether the implementation of a CAM education influenced decision-making with regard to CAM usage amongst cancer patients. Twenty people with cancer were recruited for participation in this study. The aims of this study were achieved by surveying patients via questionnaire, both prior to and following receiving an evidence-based CAM education, in either or both written or audiovisual format. This exploratory study found, consistent with the literature, that the majority of participants were obtaining their CAM use information from non-evidenced-based sources. Additionally, it found that the participants wanted more CAM use information and that they demonstrated some altered decision-making after receiving evidenced-based information. On the post-educational questionnaire, the number of participants that stated that they would use CAMs decreased by almost 14%, and some participants made CAM use decisions in accordance with the information provided in the resources. Furthermore, a small increase in CAM knowledge was demonstrated, and it was reported that the resource had prompted them to look further into CAM information. Lastly, the participants in this study found the resource to be mostly useful and helpful and preferred the animated video to the written information.

Open dialogue about complementary and alternative medicine (CAM) integrated in conventional oncology care, characteristics and impact. A systematic review

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.

Complementary and alternative medicine is positively associated with religiousness/spirituality

BACKGROUND

Complementary and alternative medicine (CAM) is used often by patients with different diseases. While some authors subsume religiousness and spirituality to CAM, others do not. The objective of the present study was to assess the prevalence and types of CAM usage as well as the participants' spirituality/religiousness in an outpatient department for endocrinology and metabolic diseases.

METHODS

All individuals visiting the outpatient department at a German university hospital from April to June 2009 were offered a standardized questionnaire on the use of dietary supplements and alternative therapies as well as their religiousness/spirituality. Demographic and clinical data of 428 respondents were taken from the electronic health record.

RESULTS

Of the respondents, 16.4% (n = 66) classified themselves to be religious/spiritual and 67.9% (n = 273) as not religious/spiritual. Women were more religious/spiritual than men (p = 0.02). 41.4% of the respondents used supplements and 27.4% additional therapies. The use of supplements and additional therapies was more frequent in people with higher religiousness/spirituality (p = 0.005 and p = 0.01,resp.) but there were no associations between religiousness/spirituality and the number of consultations, costs for drugs, appraisal of the physicians treatment methods, the perceived effectiveness of prescribed drugs, fear of late complications or of side effects.

CONCLUSIONS

A higher religiousness/spirituality is associated with a more frequent use of supplements or additional therapies in individuals with endocrinopathies or metabolic diseases. As CAM has been shown to be associated with worse outcome, addressing religiousness/spirituality which stresses the responsibility of the person for his life might offer an additional resource and should be further studied.

A scoping review of consumer needs for cancer information

OBJECTIVE

This study was a scoping review of research on cancer-related health information seeking and needs of patients, survivor, non-patients, and caregivers.

METHODS

This study used the COSI model to search for articles published from 2007 to 2017.

RESULTS

In total, 117 articles with titles and abstracts including the following terms were selected: cancer, health, information, seeking. Non-patients obtained information from the Internet, doctors, and media, whereas patients obtained information from doctors, the Internet, and media. Information needs were the highest for treatment, prognosis, and psychosocial support. Patients had the highest need for information on prognosis and treatment, whereas non-patients had the highest need for general cancer information, prevention, and cancer examination. Caregivers sought information about treatment, psychosocial support, and prevention.

CONCLUSION

This study revealed an increase in the number of research articles identifying cancer patients' information needs. Cancer patients rely on health professionals for information; thus, relevant materials are needed. Furthermore, not only medical but also psychosocial support information is needed.

PRACTICE IMPLICATIONS

There is a need for cancer information from health professionals, and thus for patient-centered training materials. Furthermore, a survey system to evaluate consumers' cancer information needs should be developed.

Conventional and complementary cancer treatments: where do conventional and complementary providers seek information about these modalities?

Background

Both conventional health care providers and complementary therapists treat cancer patients. To provide effective treatment, both types of providers should to be familiar with their own as well as alternative types of treatment. Our aim was to compare how conventional health care providers (oncology doctors, oncology nurses, family physicians) and complementary therapists (acupuncturists, reflexologists, massage therapists) seek information about conventional and complementary cancer treatments.

Method

This analysis was conducted on the basis of feedback from 466 participants. We used self-administered questionnaires in a cross-sectional study.

Results

The majority of the medical doctors (96%) searched for evidence-based information regarding conventional cancer treatments. They gathered this information mostly from guidelines, which is considered best practice and is expected from Norwegian health personnel. Eighty-one percent of the nurses gather this information from evidence based resources such as UpToDate. Colleagues were asked for information by 58% of the medical doctors and 64% of the nurses. Moreover, 50% of the medical doctors and 57% of the nurses searched for evidence-based information about complementary cancer modalities. The acupuncturists gathered evidence-based information for both conventional (79%) and complementary (77%) modalities, followed by the reflexologists (54 and 54%, respectively) and massage therapists (54 and 52%, respectively). Nearly half of the acupuncturist (49%) asked a colleague for information.

Conclusion

To provide safe cancer care, it is important that advice about complementary modalities is based on current and evidence-based evaluations. The majority of the medical doctors and nurses in this study sought information according to evidence-based medicine regarding conventional cancer treatments, and about half of them gathered evidence-based information about complementary cancer modalities. This was also true for the complementary therapists as they gathered information about complementary and conventional treatments from evidence-based evaluations. This demonstrates that since the term evidence-based medicine was first introduced in 1991, the approach has grown extensively and both conventional and complementary providers use this approach to seek information.

Addressing Unmet Information Needs: Results of a Clinician-Led Consultation Service About Complementary and Alternative Medicine for Cancer Patients and Their Relatives

Purpose. To report on a telephone consultation service with cancer patients and their relatives about complementary and alternative medicine (CAM) between 1999 and 2011. Methods. We offered a Germany-wide, free-of-charge telephone consultation service about CAM led by oncology clinicians from a comprehensive cancer center. The consultations followed a patient-centered approach with the aim to provide guidance and evidence-based information. Sociodemographic, disease-related data as well as information about the consultations’ content were collected in a standardized manner, and feedback questionnaires were sent out immediately after the consultations. Results. Overall, 5269 callers from all over Germany used the service (57% patients, 43% relatives). The “big 4” cancer types (breast, gastrointestinal, prostate, and lung) accounted for 55% of all calls. In 67% of calls, patients had just received the diagnosis or commenced anticancer therapy; 69% of patients had advanced or metastatic diseases. More than half of the callers (55%) had vague concerns like “what else can I do?” rather than specific questions related to CAM. The consultations covered a broad spectrum of issues from CAM therapies to cancer treatment and measures supportive of health, nutrition, and psychosocial support. Callers highly valued the service. Conclusions. Consulting about CAM addresses important unmet needs from cancer patients and their relatives. It provides clinicians with the opportunity to engage in open and supportive dialogues about evidence-based CAM to help with symptom management, psychological support, and individual self-care. Consulting about CAM cannot be separated from consulting about conventional care and should be provided from the beginning of the cancer journey.

Mapping the risk perception and communication gap between different professions of healthcare providers in cancer care: a cross-sectional protocol

INTRODUCTION

Studies show that patients with cancer who use complementary and alternative medicine (CAM) have a poorer survival prognosis than those who do not. It remains unclear whether this is due to a priori poorer prognosis that makes patients turn to CAM, or whether there is a factor associated with CAM use itself that influences the prognosis negatively. Healthcare providers should assist patients in safeguarding their treatment decision. However, the current non-communication between CAM and conventional providers leaves it up to the patients themselves to choose how to best integrate the two worlds of therapy. In this study, an interactive shared decision-making (SDM) tool will be developed to enable patients and health professionals to make safe health choices.

METHODS AND ANALYSIS

We will delineate, compare and evaluate perception and clinical experience of communication of risk situations among oncology experts, general practitioners and CAM practitioners. To accomplish this, we will develop a pilot and implement a large-scale survey among the aforementioned health professionals in Norway. Guided by the survey results, we will develop a β-version of a shared decision-making tool for healthcare providers to use in guiding patients to make safe CAM decisions.

ETHICS AND DISSEMINATION

Participants must give their informed and written consent before inclusion. They will be informed about the opportunity to drop out from the study followed by deletion of all data registered. The study needs no approval from The Regional Committee for Medical and Health Research Ethics because all participants are healthcare professionals. Results from this study will be disseminated in peer-reviewed medical journals.

A lecture program on complementary and alternative medicine for cancer patients--evaluation of the pilot phase

About half of all patients with cancer use complementary or alternative medicine (CAM). In 2013, we started a lecture program for patients, followed by evidence-based recommendations on counseling on CAM. These recommendations have been published before by this working group. The aim of the program is to provide scientific facts on the most often used CAM methods in standardized presentations which help patients discuss the topic with their oncologists and support shared decision making. The article presents the evaluation of the pilot phase. Participants received a standardized questionnaire before the start of the lecture. The questionnaire comprises four parts: demographic data, data concerning experience with CAM, satisfaction with the lecture, and needs for further information on CAM. In 2013, seven lectures on CAM were given in cooperation with regional branches of the German Cancer Society in several German states. Four hundred sixty patients and relatives took part (75% females and 16% males). Forty-eight percent formerly had used CAM. Most often named sources of information on CAM were print media (48%) and the Internet (37%). Most participants rated additional written information valuable. About one third would like to have an individual consultation concerning CAM. A standardized presentation of evidence on CAM methods most often used, together with recommendations on the self-management of symptoms, is highly appreciated. The concept of a highly interactive lecture comprising is feasible and if presented in lay terminology, adequate. In order to give additional support on the topic, written information should be provided as the first step.

Use of complementary and alternative medicines among Malaysian cancer patients: A descriptive study

The use of Complementary and Alternative Medicine (CAM; bǔ chōng yǔ tì dài yī xué) has been rapidly increasing among cancer patients. However, this pervasiveness is still largely unexplored among Malaysian cancer patients. The current study aimed to evaluate the patterns of CAM use among cancer patients from a local hospital in Malaysia. In addition, the study focused on the information-seeking behavior and CAM use disclosure to doctors. Of 393 patients, 184 (46.1%) had used CAM for their cancers. CAM usage was significantly associated with gender (p = 0.021), level of education (p = 0.001), employment status (p = 0.02), and monthly income (p < 0.001). Among frequently used CAM were nutritional supplements (n = 77, 41.8%), natural products (n = 74, 40.2%), and multivitamin (n = 62, 33.6%). Friends and family members were the most common source of CAM information (n = 139, 75.5%). Seventy-nine (43%) reported to disclose their CAM use to the health care providers. The most common (n = 63, 34.2%) reason of nondisclosure was "it is not important to discuss it with oncologist." This study confirmed that CAM use is common among Malaysian cancer patients, thus highlighting a greater need for patient education regarding CAM therapies and their potential interactions with conventional therapies. Although some types of CAM therapies may help patients to cope with emotional distress and improve quality of life, CAM, with no proven efficacy, may pose dangers to patients' health due to interactions with conventional therapies. Doctors and other health care providers including nurses and pharmacists should engage cancer patients in an open nonjudgmental dialog to ascertain CAM use disclosure to their health care providers.

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?

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.

Integrating complementary and alternative medicine into cancer care: Canadian oncology nurses' perspectives

The integration of complementary and alternative medicine (CAM) and conventional cancer care in Canada is in its nascent stages. While most patients use CAM during their cancer experience, the majority does not receive adequate support from their oncology health care professionals (HCPs) to integrate CAM safely and effectively into their treatment and care. A variety of factors influence this lack of integration in Canada, such as health care professional(HCP) education and attitudes about CAM; variable licensure, credentialing of CAM practitioners, and reimbursement issues across the country; an emerging CAM evidence base; and models of cancer care that privilege diseased-focused care at the expense of whole person care. Oncology nurses are optimally aligned to be leaders in the integration of CAM into cancer care in Canada. Beyond the respect afforded to oncology nurses by patients and family members that support them in broaching the topic of CAM, policies, and position statements exist that allow oncology nurses to include CAM as part of their scope. Oncology nurses have also taken on leadership roles in clinical innovation, research, education, and advocacy that are integral to the safe and informed integration of evidence-based CAM therapies into cancer care settings in Canada.

[Importance of complementary medicine approaches for patients with prostate cancer]

BACKGROUND

In Germany, many prostate cancer patients use complementary medicine (CM) or have an interest in these treatment approaches; however, the information and consultation situation of cancer patients is insufficient and therefore the Competence Network Complementary Medicine in Oncology (COCON) was launched by the German Cancer Aid Society. One of the projects of the COCON examines the use of CM and the information and counseling needs regarding these topics in various groups of cancer patients. The focus of this article is on the qualitative study reporting selected results for the subgroup of prostate cancer patients.

STUDY DESIGN AND STUDY METHODS

A total of 19 semi-structured qualitative interviews with prostate cancer patients were conducted regarding the use of CM as well as their information and consultation needs.

RESULTS

It was found that the patients interviewed discussed various issues surrounding nutrition, particularly a healthy diet, the selective use of certain foods and the use of dietary supplements. Additional themes mentioned by interviewees were physical exercise, psychological well-being, mistletoe therapy, homeopathy and traditional Chinese medicine. Patients indicated that they wanted more information and counseling opportunities with regards to CM. They also expressed a desire for more holistic care.

CONCLUSION

The results show that prostate cancer patients use a range of CM and have a need for information about CM. Prostate cancer patients are in a special situation because of a regular feedback on the prostate-specific antigen (PSA) value. This should be taken into consideration in consultation with prostate cancer patients regarding CM.

Randomised controlled trial of a tailored information pack for patients undergoing surgery and treatment for rectal cancer

PURPOSE

To evaluate the effects of a tailored information package for rectal cancer patients on satisfaction with information, anxiety and depression and readjustment.

METHOD

The study used a randomised control trial method. Seventy six patients undergoing surgery and treatment for rectal cancer were randomly assigned to an intervention (n = 43) or control group (n = 33). The intervention group received an information pack tailored according to their treatment plan and preferred information. The control group received the information currently given to these patients. Satisfaction with information was measured using the Patient Satisfaction with Cancer Treatment Education (PSCaTE) scale, anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) and readjustment was measured using the Reintegration to Normal Living Index, at three time points.

RESULTS

There was a statistically significant difference between the intervention and control group on pre and post intervention scores with patients in the intervention group expressing a higher level of satisfaction with information than those in the control group at Times 2 and 3 (p = 0.00 for both). The intervention group also had a significantly lower anxiety score than the control group at Time 3 (p = 0.03). There was no difference between depression and readjustment scores in the two groups.

CONCLUSION

The results support the hypothesis that a tailored information pack for patients with rectal cancer will positively affect satisfaction with information. These results will enhance the knowledge base surrounding the provision of tailored information to specific patient groups.

Attitude of employees of a university clinic to complementary and alternative medicine in oncology

BACKGROUND

Cancer patients often use complementary and alternative medicine (CAM), yet discussion with the oncologist is often missing and oncologists lack knowledge in CAM.

PATIENTS AND METHODS

In order to learn more about the attitude of professionals in oncology toward CAM, a survey was conducted on employees of a German university clinic using a structured questionnaire.

RESULTS

In total, 547 employees took part in the survey. One-third would definitely use CAM on cancer patients. Female employees are more interested in CAM than males (80% versus 20%; P = 0.001); physicians are less interested than nurses (57% versus 72%; P = 0.008). 2.5% of physicians and 9% of nurses are convinced that CAM is as effective as conventional therapy in cancer. Fifty-two percent of physicians and 12% of nurses agree that adverse effects due to CAM may be possible. Seventy-three percent did not consider themselves adequately informed on CAM for their professional work.

CONCLUSIONS

As a substantial part of participants would use CAM on cancer patients and most are interested in but not trained on this topic, there is a need for training of professionals from different professions working in oncology.

Survey on the worldwide Chronic Myeloid Leukemia Advocates Network regarding complementary and alternative medicine

PURPOSE

Many cancer patients use complementary and alternative medicine (CAM). However, data in hematological cancers are lacking on which types of CAM are being used, what information sources on CAM patients use and to what extent CAM is being addressed in the consultation with the hematologist.

METHODS

We developed a standardized questionnaire on CAM which was provided online to the representatives of the worldwide Chronic Myeloid Leukemia Advocates Network.

RESULTS

A total of 53 leaders of patients' advocacy groups for chronic myeloid leukemia (CML) patients from 35 countries responded to the survey. In almost all countries, CAM is important for CML patients and is widely used in addition to conventional leukemia treatment. Mostly, patients have to pay by themselves. General practitioners, herbalists, healers and naturopaths are the main sources for CAM treatments. Information on CAM is derived most frequently from the Internet, and family and friends, but rarely provided by the oncologist. Disclosure of CAM use to the oncologist is low, but increases if oncologists offer CAM.

CONCLUSIONS

In spite of very different health care systems, the features of CAM usage are similar in the different countries. We suggest extending the cooperation of self-help and scientists in order to provide training of oncologists on CAM and quality-controlled, evidence-based information on CAM on the Internet both for patients as well as health professionals as a promising strategy to increase safe use of CAM in patients with CML.

A comparison of decision-making processes for conventional and complementary medicine in cancer patients

To understand the decision-making processes involved in conventional medicine and complementary medicine cancer treatment, and the role that information plays, a cross-sectional survey of cancer patients was carried out at 2 Australian cancer centres. Data was obtained from 75 cancer patients. When asked about complementary medicine use, 36 (48%) patients reported using some form of complementary medicine in conjunction with their conventional treatment. In terms of decision-making, our findings suggest that although cancer patients appear to be at different stages of decision-making for complementary medicine compared with conventional medicine, there was no difference between the decision-making process for cancer patients when it comes to utilising conventional medicine or complementary medicine: patients reported comparable high decisional self-efficacy and low decisional conflict for both areas of medicine.

The Complementary Medicine Education and Outcomes (CAMEO) program: a foundation for patient and health professional education and decision support programs

OBJECTIVE

This paper describes the background, design and evaluation of a theory-informed education and decision support program for cancer patients considering complementary medicine (CM).

METHODS

The program was informed by the Shared Decision Making theory, the Ottawa Decision Support Framework and the Supportive Care Framework. Previous empirical evidence and baseline research were used to identify patients' and health professionals' (HPs) information and decision support needs related to CM.

RESULTS

To address the continuum of CM needs, a variety of education and decision support interventions were developed, including basic CM information and resources for patients and HPs, a group education program and one-on-one decision support coaching for patients, and an on-line education module for HPs. Evaluation of the program and individual interventions is underway.

CONCLUSIONS

This education and decision support program addresses a significant gap in care and offers an evidence-informed framework in which to translate CM evidence to conventional care settings and promote communication about CM.

PRACTICE IMPLICATIONS

Evidence-informed CM education and decision support interventions are needed to shift the culture around CM within conventional care settings and promote open communication that will lead to CM therapies being safely integrated into care.

Recommendations of community pharmacists and health food store employees regarding undiagnosed symptoms of diabetes

BACKGROUND

Consumers may seek health advice from health food store employees (HFSEs) and pharmacists. Delays in the diagnosis of time-critical illnesses may increase the likelihood of morbidity, mortality and healthcare expenditures.

OBJECTIVE

To describe the information provided by HFSEs and pharmacists for symptoms of undiagnosed Type 1 diabetes.

DESIGN

A standardized actor portrayed a consumer with symptoms of Type 1 diabetes at eight community pharmacies and 12 health food stores (HFSs) in Pittsburgh, Pennsylvania, and Chapel Hill and Durham, North Carolina. He inquired about potential diagnoses, the need to see a physician, and product recommendations.

SUBJECTS

The subjects included twelve HFSEs and eight licensed pharmacists.

RESULTS

Four of eight (50%) pharmacists and two of 12 (17%) HFSEs mentioned diabetes as a potential diagnosis. Although six pharmacists recommended urgent physician follow-up, only two HFSEs did so; two HFSEs explicitly advised against a physician visit. One pharmacist recommended a product. Nine HFSEs recommended at least one product (monthly costs, range: $24.70-$209.96).

CONCLUSIONS

Even when presented with classic symptoms of Type 1 diabetes, under-recognition of diabetes was common among HFSEs and community pharmacists. Delays in treatment present a health risk to consumers. Further research could confirm these results and inform educational interventions to improve diabetes recognition by both groups.