A Multicenter Comparison of Complementary and Alternative Medicine (CAM) Discussions in Oncology Care: The Role of Time, Patient-Centeredness, and Practice Context

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.

“Part of the Conversation”: A Qualitative Study of Oncology Healthcare Professionals’ Experiences of Integrating Standardized Assessment and Documentation of Complementary Medicine

“…Similar barriers to addressing CM use in cancer care settings have been reported in previous studies. 21 - 23 …”

Conversations on Cancer Chemotherapy Cessation in Patients With Advanced Cancer: Qualitative Findings From a Multi-Institutional Study

“…The parent study has been described in detail and entailed real-time, cross-sectional, audio-recorded interviews between oncology clinicians and patients with cancer during actual clinic visits at Mayo Clinic in Rochester, Minnesota, the University of Southern California, and the Los Angeles County Hospital. 7,8…”

Experiences of Asian Women Who Live in Urban Environments and Are Breast Cancer Survivors

“…Discussions related to traditional or complementary/alternative medicine (CAM) treatment by oncologists with survivors is limited. One study reported only 12% of oncologists’ interactions discussed CAM treatment and lasted only a few minutes (Tilburt et al, 2019). While the literature identifies many factors related to Asian American breast cancer survivors, gaps in the literature exist regarding the overall experience of urban Asian American breast cancer survivors and how that experience affects communication with their health care provider.…”