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

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 interests, 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 and safety in ways that are responsive to patient preferences and values. An exploratory typology of provider responses that encourage and discourage conversation about complementary and integrative medicine during routine oncology visits

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

“…Others have found that half to three quarters of CAM discussions were initiated by patients . In our study, the UM and SoCal university settings showed patients raising the topic in 61% and 71% of instances, respectively.…”

“…A single‐center study in Australia suggested that 24%–29% of oncology visits contained a CAM discussion . Koenig found that 34% of visits at one center in San Francisco included CAM discussion . Yet CAM use may vary by racial and ethnic subgroups as well as region and care setting .…”

Patient perspectives on supportive care in cancer: Results of the Calista 2 study

“…In a setting of increasing demand from patients, there is currently a need to bridge the gap between conventional medicine and complementary medicines within a secure framework that allows for open discussion between the physician and their patients (Frenkel, Ben‐Arye, & Cohen, 2010; Ge et al., 2013; Koenig, Ho, Trupin, & Dohan, 2015; Stub et al., 2017).…”

“It’s so hard taking pills when you don’t know what they’re for”: a qualitative study of patients’ medicine taking behaviours and conceptualisation of medicines in the context of rheumatoid arthritis

“…As Koenig et al [52] point out there are ways in which providers can promote communication about CAM and traditional remedies with patients, without necessarily endorsing the use of such products. Healthcare providers should be well informed about the kinds of products that patients may be accessing so that they can counsel patients regarding the concurrent use of these medicines with prescribed regimens and empower patients to make appropriate decisions in this regard.…”