Communication predictors and consequences of Complementary and Alternative Medicine (CAM) discussions in oncology visits

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 (< one minute), the majority patient initiated (65%) and more common for patients in early stages of cancer care. Longer visits (35 vs 29 minutes; p<05), greater patient engagement in visit dialogue, lowered clinician verbal dominance and a more patient-centered pattern of visit communication were significantly related to visits with CAM discussions (all p values<01). Both patient and clinician visit satisfaction was higher with CAM discussion (p<05). 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.

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

“…We previously reported that 36 of 327 (11%) consultations at the UM site contained some mention of CAM . Table shows significant variation in CAM discussion from the UM site with the SoCal sites.…”

“…We analyzed visit recordings using the Roter Interaction Analysis System, a taxonomy characterizing all articulated thoughts by each speaker into mutually exclusive and exhaustive codes including psychosocial information exchange, expression and response to emotion, facilitation, and partnering as well as overall positive and negative affect . We defined patient‐centeredness as the extent to which psychosocial, lifestyle, emotional, and facilitative exchanges occurred relative to medically focused and directive exchanges . We also collected duration of session in minutes.…”

“…Yet CAM use may vary by racial and ethnic subgroups as well as region and care setting . In our analysis of one upper Midwest (UM) practice, CAM discussions occurred in 11% of visits; CAM discussions were more likely to occur in visits that were longer, with more patient‐centered communication .…”

Looking Back, Looking Forward: The Ethical Framing of Complementary and Alternative Medicine in Oncology Over the Last 20 Years

“…Those conversations are scant. In a large NIH‐funded observational study, we found that although CAM is discussed in a relative minority of medical oncology visits (11%), and the discussions were brief (<4 minutes total in a visit), those discussions were also characterized by greater patient engagement in dialogue and less physician verbal dominance . Furthermore, conversations that include CAM are rated as better by both patient and clinician.…”

Correlation of Antioxidant and Antiproliferative Activity of Amla and Ginger

“…For public health professionals, the question of whether or not antioxidants have a safe chemopreventive role is central: It is clearly much more effective to prevent cancer than deal with its consequences including the damaging side effects of many chemotherapeutics. However, evidence is lacking for the effectiveness of most CAM therapies for cancer [18]. In parallel, cancer stem cells (CSCs) have been implicated in cancer progression, recurrence, and thereby poor prognosis due to their inherent quiescence and drug-resistant properties [19,20].…”