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

The oncologist

article

Jon Tilburt¹  Aminah Jatoi⁵  Amelia Barwise⁶  Ashok Kumbamu³  Victor Montori⁴  Barbara A. Koenig⁸  Gail Geller⁹  Susan Larson^1,10  Debra L. Roter^1,10  Kathleen J. Yost³  Heinz-Josef Lenz^1,12  María Luisa Zúñiga^1,13  Thomas O'Byrne³  Megan E. Branda³  Aaron L. Leppin⁴  Brittany Kimball^1,15  Cara Fernandez⁷ 

[1] Division of General Internal Medicine, Mayo Clinic;Biomedical Ethics Research Program, Mayo Clinic;Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic;Division of Health Care Policy and Research, Mayo Clinic;Division of Medical Oncology, Mayo Clinic;Division of Critical Care, Mayo Clinic;Knowledge and Evaluation Research Unit, Mayo Clinic;Program in Bioethics, University of California San Francisco;Berman Institute of Bioethics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University;Department of Health, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University;Division of Epidemiology, Mayo Clinic;Division of Medical Oncology, Keck School of Medicine, University of Southern California;School of Social Work, San Diego State University;Division of Biostatistics, Health Sciences Research, Mayo Clinic;Departments of Internal Medicine and Pediatrics, University of Minnesota

关键词: Oncology;    Complementary medicine;    Alternative medicine;    Patient-centered care;   

DOI  :  10.1634/theoncologist.2019-0093

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

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.

【 授权许可】

CC BY|CC BY-NC