In consultations between patients with cancer and their clinicians, the topic of complementary medicine receives little attention
Patients with cancer make extensive use of complementary medicine, such as acupuncture, yoga or nutritional supplements. Yet this topic is hardly discussed in consultations between patients and their clinicians. Nivel research shows that the topic of complementary medicine is usually introduced by the patient. The clinician does not always address this, and important aspects such as safety and effectiveness often remain undiscussed. This while using complementary medicine can have important benefits for the patient, but there can also be adverse effects.
Patient usually the initiator of the topic of complementary medicine
By analyzing audio recordings of 80 oncology consultations between patients with cancer and their clinician, we examined how often and in what manner the topic of complementary medicine was discussed. In 36 of the 80 consultations, some type of complementary medicine was mentioned, mostly related to lifestyle (e.g. nutrition, exercise). The patient was usually the one who initiated the topic of complementary medicine. In a quarter of the cases (26%) that the patient brought up the topic, the clinician did not address this at all. Only in 12% of cases, the clinician asked an additional question about the topic.
Safety, effectiveness and costs of complementary medicine often not discussed
In most cases when complementary medicine was brought up, a detailed discussion about it did not occur. Occasionally, the conversation about complementary medicine was more extensive and aspects such as safety or effectiveness came up (in 14% and 8% of the times complementary medicine was discussed, respectively). In most cases, the patient asked his or her clinician about the safety of a particular type of complementary medicine or about scientific evidence for the efficacy of herbs, supplements or nutrition. In three consultations, costs or reimbursement of complementary medicine was discussed.
Clinicians are an important source of information for patients with cancer when it comes to safety and effectiveness of complementary medicine
Clinicians and patients predominantly positive about complementary medicine
In addition to the contents of the conversation about complementary medicine, we also observed patient and clinician attitudes during the conversation. Clinicians expressed mostly positive or neutral opinions about complementary medicine during the consultations. For example, they encouraged the use of complementary medicine, or did not express a clear opinion. Patients' attitudes towards complementary medicine were also predominantly positive to neutral.
About the study
Nivel has a huge amount of patient-provider consultations recorded on video or audio within the Database Communication in Healthcare. For this study, we used previously recorded oncology consultations made at several hospitals in the Netherlands. These oncology consultations were reanalyzed using a self-designed observation scheme, to see if and how complementary medicine was discussed. A total of 80 recordings from the two previous studies were suitable for this analysis.