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Klafke N, Bossert J, Boltenhagen U, Froehlich D, Mahler C, Joos S, Wensing M. Counseling lifestyle medicine in oncology: A qualitative analysis of interprofessional patient-nurse-physician interactions. PATIENT EDUCATION AND COUNSELING 2024; 127:108352. [PMID: 38905751 DOI: 10.1016/j.pec.2024.108352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 05/23/2024] [Accepted: 06/14/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVES Counseling plays a key role in promoting health behaviors, providing evidence-based information, and supporting patients with cancer during and after treatment. This study aimed to evaluate an interprofessional counseling service on Complementary and Integrative Health (CIH) for patients being treated at Comprehensive Cancer Centers (CCCs) in Southern Germany. METHODS Patients participating in the CCC-Integrativ study received three CIH counseling sessions within three months in addition to their conventional cancer treatment. Medical and nursing staff participated in a study-specific blended learning training program before conducting the counseling. As part of the process evaluation, 30 audio-recorded counseling sessions were transcribed verbatim and analyzed by conducting a content analysis using MAXQDA 2020. RESULTS Throughout the counseling, patients were conceded to address various health issues, which mainly revolved around symptom management interlaced with the areas of nutrition, exercise, and relaxation. The interprofessional teams conducted the counseling in a structured and patient-oriented manner. They worked together to motivate the patients to apply procedures from the CIH field independently, even if patients sometimes experienced difficulties in implementation. CONCLUSIONS Interprofessional collaboration improved healthcare quality, as patients received comprehensive and evidence-based advice on their supportive needs and lifestyle issues. Both professions could equally contribute their areas of knowledge and expertise and apply them to the benefit of the patients. PRACTICE IMPLICATIONS Providing an integrative counseling service and adequate training on interpersonal communication and CIH for healthcare professionals will improve patient-centered care.
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Affiliation(s)
- Nadja Klafke
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
| | - Jasmin Bossert
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Ursula Boltenhagen
- Institute of Health Sciences, Department of Nursing Science, University Hospital Tuebingen, Tuebingen, Germany
| | - Daniela Froehlich
- Institute for General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
| | - Cornelia Mahler
- Institute of Health Sciences, Department of Nursing Science, University Hospital Tuebingen, Tuebingen, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Koenig CJ, Vasquez TS, Peterson EB, Wollney EN, Bylund CL, Ho EY. Mapping Uncharted Terrain: A Systematic Review of Complementary and Integrative Health Communication Using Observational Data in Biomedical Settings. HEALTH COMMUNICATION 2023; 38:3147-3162. [PMID: 36602254 DOI: 10.1080/10410236.2022.2140080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Complementary and integrative health (CIH) use is diverse and highly prevalent worldwide. Prior research of CIH communication in biomedical encounters address safety, efficacy, symptom management, and overall wellness. Observational methods are rarely used to study CIH communication and avoid recall bias, preserve ecological validity, and contextualize situated clinical communication. Following PRISMA guidelines, we systematically reviewed studies at the intersection of social scientific observational research and findings about CIH communication between clinicians, patients, and caregivers in biomedical settings. We identified international, peer-reviewed publications from seven databases between January 2010 and December 2020. Titles and abstracts were first screened for inclusion, then full studies were coded using explicit criteria. We used a standard checklist was modified to assess article quality. Ten of 11,793 studies examined CIH communication using observational methods for CIH communication in biomedical settings. Studies used a range of observational techniques, including participant and non-participant observation, which includes digital audio or video recordings. Results generated two broad sets of findings, one focused on methodological insights and another on CIH communication. Despite methodological and topic similarities, included studies addressed CIH communication as a process and as proximal and intermediate health outcomes. We recommend how observational studies of CIH communication can better highlight relationships between communication processes and health outcomes. Current research using observational methods offers an incomplete picture of CIH communication in biomedical settings. Future studies should standardize how observational techniques are reported to enhance consistency and comparability within and across biomedical settings to improve comparability.
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Affiliation(s)
| | | | - Emily B Peterson
- Annenberg School for Communication and Journalism, University of Southern California
| | | | - Carma L Bylund
- Health Outcomes & Biomedical Informatics, University of Florida
| | - Evelyn Y Ho
- Communication Studies, San Francisco State University
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3
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Kwong MH, Ho L, Li ASC, Nilsen P, Ho FF, Zhong CCW, Chung VCH. Integrative oncology in cancer care - implementation factors: mixed-methods systematic review. BMJ Support Palliat Care 2023:spcare-2022-004150. [PMID: 37173126 DOI: 10.1136/spcare-2022-004150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Integrative oncology (IO) appears to be beneficial to patients with cancer, but its implementation remains a challenge. Guided by the Theoretical Domains Framework (TDF) and the Capability-Opportunity-Motivation-Behaviour (COM-B) model, this systematic review identified the barriers to and facilitators of IO implementation in conventional cancer care settings. METHODS We searched eight electronic databases from their inception until February 2022 for qualitative, quantitative or mixed-methods empirical studies reporting the implementation outcomes for IO services. Critical appraisal approach was tailored according to study types. The identified implementation barriers and facilitators were mapped onto TDF domains and the COM-B model, and subsequently onto the behavioural change wheel (BCW) for formulating behavioural change interventions. RESULTS We included 28 studies (11 qualitative, 6 quantitative, 9 mixed-methods and 2 Delphi studies) of satisfied methodological quality. The main implementation barriers were the lack of IO knowledge, the absence of funding and healthcare professionals' low level of IO receptiveness. The key implementation facilitators were the dissemination of evidence on IO clinical benefits, the equipping of professionals with IO service delivery skills and the provision of a supportive organisational climate. CONCLUSION Multifaceted implementation strategies are needed to address the determinants influencing IO service delivery. Based on our BCW-based analysis of the included studies, the key behavioural change techniques are: (1) educating healthcare professionals about the value and application of traditional and complementary medicine; (2) ensuring access to actionable clinical evidence on IO effectiveness and safety and (3) designing guidelines on communicating traditional and complementary medicine interventions with patients and caregivers for biomedically trained doctors and nurses.
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Affiliation(s)
- Ming Hong Kwong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Leonard Ho
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Angus S C Li
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Per Nilsen
- Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Östergötland, Sweden
| | - Fai Fai Ho
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Claire C W Zhong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Vincent C H Chung
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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Akeeb AA, King SM, Olaku O, White JD. Communication Between Cancer Patients and Physicians About Complementary and Alternative Medicine: A Systematic Review. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:80-98. [PMID: 36149678 PMCID: PMC10081707 DOI: 10.1089/jicm.2022.0516] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: Complementary and alternative medicine (CAM) has become increasingly popular among cancer patients and is often used concomitantly with standard cancer therapies. Nonetheless, disclosure of CAM utilization by cancer patients to physicians, along with the provision of information on CAM therapies by physicians, is poor. This review explores the literature to synthesize existing information on communication about CAM usage, reasons for nondisclosure, and the clinical implications thereof. Methods: A search of medical literature published between December 1, 2009, and October 1, 2021 (last searched on April 18, 2022), on communications between physicians and cancer patients about CAM treatments was conducted through MEDLINE and EMBASE. Results were screened for inclusion, dually reviewed, and assessed using the QualSyst quality appraisal instrument. Findings were categorized and synthesized for review. Results: A total of 30 articles were located (n = 8721 total participants), which discussed elements related to patient disclosure of CAM use (n = 16), provider experiences or perceptions related to communication about CAM (n = 3), patterns of this communication (n = 6), and recommendations for effectively discussing CAM with cancer patients (n = 5). Reports indicate that nondisclosure is common throughout the cancer care spectrum. Factors influencing nondisclosure range from patient beliefs and attitudes about their provider, demographic characteristics, disease progression, physician-patient relationship, physician noninquiry, and type of CAM used; ultimately creating a gap in care that may have serious medical implications. Discussion: Many of the studies identified are small and confined to a single-center, hospital-network, or geographic setting, thereby limiting the applicability of findings and recommendations. Nonetheless, improving patient-physician communication is essential in delivering evidence-informed, patient-centered care and crucial for achieving patient satisfaction and positive health outcomes. The lack of adequate CAM dialogue about CAM use increases the risk of adverse interactions with conventional cancer treatments and results in missed opportunities for providers and patients to engage in vital information exchange. Future research and education are necessary to further identify barriers surrounding patient-provider communication about CAM treatments.
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Affiliation(s)
- Ameenat A. Akeeb
- Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Sophia M. King
- Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Oluwadamilola Olaku
- Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Jeffrey D. White
- Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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Ho EY, Leung G, Lauer B, Jih J, Karliner L. Complementary and integrative healthcare communication in Chinese American patient / primary care visits: An observational discourse analysis. PEC INNOVATION 2022; 1:100082. [PMID: 36506917 PMCID: PMC9733679 DOI: 10.1016/j.pecinn.2022.100082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective Chinese-American patients use CIH at high rates but disclosure of CIH use to clinicians is low. Further, the content of CIH talk between patients and their clinicians is not well described. We aimed to characterize CIH talk between Chinese-American patients and their primary care clinicians. Methods Discourse analysis of 70 audio-recordings of language concordant and discordant-interpreted visits. Results Nearly half of all visits (48.6%) had some form of CIH communication. 'Simple CIH talk' focused on a single CIH topic resulting in a positive, neutral, or negative response by clinicians. 'CIH-furthering talk' was characterized by clinicians and patients addressing more than one CIH topic or including a combination of orientations to CIH by both clinicians and patients. CIH-furthering talk characterized by clinician humility could enhance rapport, cultural understanding, and open communication. CIH-furthering talk also led to miscommunication and retreat toward biomedicine. Conclusion CIH communication occurred frequently during language concordant and discordant-interpreted visits with Chinese-American patients. Both patients and clinicians used CIH-furthering talk as a conversational resource for managing care. Innovation This discourse analysis of visits between Chinese-American patients and their clinicians advances understanding of CIH communication beyond disclosure, illustrating the complexity of linguistic and cultural nuances that affect patient care.
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Affiliation(s)
- Evelyn Y. Ho
- Department of Communication Studies, University of San Francisco, 2130 Fulton St., San Francisco, CA 94117, USA,Asian American Research Center on Health, San Francisco, CA, USA,Corresponding author at: University of San Francisco, 2130 Fulton Street, Communication Studies KA 313, San Francisco, CA 94117, USA., (E.Y. Ho)
| | - Genevieve Leung
- Department of Rhetoric and Language, University of San Francisco, 2130 Fulton St., San Francisco, CA 94117, USA
| | - Brady Lauer
- Department of Communication Studies, University of San Francisco, 2130 Fulton St., San Francisco, CA 94117, USA
| | - Jane Jih
- Asian American Research Center on Health, San Francisco, CA, USA,Department of Medicine, University of California San Francisco, 1545 Divisadero St., San Francisco, CA 94143, USA,Multiethnic Health Equity Research Center, University of California San Francisco, 490 Illinois Street, San Francisco, CA 94158, USA
| | - Leah Karliner
- Asian American Research Center on Health, San Francisco, CA, USA,Department of Medicine, University of California San Francisco, 1545 Divisadero St., San Francisco, CA 94143, USA,Multiethnic Health Equity Research Center, University of California San Francisco, 490 Illinois Street, San Francisco, CA 94158, USA
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Mentink MDC, van Vliet LM, Timmer-Bonte JANH, Noordman J, van Dulmen S. How is complementary medicine discussed in oncology? Observing real-life communication between clinicians and patients with advanced cancer. PATIENT EDUCATION AND COUNSELING 2022; 105:3235-3241. [PMID: 35989202 DOI: 10.1016/j.pec.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study aims to examine the structure of communication about complementary medicine (CM) between patients with cancer and clinicians during oncology consultations. METHODS Previously, consultations between 29 clinicians and 80 patients with advanced cancer were recorded in six hospitals in the Netherlands. The present study considers a secondary analysis. References to CM during the consultation were coded using a self-developed observational coding scheme. RESULTS At least one reference to CM was observed in 35 out of 80 consultations (44 %), with a total of 73 references. In most cases, CM was initially referred to by patients. Clinicians often did not elaborate on the subject of CM. Relevant aspects related to CM (e.g., safety, effectiveness) were infrequently discussed. Both patients and clinicians showed predominantly neutral to positive attitudes towards CM. CONCLUSIONS This study shows that patients are still the main initiators of discussions about CM and the topic is not consistently discussed in daily oncology practice. PRACTICE IMPLICATIONS If exploration of patients' interest in CM or its use became routine in oncology practice, it may relieve patients of the burden of introducing the topic, decrease potential risks of CM use and increase access to evidence-based CM for all patients with cancer.
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Affiliation(s)
- Marit D C Mentink
- Nivel, Netherlands Institute for Health Services Research, Department of Communication in Healthcare, Utrecht, Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands.
| | - Liesbeth M van Vliet
- Leiden University, Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden, Netherlands; Leiden University, Leiden Institute for Brain and Cognition, Leiden, Netherlands
| | | | - Janneke Noordman
- Nivel, Netherlands Institute for Health Services Research, Department of Communication in Healthcare, Utrecht, Netherlands
| | - Sandra van Dulmen
- Nivel, Netherlands Institute for Health Services Research, Department of Communication in Healthcare, Utrecht, Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands
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7
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Rivera AS. Complementary medicine as a risk factor for catastrophic expenditures in people with cancer. THE LANCET GLOBAL HEALTH 2022; 10:e313-e314. [DOI: 10.1016/s2214-109x(22)00034-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022] Open
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Ho EY, Bylund CL, Wollney E, Peterson EB, Wong HN, Koenig CJ. A systematic review of communication about Complementary and Integrative Health (CIH) in global biomedical settings. PATIENT EDUCATION AND COUNSELING 2021; 104:2900-2911. [PMID: 34030929 DOI: 10.1016/j.pec.2021.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/08/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES A systematic review to analyze communication rates of complementary and integrative health (CIH) and analyze how communication terms, such as "disclosure," are measured and operationalized. METHODS We searched seven databases for studies published between 2010 and 2018 with quantitative measurements of patients' communication of CIH to a biomedical clinician. We analyzed communication terms used to describe patients reporting CIH usage. We also examined the conceptual and operational definitions of CIH provided and whether those terms were explicitly operationalized. We aggregated the percentage, rate, or ratio of CIH users that communicated about CIH with their clinicians by disease type and geographical region. RESULTS 7882 studies were screened and 89 included in the review. Studies used a wide range of conceptual and operational definitions for CIH, as well as 23 different terms to report communication related to reporting CIH usage. Usage varied by disease type and geographical region. CONCLUSIONS Studies of CIH and CIH communication may measure different kinds of social and communicative phenomena, which makes comparison across international studies challenging. PRACTICE IMPLICATIONS Future studies should employ standardized, replicable measures for defining CIH and for reporting CIH communication. Clinicians can incorporate questions about prior, current, and future CIH use during the medical visit.
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Affiliation(s)
- Evelyn Y Ho
- Department of Communication Studies, University of San Francisco, San Francisco, USA; Asian American Research Center on Health, San Francisco, USA.
| | - Carma L Bylund
- College of Journalism and Communications, University of Florida, Gainesville, USA
| | - Easton Wollney
- College of Journalism and Communications, University of Florida, Gainesville, USA
| | - Emily B Peterson
- Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, USA
| | - Hong-Nei Wong
- Lane Medical Library & Knowledge Management Center, Stanford University School of Medicine, Stanford, Palo Alto, USA
| | - Christopher J Koenig
- Department of Communication Studies, San Francisco State University, San Francisco, USA; Medical Cultures Lab, University of California, San Francisco, San Francisco, USA
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Simon H, Ganem G, Touboul C, Lhomel C, Morère J. Patient perspectives on supportive care in cancer: Results of the Calista 2 study. Eur J Cancer Care (Engl) 2020; 29:e13299. [DOI: 10.1111/ecc.13299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/03/2020] [Accepted: 08/07/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Hélène Simon
- Institut de Cancérologie et d’Hématologie Brest France
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Agarwal V. Patient Communication of Chronic Pain in the Complementary and Alternative Medicine Therapeutic Relationship. J Patient Exp 2020; 7:238-244. [PMID: 32851146 PMCID: PMC7427370 DOI: 10.1177/2374373519826137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Patient descriptions of pain shape the pain experience, yet there is insufficient understanding of how patient communication can help providers lessen pain’s psychological and physical impact. Objective: To examine how individuals communicate their pain experience in the complementary and alternative medicine (CAM) provider-patient relationship. Method: Qualitative thematic framing examining semistructured interviews of a purposive and snowball sample of CAM patients (N = 13; 850 double-spaced pages) recruited from the mid-Atlantic region of the United States. Results: Complementary and alternative medicine patients communicate the pain experience through an awareness of their interdependence with: (a) relational spaces as attention to the self, the healing practices, and the provider; (b) physical spaces as openness to surroundings and the spatiality and temporality of self; and (c) physiological spaces as breathing and neurological and immune system functioning. Conclusion: A therapeutic relationship cultivating interdependence through awareness of relational, physical, and physiological spaces supports patients’ ability to open up to, know, and accept their body. The CAM provider’s work connects their practice with patient awareness of control over their environment, relationships, and physiology to redefine their pain experience.
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Affiliation(s)
- Vinita Agarwal
- Department of Communication Arts, Fulton School of Liberal Arts, Salisbury University, Salisbury, MD, USA
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Tilburt J, Yost KJ, Lenz HJ, Zúñiga ML, O'Byrne T, Branda ME, Leppin AL, Kimball B, Fernandez C, Jatoi A, Barwise A, Kumbamu A, Montori V, Koenig BA, Geller G, Larson S, Roter DL. A Multicenter Comparison of Complementary and Alternative Medicine (CAM) Discussions in Oncology Care: The Role of Time, Patient-Centeredness, and Practice Context. Oncologist 2019; 24:e1180-e1189. [PMID: 31101701 DOI: 10.1634/theoncologist.2019-0093] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/10/2019] [Indexed: 11/17/2022] Open
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.
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Affiliation(s)
- Jon Tilburt
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathleen J Yost
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Heinz-Josef Lenz
- Division of Medical Oncology, Keck School of Medicine, University of Southern California, Los Angeles California, USA
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, California, USA
| | - Thomas O'Byrne
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Biostatistics, Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Megan E Branda
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Biostatistics, Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron L Leppin
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Brittany Kimball
- Departments of Internal Medicine and Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cara Fernandez
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Aminah Jatoi
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amelia Barwise
- Division of Critical Care, Mayo Clinic, Rochester, Minnesota, USA
| | - Ashok Kumbamu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor Montori
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Barbara A Koenig
- Program in Bioethics, University of California San Francisco, San Francisco, California, USA
| | - Gail Geller
- Berman Institute of Bioethics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan Larson
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Debra L Roter
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Kumbamu A, Geller G, Leppin A, Fernandez C, Tilburt J, Koenig B. Contending Worldviews in the Clinical Encounter: An Empirical Study of Complementary and Alternative Medicine Deliberations in Contemporary Medical Oncology. J Altern Complement Med 2018; 24:996-1002. [PMID: 30156425 DOI: 10.1089/acm.2018.0200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE In this article, the authors characterize the different ways patients and clinicians discuss complementary and alternative medicine (CAM) during routine cancer care. METHODS Over a period of two years, the authors audio-recorded clinical interactions between 37 medical oncology clinicians and a sample of 327 oncology patients at an academic cancer center in the Midwest United States. Recordings of conversations that included any discussion of CAM were transcribed and analyzed using a qualitative content analysis approach. RESULTS Out of 327 conversations, CAM was mentioned and/or discussed in only 31 encounters. Communication dynamics between clinician and patient involve several factors: the condition of the patient and his or her knowledge about and experience with CAM, the clinician's knowledge and values about CAM, perceived assumptions and stereotypes about CAM, and institutional response to the integration of CAM in cancer care. CONCLUSION Addressing the difficult and sensitive topic of CAM in cancer care requires hearing patients in a manner meaningful to them. In that sense, CAM can serve as an important marker and test case in the march toward shared decision-making and patient-centered communication generally.
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Affiliation(s)
- Ashok Kumbamu
- 1 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery , Mayo Clinic, Rochester, Minnesota
| | - Gail Geller
- 2 Johns Hopkins University , Baltimore, Maryland
| | | | | | - Jon Tilburt
- 4 Program in Professionalism and Bioethics, Mayo Clinic , Rochester, Minnesota
| | - Barbara Koenig
- 5 Institute for Health Aging, University of California San Francisco , San Francisco, California
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Koenig CJ, Wenger M, Graham GD, Asch S, Rongey C. Managing professional knowledge boundaries during ECHO telementoring consultations in two Veterans Affairs specialty care liver clinics: A theme-oriented discourse analysis. J Telemed Telecare 2018. [PMID: 29514547 DOI: 10.1177/1357633x18756454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Consultations are the traditional method of communication between generalist and specialist providers managing patients with specialty care needs. Traditional written consultations have limitations, including inadequate clinical information and inappropriate, or unclear consultation questions. Teleconsultations minimize these limitations through real-time communication between generalist and specialist providers to actively manage professional knowledge boundaries about specialty care problems. METHODS We video-recorded 37 teleconsultation sessions, resulting in 115 consultations between generalist and specialty care providers participating in Veterans Affairs (VA) Extension for Community Healthcare Outcomes (ECHO) liver clinics. Data were collected at two US sites across nine months to observe consultation communication among 33 primary care generalists and three liver specialists. Video recordings were transcribed verbatim and analysed using theme-oriented discourse analysis to characterize consultation question content and format. RESULTS Generalists' consultation question content addressed a range of topics, including treatment, diagnosis, interpreting results, patient communication, screening and surveillance, and care coordination. Some generalists relied on descriptive narratives rather than a specific question to convey complex patient cases. Consultation question format showed nearly even division between targeting general medical knowledge and specialty care knowledge domains, including specialty care, medical, organizational, and experiential knowledge. DISCUSSION Timely access to specialists through teleconsultation has the potential to transform specialty care delivery. This article examines provider-to-provider interactions to understand how the communication process contributes to knowledge management during teleconsultations. Video studies of health information technology use provide a rich opportunity for analysing real-time communication that may help improve cross-specialty collaboration and the coordinated management of patients with specialty care needs.
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Affiliation(s)
- Christopher J Koenig
- 1 San Francisco State University, San Francisco, CA, USA.,2 Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,3 San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Matthew Wenger
- 3 San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Glenn D Graham
- 3 San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.,4 Specialty Care Services, VA Central Office, Washington, DC, USA
| | - Steven Asch
- 2 Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,5 Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Catherine Rongey
- 6 University of California, San Francisco, San Francisco, CA, USA.,7 Kaiser Permanente, Vallejo, CA, USA
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Kobue B, Moch S, Watermeyer J. "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. BMC Health Serv Res 2017; 17:303. [PMID: 28441949 PMCID: PMC5405531 DOI: 10.1186/s12913-017-2246-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 04/19/2017] [Indexed: 12/22/2022] Open
Abstract
Background Patients with chronic illnesses are often required to take lifelong medication to alleviate symptoms and prevent disease progression. Many patients find it difficult to adhere to prescribed medication for various reasons, some of which may link to the way they conceptualise medicines and understand their illness and treatment. This study explores the medicine taking behaviours of patients presenting with Rheumatoid Arthritis (RA), a chronic inflammatory autoimmune disease. We focused particularly on patients’ conceptualisation and understanding of medicines within this disease context, against a backdrop of scarce healthcare resources. Methods We conducted semi-structured interviews with 18 female patients at a rheumatology clinic in South Africa, as well as a review of participants’ medical records. We conducted a secondary analysis of the data using thematic analysis and framework analysis principles. Results Participants reported a range of medicine taking behaviours including self-medicating, adding complementary and alternative medicines (CAM) or traditional remedies, and sometimes acquiring prescribed medicines illegally. Participants provided insights into their understanding of what constitutes a medicine and what substances can be added to a prescribed regimen, which impacted on adherence. Importantly, the majority of participants demonstrated poor understanding of their illness, medications, regimens and dosage instructions. Conclusions Medicine taking in the context of RA, within the studied demographic, is complex and appears strongly mediated by individual and contextual factors. Poor patient understanding, individual conceptualisation of medicines and medicine taking, and the availability of a range of additional medicines and remedies impact on adherence. Based on these findings, we make some suggestions for how healthcare providers can play a greater role in educating patients living with RA about medicines, CAM and traditional remedies, as well as medicine taking behaviours.
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Affiliation(s)
- Boitshoko Kobue
- Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, 1 Jan Smuts Ave, Braamfontein, Johannesburg, 2050, South Africa
| | - Shirra Moch
- Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, and Centre for Health Science Education, Faculty of Health Sciences, University of the Witwatersrand, 1 Jan Smuts Ave, Braamfontein, Johannesburg, 2050, South Africa.
| | - Jennifer Watermeyer
- Health Communication Research Unit, School of Human and Community Development, University of the Witwatersrand, 1 Jan Smuts Ave, Braamfontein, Johannesburg, 2050, South Africa
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Dohan D, Garrett SB, Rendle KA, Halley M, Abramson C. The Importance Of Integrating Narrative Into Health Care Decision Making. Health Aff (Millwood) 2017; 35:720-5. [PMID: 27044974 DOI: 10.1377/hlthaff.2015.1373] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
When making health care decisions, patients and consumers use data but also gather stories from family and friends. When advising patients, clinicians consult the medical evidence but also use professional judgment. These stories and judgments, as well as other forms of narrative, shape decision making but remain poorly understood. Furthermore, qualitative research methods to examine narrative are rarely included in health science research. We illustrate how narratives shape decision making and explain why it is difficult but necessary to integrate qualitative research on narrative into the health sciences. We draw on social-scientific insights on rigorous qualitative research and our ongoing studies of decision making by patients with cancer, and we describe new tools and approaches that link qualitative research findings with the predominantly quantitative health science scholarship. Finally, we highlight the benefits of more fully integrating qualitative research and narrative analysis into the medical evidence base and into evidence-based medical practice.
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Affiliation(s)
- Daniel Dohan
- Daniel Dohan is a professor in the Philip R. Lee Institute for Health Policy Studies and in the Department of Anthropology, History, and Social Medicine, both at the University of California, San Francisco (UCSF)
| | - Sarah B Garrett
- Sarah B. Garrett is a research analyst in the Philip R. Lee Institute for Health Policy Studies, UCSF
| | - Katharine A Rendle
- Katharine A. Rendle is a cancer prevention fellow in the Division of Cancer Prevention, National Cancer Institute, in Bethesda, Maryland
| | - Meghan Halley
- Meghan Halley is an assistant scientist at the Palo Alto Medical Foundation Research Institute, in California
| | - Corey Abramson
- Corey Abramson is an assistant professor in the School of Sociology at the University of Arizona, in Tucson
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