Table 1.
Eligible Studies with Information on the Discussion of Complementary and Alternative Medicine Use Between Cancer Patients and Providers
| Study | Date published | Objective | Design | Setting | Participants | Relevant results | QualSyst score |
|---|---|---|---|---|---|---|---|
| Arslan and Guler17 | 2017 | (1) To investigate CAM usage and knowledge levels of chemotherapy-receiving cancer patients. | Questionnaire | Tepecik Research and Training Hospital in Izmir, Turkey | Cancer patients (n = 289) | Sixty-two of 289 patients (22%) received CAM. Nearly half of these patients did not inform their clinicians about their use of CAM. | 0.89 |
| Black et al18 | 2016 | (1) To understand the prevalence and patterns of CIH use among Hispanics. | In-person and/or telephone-based interview | Cases were identified from the California Cancer Registry and/or from the LAC+USC County Hospital and USC Norris Comprehensive Cancer Center in Los Angeles, CA | Colorectal cancer patients (n = 631) | Among 631 Hispanic patients, 40.1% reported ever using CIH. About 60% of participants reported CIH use to address specific health conditions; however, most patients did not discuss CIH use with their physicians (76.3%). | 0.86 |
| Butler et al19 | 2011 | (1) To examine the prevalence and predictors of CAM use among rural patients with localized prostate cancer and (2) the disclosure of CAM use to their physicians. | Three in-person semistructured interview surveys (conducted within 1, 6, and 9 months of diagnosis) | Undescribed center(s) in rural, southwest Georgia | Prostate cancer patients (n = 321) | At baseline, 26.4% reported ever using CAM. Fifty-six percent of these patients did not disclose their CAM use to their physicians. While 44% of the study sample disclosed using CAM to their doctors before treatment, 61% disclosed after treatment began (p = 0.05). | 0.86 |
| Choi et al20 | 2012 | (1) To investigate in depth the use of CAMs by cancer patients at the EOL and (2) how they communicate with physicians about them. | Questionnaire | Seventeen hospitals in Korea | Cancer patients (n = 1662) | The prevalence of CAM use among cancer patients at the EOL was 37.0%. 93.1% of CAM-users were using pharmacologic agents. Only 42.5% discussed CAM use with their physicians. | 1.0 |
| Chow et al24 | 2010 | (1) To evaluate determinants, expectations, association with QOL, and doctor's awareness of CAM use in Singapore cancer patients. | Cross-sectional survey | Cancer Centre of the National University Hospital in Singapore | Cancer patients (n = 316) | Fifty-one percent of CAM users informed their doctors about their use and 15% of doctors reported to be aware of CAM use in these patients. Twenty-five percent of patients reported concurrent use of oral CAM and chemotherapy, of which oncologists were unaware in 86% of cases. | 0.89 |
| Corina et al31 | 2016 | (1) To learn about the values, norms and defining features that characterize oncologist–patient discussions on CAM. | Semistandardized telephone interviews | Inpatient and outpatient settings in Germany | Oncologists (n = 17) | Discussions on CAM tend to reflect the idea that CAM belongs “to another world.” Many interviewees mentioned an apparent lack of scientific proof, especially when their aim was to warn patients against the use of CAM. Advice on CAM is seen by oncologists as an important service they provide to their patients, even though their knowledge of the subject is often limited. | 0.78 |
| Davis et al6 | 2012 | (1) To explore the nondisclosure of CAM use among cancer patients, including reasons for and outcomes from nondisclosure of CAM use, within the context of patient–doctor communication. | Systematic review | Various | Twenty-one articles | Studies reported a prevalence of CAM use among patients with cancer ranging between 11% and 95%. Patient–doctor communication about the use of CAM was associated with an enhanced patient–doctor relationship and higher patient satisfaction. | 1.0 |
| Frenkel and Cohen2 | 2014 | (1) To realize the components of effective communication about the use of CIM in cancer care. | Literature review | Various | Not reported | The communication process requires a very sensitive approach that depends on effective communication skills, experience in listening, encouraging hope, and the ability to convey empathy and compassion. This process is coupled with the use of reliable information sources that can be shared with the patient and his or her family in making decisions about this use. | 0.63 |
| Frenkel et al14 | 2010 | (1) To present an overview of the literature regarding communication in cancer care related to CAM use and (2) discuss a possible model of effective patient–physician communication about CAM use in cancer care. | Literature review | Various | Not reported | A communication approach that fosters a collaborative relationship that includes adequate information exchange, responds to emotional needs, and manages uncertainty can lead to informed decisions about CAM use. | 0.63 |
| Ge et al25 | 2013 | (1) To quantify the extent of patient–physician communication about CAM and (2) identify factors associated with its discussion in RT settings. | Cross-sectional survey | Department of Radiation Oncology at the Hospital of the University of Pennsylvania in Philadelphia, PA | RT patients (n = 305) | In multivariate analyses, female patients (AOR 0.45, 95% CI 0.21–0.98) were less likely to discuss CAM with their radiation oncologists. CAM users were more likely to discuss CAM with their radiation oncologists than were non-CAM users (AOR 4.28, 95% CI 1.93–9.53). | 0.91 |
| Hunter et al15 | 2014 | (1) To investigate the type and prevalence of CAM among an Australian regional radiotherapy patient cohort and the disclosure of information to the consultant radiation oncologist. | Questionnaire | Peter MacCallum Cancer Centre, University of Melbourne in Melbourne, Victoria, Australia | Cancer patients (n = 152) | Sixty-nine of the 152 patients (45.4%) reported active CAM use. | 1.0 |
| Juraskova et al33 | 2010 | (1) To describe communication patterns between oncologists and breast cancer patients regarding CAM use and (2) assess the relationship between CAM discussions and anxiety levels. | Interaction analysis of audiotaped initial consultations | Seven public hospitals in Australia and New Zealand | Breast cancer patients (n = 102); Oncologists (n = 24) | At least 1 instance of CAM discussion in 24 of the 102 consultations (24%). CAM discussions were mainly patient initiated (73%). | 1.0 |
| King et al30 | 2015 | (1) To understand why communication about CAM is not occurring between patients and HCPs and (2) how CAM communication could be improved during HCP–patient interactions. | Questionnaire | Two outpatient clinics in Calgary, Alberta | Cancer outpatients (n = 481); HCPs (n = 100) | HCPs reported limited training about CTs but most (90%) expressed interested in receiving more training. The majority of HCPs (>80%) reported limited knowledge about the role of CTs in cancer care or evidence to support CT use. Questions about communication and interactions revealed that 80% of patients reported not having had an HCP speak to them about CTs. However, 63% of HCPs reported addressing CT use. | 0.91 |
| Koenig et al35 | 2015 | (1) To characterize how providers respond to patient mentions of CIM during routine oncology visits. | Longitudinal ethnographic study | Four oncology clinics in the Western United States | Advanced cancer patients (n = 82) | CIM was mentioned in 78/229 (34%) of the total observed visits. Patients initiated talk about CIM (76%) more than providers (24%). Providers' responses inhibited further talk in 44% of observations and promoted talk in 56% of observations. | 0.89 |
| Lee et al32 | 2014 | (1) To explore oncologists' knowledge, attitudes, and practice patterns regarding HS use by their patients. | Questionnaire (e-mail and snail mail) | United States | Oncologists (n = 392) | Fifty-nine percent of respondents had not received any education on the topic of CAM. | 1.0 |
| Luo and Asher37 | 2017 | (1) To define CAM use by cancer patients and (2) investigate factors that might influence changes in CAM use in relation to cancer diagnoses. | Questionnaire (snail mail) | NCCH | Cancer patients (n = 603) | Initiation of CAM use after cancer diagnosis was positively associated with a patient having a conversation about CAM use with his or her oncology provider. Patients practicing mind–body medicine before cancer diagnosis who engaged in a CAM-related conversation with their oncologist were less likely to cease practice. | 0.89 |
| Lüthi et al29 | 2021 | (1) To explore CAM use by pediatric oncology patients in relation to specific time intervals and (2) communication about CAM use between parents and oncologists. | Retrospective cross-sectional study | Pediatric hematology-oncology center at Lausanne University Hospital in Switzerland | Parents of cancer patients (n = 140) | CAM was used by 54.3% of patients before diagnosis and 69.3% of patients after diagnosis. Forty percent of respondents did not discuss CAM with their oncologist. | 0.86 |
| Oh et al23 | 2010 | (1) To examine patient–doctor communication about the use of CAM by adult patients with cancer and (2) compare patients' satisfaction with the consultation between patients who had and those who had not discussed the use of CAM with their doctors. | Questionnaire | Three major university teaching hospitals in Sydney, Australia | Cancer patients (n = 381) | Sixty-five percent of cancer patients used at least one form of CAM. Use of CAM was not discussed with the oncologist by 55% of respondents using biologically based CAM and by 80% of those using non–biologically based CAM since the diagnosis of cancer. | 0.83 |
| Rausch et al16 | 2011 | (1) To evaluate the frequency of CAM use among radiation oncology patients, the coping strategies that influenced this use, and the rates of disclosure of CAM use to their health care providers. | Questionnaire | Two rural radiation oncology clinics in south central Minnesota | RT patients (n = 153) | CAM use was reported in 95% of the participants. One hundred and twelve participants reported taking vitamins, minerals, or supplements, and 47% of those 112 did not disclose this use to their providers. | 0.89 |
| Rogge et al8 | 2021 | (1) To evaluated whether using blended learning (e-learning plus a workshop) to train oncology physicians in providing advice on CIM therapies to their patients with cancer, in addition to distributing an information leaflet on reputable CIM websites, had different effects on patient-reported outcomes for the consultation than only distributing the leaflet. | Multicenter, cluster-randomized trial | Private practices and hospital departments in Germany | Cancer patients (n = 291; 128 in the intervention group and 169 in the control group); Oncologists (n = 41) | Patients in the intervention group rated physician–patient communication higher on all EORTC QLQ-COMU26 scales (mean total score, 84.3 [95% CI, 79.5–89.2] vs. 73.6 [95% CI, 69.3–78.0]; p = 0.002), were more satisfied with the advice (mean, 4.2 [95% CI, 4.0–4.4] vs. 3.7 [95% CI, 3.5–3.8]; p < 0.001), and were readier to make a decision (mean, 63.5 [95% CI, 57.4–69.6] vs. 53.2 [95% CI, 47.8–58.7]; p = 0.016) than the control group. | 0.92 |
| Roter et al34 | 2016 | (1) To describe CAM discussions in oncology visits, (2) the communication patterns that facilitate these discussions, and (3) their association with visit satisfaction. | Prospective, observational study and questionnaire | Academic medical oncology practices in the Upper Midwest of the United States | Cancer patients (n = 327); oncology physicians and NPs (n = 37) | CAM was discussed in 36 of 327 visits; discussions were brief (<1 min), the majority patient initiated (65%) and more common for patients in early stages of cancer care. | 0.95 |
| Salamonsen36 | 2013 | (1) To explore possible connections between cancer patients' communication experiences with doctors and the decision to use CAM as either supplement or alternative to CT. | Face-to-face interviews | The NAFKAM in Tromsø, Norway | Cancer patients (n = 13); Doctors (n = 46) | The analysis revealed three connections between doctor–patient communication and patients' treatment decisions: (1) negative communication experiences because of the use of CAM; (2) negative communication experiences resulted in the decision to use CAM, and in some cases to decline CT; and (3) positive communication experiences led to the decision to use CAM as supplement, not alternative to CT. | 0.80 |
| Schofield et al39 | 2010 | (1) To develop evidence-based guidelines to assist oncology HP to have respectful, balanced and useful discussions with patients about CAM. | Systematic review | Various | Thirty-six articles | Evidence-based guidelines are presented as a sequence of recommended steps: (1)eElicit the person's understanding of the situation; (2) respect cultural and linguistic diversity and different epistemologic frameworks; (3) ask questions about CAM use at critical points in the illness trajectory; (4) explore details and actively listen; (5) respond to the person's emotional state; (6) discuss relevant concerns while respecting the person's beliefs; (7) provide balanced, evidence-based advice; (8) summarize discussions; (9) document the discussion; (10) monitor and follow-up. | 1.0 |
| Sewitch et al28 | 2011 | (1) To gather data about CAM use by site of cancer, (2) reasons for use and rates of use disclosure to treating physicians, and (3) to better understand CAM use and patient perspectives of CAM discussions that occur or not between cancer patients and their physicians. | Questionnaire; focus group discussion | St. Mary's Hospital Center in Montreal, Canada | Cancer patients (n = 100) | In the past 1 and 12 months, natural health products were used by 70% and 80% of respondents, respectively; mind–body therapies by 61% and 64%, respectively, and CAM practitioners by 11% and 29%, respectively. | 0.73 |
| Sohl et al26 | 2015 | (1) To examine CHA disclosure to follow-up care physicians in a diagnostically diverse sample of cancer survivors by describing rates, reasons, and predictors of CHA disclosure with a focus on patient-centered communication and responses from physicians. | Cross-sectional survey | CPIC SEER registry | Cancer survivors (n = 623); CHA-users (n = 196) | Disclosure was significantly associated with patient-centered communication even when adjusting for hypothesized covariates (OR = 1.37; 95% CI, 1.09–1.71]). Perceived physician knowledge of the patient-as-person (OR = 1.28; CI, 1.10–1.48) and information exchange (OR = 1.27; CI, 1.02–1.60) were the aspects of patient-centered communication that contributed to this association. | 1.0 |
| Stub et al38 | 2016 | (1) To examine the qualitative research literature on the perception of and communication about the risk of complementary therapies between different health care providers and cancer patients. | Literature review | Various | Twenty-seven articles | The main risk situations identified were (1) differences in treatment concepts and philosophical values among complementary and conventional health care providers, (2) adverse effects from complementary products and herbs due to their contamination/toxicity and interactions with conventional cancer treatment, (3) health care physicians and oncologists find it difficult to recommend many complementary modalities due to the lack of scientific evidence, and (4) lack of knowledge and information about complementary and conventional cancer treatments among different HCPs. | 1.0 |
| Sullivan et al21 | 2015 | (1) To investigate trends and regional variations in CAM use by cancer patients in regional and remote populations. | Questionnaire | Regional cancer care center in Toowoomba, South East Queensland, Australia | Cancer patients (n = 142) | Sixty-eight percent of patients were currently or had previously used at least one form of CAM. Disclosure of CAM use to either the general practitioner or specialist was reported by 46% and 33% of patients, respectively. | 0.86 |
| Ustundag and Demir Zencirci10 | 2015 | (1) To determine the use and effects of CAM on cancer patients receiving chemotherapy. | Cross-sectional survey | Daytime Chemotherapy Unit of the College District Outpatients in the Ankara Numune Education and Research Hospital in Ankara, Turkey | Cancer outpatients (n = 397) | Most of patients resorting to CAM were women (52.6%), housewives (51.5%), and patients with a family history of cancer (37.7%). | 0.94 |
| Witt et al40 | 2020 | (1) To develop and pretest a CIM-specific physician-consultation framework for potential implementation. | Implementation study | Germany | Oncologists (n = 47) | The manual-guided consultation was considered suitable. The structure and time frame (20 min or less) of the consultation as well as the training were feasible and well accepted. | 0.95 |
| Wortmann et al22 | 2016 | (1) To evaluate the prevalence and predictors for the use of CAM by cancer patients under active treatment with chemo- or radiotherapy or in aftercare. | Questionnaire | Department of Radiotherapy–Radiooncology of the University of Munster/Westfalia, the ambulance for oncology of the St. Franziskus Hospital at Munster, and offices of 13 GPs from a network in Munster, Germany | Cancer patients (n = 506) | Fifty-one percent admitted using CAM. Thirty-five percent informed the oncologist about using CAM, 56% informed the GP, and 26% did not inform any physician. | 0.80 |
AOR, adjusted odds ratio; CAM, complementary and alternative medicine; CHA, complementary health approach; CI, confidence interval; CIH, complementary and integrative health; CIM, complementary and integrative medicine; CPIC, Cancer Prevention Institute of California; CT, conventional treatment; EORTC QLQ-COMU26, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for the assessment of communication between patients and professionals; EOL, end-of-life; GP, General Practitioner; HCP, health care provider; HP, health professionals; HS, herbal supplement; NAFKAM, National Research Center in Complementary and Alternative Medicine; NCCH, North Carolina Cancer Hospital; NPs, Nurse Practitioners; OR, odds ratio; QOL, quality of life; RT, radiation therapy; SEER, Surveillance Epidemiology and End Results.