Research shows that half of the cancer patients in Norway use different forms of Complementary and Alternative Medicine (CAM) during the course of disease. Many of these patients want to discuss the use of CAM with their GP or an oncologist/cancer nurse. Patients highly value health personnel’s assessment and knowledge of CAM, and appreciate their opinions. A discussion about CAM, which the provider should initiate, would strengthen the relationship between the patient and the provider.
On the other hand, research shows that health personnel are unwilling to address this issue, often resulting from lack of knowledge about CAM. Moreover, many people think it is difficult to recommend treatment modalities that lack scientific documentation of effect. In addition, it may be challenging to find the time for such conversations, as time is scarce for most providers.
Several studies show that it may be risky to combine CAM and chemotherapy. Some herbs (for instance phytoestrogens and St John’s wort) are not to be used along with conventional cancer treatment. (This risk is regarded as direct risk.) Furthermore, high doses of vitamin A and C should be avoided. Therefore, it is important that health personnel discuss these issues with the patients in an open and unprejudiced manner. Finally, the information should be included in the patient’s anamnesis to avoid misfortunate incidents.
Little research has been made on how and if alternative providers communicate with their cancer patients about the pros and cons of combining alternative and conventional treatment. Research shows that alternative providers have other models of disease causality and a different treatment philosophy compared to conventional providers. This may be challenging for all parties involved and may maintain the communication gap between the different professions. Furthermore, it is unclear what kind of medical knowledge alternative providers have. To assess the patients’ symptoms and refer them to conventional treatment when necessary, requires basic medical knowledge from the provider. Lack of such knowledge may be connected to risk for the patients. (This is regarded as indirect risk.)
In this project we will find out how the different health professions communicate with their cancer patients about their use of alternative treatment, and how they assess risk for cancer patients who want to combine alternative and conventional treatment in the course of their disease.
In this project we will design and develop a questionnaire to assess and map the perception of communication and risk, clinical experiences of direct and indirect risk situations for patients who combine alternative and conventional treatment. The target group is GPs, oncologists, cancer nurses, and CAM providers in Norway. Based on the results from the study, we will design and develop a beta version of a web tool (Shared Decision Making Tool) that health personnel can use to guide their patients to safe choices regarding CAM, which is in line with their own treatment goals. The tool may also be used by patients and their relatives, as well as CAM providers.
Post doctor: Trine Stub
The project started in May 2014 and will complete in September 2017
This is a cooperation project between NAFKAM, Nasjonalt kompetansesenter for samhandling og telemedisin and Walk Forest School of Medicine, North Carolina, USA
This project was completed in September 2017.
The following four articles have been published so far:
- The Norwegian Cancer Society. Tar i bruk alle midler 2008 03.05.2012 [cited 2012 03.05.]. Available from: http://www.kreftforeningen.no/aktuelt/aktuelt_i_media/tar_i_bruk_alle_midler__11134.
- Risberg T, Bremnes RM, Vickers A, Wist EA, Kaasa S. Does use of alternative medicine aggravate the survival prognosis in cancer? Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke. 2003;123(5):628-
- Salamonsen A. Doctor-patient communication and cancer patients' choice of alternative therapies as supplement or alternative to conventional care. Scandinavian Journal of Caring Science. 2012;10.1111/j.1471-6712.2012.01002.x.
- Molassiotis A, Fernandez-Ortega P, Pud D. Use of complementary and alternative medicine in cancer patients:a European survey. Ann Oncol. 2005;16(16):655-63.