How to communicate effectively about complementary, integrative and alternative medicine

Health professionals and cancer patients: how to communicate effectively about complementary, integrative and alternative medicine

By Anita Salamonsen, MSc, PhD¹ and Moshe Frenkel, MD^2,3

¹National Research Center in Complementary and Alternative Medicine, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
²Department of Family Medicine, University of Texas Medical  Branch, Galveston, Texas, USA
³Integrative Medicine Service, Institute of Oncology, Meir medical Center, Kfar Saba,  Israel

Background

The use of complementary and alternative medicine (CAM) in oncology settings is widespread. Improving CAM-related communication within the sphere of conventional cancer care is crucial to patient safety, optimal treatment outcomes and the patient’s trust in healthcare professionals.

Studies have revealed, however, that only a few oncologists and physicians feel comfortable discussing CAM with cancer patients. This situation may have arisen as the result of various barriers to communication, including insufficient scientific knowledge, of the risks and positive outcomes of CAM. Other factors might involve lack of time during clinical consultations and also concerns about the financial costs associated with CAM use.

Although many cancer patients express a wish to disclose their use of CAM to healthcare professionals, less than 50% actually do so. Of the cancer patients raising the subject of CAM use in oncology settings, quite a number have reported negative experiences as a consequence; some of these may even have led to a decision to delay or even decline important conventional treatment. Effective communication is thus an essential component in upholding the cancer patient’s trust in healthcare professionals, as well as acting to encourage the patient’s likelihood of adhering to evidence-based recommendations. Delays in conventional cancer treatment, or negative interactions between conventional and CAM treatments, might thereby be more effectively avoided.

Practical guidelines – the ‘how’ and the ‘what’

It has been emphasised that conventional healthcare professionals have an ethical responsibility to open a dialogue with their patients regarding the use of CAM. Being a CAM expert is by no means necessary in order to engage in a respectful, balanced and helpful discussion about CAM use with cancer patients. Effective communication on the use of CAM requires the use of such general skills as:

• experience in listening
• encouraging hope
• the ability to convey empathy and compassion

An effective and supportive communication process can be divided into the ‘how’ and the ‘what’. The ‘how’ relates to the process of information exchange in shared decision-making, the ‘what’ relates to the content of that information exchange, which would be based on reliable information resources such as this website and others, such as the Society for Integrative Oncology and the US National Center for Complementary and Alternative Medicine.

The ‘how’ relates to:

• change in clinical attitude
• process of information gathering
• shared decision-making integrated with empathic communication
• addressing patients’ unmet physiological and emotional needs
• discussing issues of uncertainty

Truly supportive communication behaviour has been described in the literature as being affective, socio-emotional and interactional, with a focus on each patient in the context of their individual psychological and social circumstances. In-depth studies of cancer patients who use CAM show that such patients are searching for:

• patient–provider relationships based on mutual trust
• doctors who understand patients’ individual illness experiences and healthcare needs
• doctors willing to discuss patients’ use of CAM openly
• doctors who value patients’ own efforts involving treatment processes
• doctors who address issues related to mind, body and spirit

From the perspective of a cancer patient using CAM, the overall goal in effective communication between physician and CAM user is to ensure that the decision-making process is shared, and also supported by the best available evidence. Medical evidence is essential, but so is an understanding of what actually influences a patient’s quality of life and how patients make their decisions. It has been maintained by CAM users that they have, on occasion, become aware that their healthcare professionals harbour uncertainties about CAM because of their own lack of relevant education and scientific information about it. Under such circumstances, patients would prefer that physicians and oncology experts admit to those uncertainties, particularly with regard to the possible benefits and risks associated with a CAM treatment. In light of this, the professional could then help patients in their search for reliable information.

Schofield and colleagues (2010), Frenkel and colleagues (2010, 2014) and Salamonsen (2013, 2015) have provided recommendations for how healthcare professionals could communicate more effectively with their patients regarding CAM. Their recommendations are summarised here:

Literature

• Broom A, Adams J:Oncology clinician's accounts of discussing complementary and alternative medicine with their patients.Health: An interdisciplinary Journal for the Study of Health, Illness and Medicine 2009,13:317-336.
• Frenkel M, Ben-Arye E, Cohen L:Communication in cancer Care: Discussing complementary and alternative medicine.Integrative Cancer Therapies 2010,9(2):177-185.
• Frenkel M, Cohen L:Effective communication about the use of complementary and integrative medicine in cancer care. Journal of Alternative and Complementary Medicine 2014,20(1):12-18.
• Maha N, Shaw A:Academic doctor's views of complementary and alternative medicine (CAM) and its role within the NHS: An exploratory qualitative study.BMC Complement Altern Med 2007,7(17):1-11.
• Salamonsen A:Doctor-patient communication and cancer patient's choice of alternative therapies as supplement or alternative to conventional care.Scandinavian Journal of Caring Science 2013,27(1):70-76.
• Salamonsen A:Mind the Gap! Lay and Medical Perceptions of Risks Associated With the Use of Alternative Treatment and Conventional Medicine. Forschende Komplementärmedizin/ Research in Complementary Medicine 2015,22(1):24-29.
• Schofield P, Diggens J, Charleson C, Marigliani R, Jefford M:Effectively discussing complementary and alternative medicine in a conventional oncology setting: Communication recommendations for clinicians. Patient Education and Counseling 2010,79:143-151.
• Sohl SJ, Borowski LA, Kent EE, Smith AW, Oakley-Girvan I, Rothman RL, Arora, NK:Cancer survivors’ disclosure of complementary health approaches to physicians: The role of patient-centered communication. Cancer 2014, doi: 10.1002/cncr.29138.
• Tovey P, Broom A:Oncologist's and specialist cancer nurse's approaches to complementary and alternative medicine and their impact on patient action.Social Science & Medicine 2007,64(12):2550-2564.
• Verhoef MJ, Boon HS, Page SA:Talking to cancer patients about complementary therapies: Is it the physicians's responsibility?Current Oncology 2008,15(2):18-23.

Citation:
Anita Salamonsen and Moshe Frenkel, CAM-Cancer Consortium. How to communicate effectively about complementary, integrative and alternative medicine [online document]. December 4, 2015.