Christopher J Koenig1, Evelyn Y Ho2, Laura Trupin3, Daniel Dohan3. 1. Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, USA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA. Electronic address: Christopher.Koenig@ucsf.edu. 2. Department of Communication Studies, University of San Francisco, San Francisco, USA. 3. Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA.
Abstract
OBJECTIVE: To characterize how providers respond to patient mentions of complementary and integrative medicine (CIM) during routine oncology visits. METHODS: Ethnographic methods were used over a two and a half year period with 82 advanced cancer patients and their providers across four oncology clinics. Participant observation fieldnotes were analyzed using Discourse Analysis. RESULTS: CIM was mentioned in 78/229 (34%) of the total observed visits. Patients initiated talk about CIM (76%) more than providers (24%). Patients mentioning CIM may indicate a preference for or interest in non-pharmacological adjunctive treatment options. Providers' responses inhibited further talk in 44% of observations and promoted talk in 56% of observations. CONCLUSION: How providers respond may indicate their willingness to discuss a range of treatment options and to collaboratively engage in treatment decision-making. Provider responses that inhibited CIM conversation passed on the opportunity to discuss patient preferences, and responses that promoted further conversation helped counsel patients about appropriate CIM use. Promoting discussion did not require additional time or extensive knowledge about CIM. PRACTICE IMPLICATIONS: Providers can facilitate high quality communication without endorsing CIM to help patients make treatment decisions and to evaluate CIM appropriateness in response to patient values and preferences. Published by Elsevier Ireland Ltd.
OBJECTIVE: To characterize how providers respond to patient mentions of complementary and integrative medicine (CIM) during routine oncology visits. METHODS: Ethnographic methods were used over a two and a half year period with 82 advanced cancerpatients and their providers across four oncology clinics. Participant observation fieldnotes were analyzed using Discourse Analysis. RESULTS:CIM was mentioned in 78/229 (34%) of the total observed visits. Patients initiated talk about CIM (76%) more than providers (24%). Patients mentioning CIM may indicate a preference for or interest in non-pharmacological adjunctive treatment options. Providers' responses inhibited further talk in 44% of observations and promoted talk in 56% of observations. CONCLUSION: How providers respond may indicate their willingness to discuss a range of treatment options and to collaboratively engage in treatment decision-making. Provider responses that inhibited CIM conversation passed on the opportunity to discuss patient preferences, and responses that promoted further conversation helped counsel patients about appropriate CIM use. Promoting discussion did not require additional time or extensive knowledge about CIM. PRACTICE IMPLICATIONS: Providers can facilitate high quality communication without endorsing CIM to help patients make treatment decisions and to evaluate CIM appropriateness in response to patient values and preferences. Published by Elsevier Ireland Ltd.
Entities:
Keywords:
Alternative and integrative medicine; Cancer; Complementary; Discourse analysis; Ethnography; Provider–patient communication; USA
Authors: Jun James Mao; Christina Shearer Palmer; Kaitlin Elizabeth Healy; Krupali Desai; Jay Amsterdam Journal: J Cancer Surviv Date: 2010-10-06 Impact factor: 4.442
Authors: Jon Tilburt; Kathleen J Yost; Heinz-Josef Lenz; María Luisa Zúñiga; Thomas O'Byrne; Megan E Branda; Aaron L Leppin; Brittany Kimball; Cara Fernandez; Aminah Jatoi; Amelia Barwise; Ashok Kumbamu; Victor Montori; Barbara A Koenig; Gail Geller; Susan Larson; Debra L Roter Journal: Oncologist Date: 2019-05-17