Asking About Alternative Medicine

Oncology nurse training may improve CAM conversations with cancer patients

(RxWiki News) An estimated 30 percent of Americans take care of their health using something other than Western medicine. This alternative care includes taking vitamins and supplements to receiving massage and acupuncture.

A recent study found that a brief training video helped oncology nurses talk to cancer patients about their use of complementary and alternative medicine (CAM).

That training, however, didn't seem to change patients’ views of these conversations.

Even though nurses who watched the training video were more likely to talk about CAM with their patients than nurses who didn't watch the video, those patients did not report that they were talking more often with nurses about their CAM use.

"Tell your healthcare team about all of your medicines."

Patricia A. Parker, PhD, associate professor of behavioral science at The University of Texas MD Anderson Cancer Center in Houston, Texas, led this study to assess how a brief training video would affect how often oncology nurses asked patients about their CAM use.

This study also looked at CAM use among cancer patients, including types of alternative therapies and the reasoning behind their choices to practice CAM therapies or not.

The researchers worked with 175 nurses. The nurses were randomly assigned to either continue usual care or view an educational video and receive a laminated card to remind them to ask their patients about CAM practices.

At the start of the trial, the nurses completed questionnaires about talking with patients regarding their CAM practices. The nurses completed the same questionnaire two months after the training.

The video was developed by the MD Anderson Integrative Medicine Program. It addressed a number of issues relating to diet, herbal supplements, legal and ethical obligations to patients, as well as the steps nurses could take to begin a conversation about CAM in an effort to offer patient guidance.

Patients were also questioned about their CAM use and their experiences in talking with nurses about their self-care practices. A total of 699 patients took the survey at the beginning of the trial, and 650 survivors completed the questionnaire at follow-up.

Of all the patients, 40 percent reported using CAM after their cancer diagnosis. Most of the nurses (64 percent) underestimated the number of patients who used CAM.

The patients said their reasons for choosing CAM included thinking that these therapies would be helpful overall, would address emotional and spiritual aspects of fighting cancer, would boost the immune system and/or help relieve cancer treatment side effects.

Those who did not use CAM reported most often a lack of information and skepticism about using alternative therapies.

Nurses who viewed the video were four times more likely to ask their patients about CAM use than the nurses who were not trained.

However, patients did not report being asked more often about their CAM use, regardless of which nurses they interacted with.

"CAM use in community-based oncology patients is common and is underestimated by oncology nurses. The brief, low-intensity intervention presented herein was found to be sufficiently powerful to change nurses' perceptions of their behavior but may not have been intensive enough to yield changes that were evident to patients," the authors wrote.

Brian D. Lawenda, MD, clinical director of Radiation Oncology at 21st Century Oncology in Las Vegas, told dailyRx News, "The results of this study will hopefully serve as reminder to the oncology community that we don't always do the best job in gathering information from our patients when it comes to their use of CAM therapies."

Dr. Lawenda continued, "This study highlights the importance of incorporating more education in nursing training about CAM therapies and ways to improve communication with patients about this subject.

"As an integrative oncologist who asks questions about CAM therapy use with my patients all the time, I am very aware that you have to take the time to really connect with your patients and prove to them that you are knowledgeable about CAM therapies before many of them fully open up to you about their use of these therapies," said Dr. Lawenda, who is founder of

This study was published in the July issue of the journal CANCER.

Several of the authors received research support from various governmental and private foundation sources. Co-author Ms. Kokx is employed as a research nurse at the Grand Rapids Clinical Oncology Program.

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Review Date: 
July 8, 2013