Effectively discussing complementary and alternative medicine in a conventional oncology setting: communication recommendations for clinicians.
OBJECTIVE
Justifiable concerns around the use of complementary and alternative medicines (CAM) amongst cancer patients are becoming increasingly prominent. The aim was to develop evidence-based guidelines to assist oncology health professionals (HP) to have respectful, balanced and useful discussions with patients about CAM.


METHODS
A systematic review was conducted, covering relevant literature from 1997 to 2007. The level of evidence was rated using a standardized rating system. The evidence was qualitatively synthesised into structured recommendations by a multidisciplinary team including a consumer.


RESULTS
The search identified 78 original papers; 36 directly related to discussing CAM. No randomized controlled trials specifically addressing the methods or benefits of discussing CAM were identified. Evidence based guidelines are presented as a sequence of recommended steps: (1) Elicit the person's understanding of their situation; (2) Respect cultural and linguistic diversity and different epistemological 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.


CONCLUSIONS
This represents the first comprehensive guidelines for discussing CAM.


CONCLUSIONS
Given the concerns surrounding CAM use, it is critical to encourage informed decision-making about CAM and ultimately, improve outcomes for patients.
Nursing and Supportive Care Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. penelope.schofield@petermac.org
Penelope
P
Schofield
Justine
J
Diggens
Catherine
C
Charleson
Rita
R
Marigliani
Michael
M
Jefford
D003142:Communication; D000529:Complementary Therapies; D018864:Cultural Diversity; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D010353:Patient Education as Topic / Q000379:methods*; D017410:Practice Guidelines as Topic; D011369:Professional-Patient Relations; D012017:Referral and Consultation