title: Asking patients the right questions about herbal and dietary supplements: Cross cultural perspectives.
abstract: BACKGROUND
  Use of dietary supplements (DS) during hospitalization carries risks such as reducing drug treatment efficacy and increasing peri-operative complications due to DS-drug interactions and DS side effects. In this study, we aimed to develop socio-cultural-sensitive patient histories to detect DS use amongst hospitalized patients from different backgrounds.
  
  
  METHODS
  Prospective cohort study of hospitalized patients from June 2009 through March 2010, using mixed quantitative (questionnaires), and qualitative (semi-structured interviews) research methodology to detect DS use.
  
  
  RESULTS
  Data were provided by 691 of 895 patients (response rate 77.2%). Of these, 359 (51.9%) reported using DS in the previous year. 168 (46.8%) disclosed DS use following a standard question on DS consumption. 191 (53.2%) respondents disclosed DS use only following further questioning utilizing DS-related keywords. Leading questioning techniques that facilitated admitting DS use included: naming common DS (50.6% disclosure rate), and using traditional/herbal medicine (THM) related keywords (41.3% disclosure rate) such as infusions, teas, herbs picked in the garden. A logistic multivariate regression model indicated that disclosure of DS use, by using THM related keywords was associated with non-Jewish religion [EXP(B)=3.57, 95% C.I. 1.70-7.50, p=0.001], dwelling in rural areas (p=0.004), and having a lower degree of education (p=0.01).
  
  
  CONCLUSIONS
  Improved history taking regarding DS use in hospitalized patients can be accomplished by using specific keywords that address socio-cultural diversities as in the following question: "Do you use any natural, folk, traditional, grandma remedies, herbs picked in the garden, infusions or herbal teas to improve your health?.
authors.affiliation: Department of Family Medicine, Complementary and Traditional Medicine Unit, Technion-Israel Institute of Technology, Haifa, Israel; Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Clalit Health Services, Western Galilee District, Haifa, Israel; Integrative Oncology Program, The Oncology Service, Lin Medical Center, Israel. Electronic address: eranben@netvision.net.il.
authors.forename: Eran
authors.initials: E
authors.lastname: Ben-Arye
authors.affiliation: Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Inbal
authors.initials: I
authors.lastname: Halabi
authors.affiliation: Department of Internal Medicine, Bnai Zion Hospital, Haifa, Israel; Department of Integrative Surgery Service, Bnai Zion Hospital, Haifa, Israel; School of Public Health, University of Haifa, Haifa, Israel.
authors.forename: Samuel
authors.initials: S
authors.lastname: Attias
authors.affiliation: Clinical Pharmacology Unit, Internal Medicine C, Haemek Medical Center, Afula, Israel Affiliated to the Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Lee
authors.initials: L
authors.lastname: Goldstein
authors.affiliation: Department of Internal Medicine, Bnai Zion Hospital, Haifa, Israel; Department of Integrative Surgery Service, Bnai Zion Hospital, Haifa, Israel.
authors.forename: Elad
authors.initials: E
authors.lastname: Schiff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D019587:Dietary Supplements / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D008517:Phytotherapy / Q000706:statistics & numerical data*; D010936:Plant Extracts / Q000627:therapeutic use*; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D010936:Plant Extracts
keywords: Complementary alternative medicine; Dietary supplements; Doctor–patient communication; Herbs; Safety; Traditional medicine