title: An exploratory typology of provider responses that encourage and discourage conversation about complementary and integrative medicine during routine oncology visits.
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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors: 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.
authors: Christopher J
authors: CJ
authors: Koenig
authors: Department of Communication Studies, University of San Francisco, San Francisco, USA.
authors: Evelyn Y
authors: EY
authors: Ho
authors: Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA.
authors: Laura
authors: L
authors: Trupin
authors: Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA.
authors: Daniel
authors: D
authors: Dohan
mesh_terms: D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D003142:Communication; D000529:Complementary Therapies; D006801:Humans; D055048:Integrative Medicine; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D018802:Patient-Centered Care; D010817:Physician-Patient Relations
keywords: Alternative and integrative medicine; Cancer; Complementary; Discourse analysis; Ethnography; Provider–patient communication; USA