Communication predictors and consequences of Complementary and Alternative Medicine (CAM) discussions in oncology visits.
Cancer patients use complementary and alternative medicine (CAM), but do not routinely talk about it with their clinicians. This study describes CAM discussions in oncology visits, the communication patterns that facilitate these discussions and their association with visit satisfaction.



327 patients (58% female; average age 61) and 37 clinicians were recorded during an oncology visit and completed post-visit questionnaires. All CAM discussions were tagged and the Roter Interaction Analysis System (RIAS) was used to code visit dialogue.



CAM was discussed in 36 of 327 visits; discussions were brief (<one minute), the majority patient initiated (65%) and more common for patients in early stages of cancer care. Longer visits (35 vs 29min; p<0.05), greater patient engagement in visit dialogue, lowered clinician verbal dominance and a more patient-centered pattern of visit communication were significantly related to visits with CAM discussions (all p values<0.01). Both patient and clinician visit satisfaction was higher with CAM discussion (p<0.05).



CAM discussions do not occur at random; they take place in visits characterized by patient-centered communication and are associated with higher visit satisfaction.



CAM discussions are perceived positively by both patients and clinicians and are facilitated by patient-centered visit communication.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Debra L
DL
Roter
Mayo Clinic, Rochester, MN, USA.
Kathleen J
KJ
Yost
Mayo Clinic, Rochester, MN, USA.
Thomas
T
O'Byrne
Mayo Clinic, Rochester, MN, USA.
Megan
M
Branda
Mayo Clinic, Rochester, MN, USA.
Aaron
A
Leppin
Mayo Clinic, Rochester, MN, USA.
Brittany
B
Kimball
Mayo Clinic, Rochester, MN, USA.
Cara
C
Fernandez
Mayo Clinic, Rochester, MN, USA.
Aminah
A
Jatoi
Mayo Clinic, Rochester, MN, USA.
Ashok
A
Kumbamu
Mayo Clinic, Rochester, MN, USA.
Victor
V
Montori
University of California San Francisco, San Francisco, CA, USA.
Barbara
B
Koenig
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Gail
G
Geller
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Susan
S
Larson
Mayo Clinic, Rochester, MN, USA. Electronic address: Droter1@jhu.edu.
Jon
J
Tilburt
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003142:Communication; D000529:Complementary Therapies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D009819:Office Visits; D000072103:Oncologists / Q000523:psychology*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D013637:Tape Recording
Clinician satisfaction; Complimentary and Alternative Medicine (CAM); Patient satisfaction; Patient-physician communication; Roter Interaction Analysis System (RIAS)