OCCAM Develops New Patient Education Resource to Enhance Patient-Provider Communication About CAM Use

Talking about Complementary and
Alternative Medicine with Health Care
Providers: A Workbook and Tips

Clear communication among oncologists, primary care physicians, and cancer patients is important throughout the entire cancer journey, but particularly when patients are using or thinking about complementary and alternative therapies. Use of complementary and alternative medicine (CAM) continues to gain popularity among cancer patients and survivors. CAM therapies provide a way for patients to manage their symptoms, regain a sense of control, improve their quality of life, and establish better pain management.¹ Yet, as the prevalence of CAM use continues to grow, the communication gap between health care providers and patients widens, as nearly half of those who use CAM therapies fail to report their use to their providers.² In recognition of the important role communication plays in the relationship between providers and their patients, the Office of Cancer Complementary and Alternative Medicine (OCCAM) has developed a new patient education resource: Talking About Complementary and Alternative Medicine With Your Health Care Provider: A Workbook and Tips (http://cam.cancer.gov/health_information/talking_about_cam.htm).

There are several reasons patients fail to disclose their use of CAM therapies to their providers, such as: a fear of a negative response from their oncologist; a perception of physician unfamiliarity with CAM therapies; a failure of the physician to ask about CAM use; a disinterest among physicians about CAM; and a lack of awareness among patients that they should be disclosing CAM use.³ When patients wish to discuss their complementary treatments with their physician(s), it is often up to the patient to begin the dialogue. Regardless of who initiates the conversation, communication about CAM use is important because certain CAM therapies, like herb or dietary supplementation, may interfere with the effectiveness of prescription medications or conventional treatment, like chemotherapy.

OCCAM’s new publication attempts to reduce some of the miscommunication about CAM, through a series of interactive worksheets that encourage the patient to take an active role in their health care. This resource was created for health care providers and patients to strengthen the model of patient-centered care. Talking About Complementary and Alternative Medicine With Your Health Care Provider: A Workbook and Tips seeks to increase a patient’s confidence when talking to their provider about their use of complementary therapies by helping them understand their motivations for CAM use, the effects CAM therapies have on their symptoms, and the importance of disclosing herb, vitamin, and dietary supplement use. This resource also provides strategies on how to talk with health care providers about CAM use and a guide to understanding cancer CAM terms and therapies.

The workbook is a fifteen-page PDF designed to help providers understand the patterns of CAM use by cancer patients and survivors. Additionally, each sheet included in the workbook can also be individually downloaded from OCCAM’s website allowing the user to customize this resource to best fit their needs. Through the use of health diaries, a tool successfully used in oncology practice to document pain management and patterns⁴, patients are able to record their nutritional supplement use, note different CAM therapies they’ve tried over the course of a month, and organize all of their conventional and complementary practitioners’ contact information. These tracking sheets provide an easy method to capture a patient’s health- related behaviors and actions and have the potential to be integrated into a patient’s medical record.

During the workbook creation, the National Cancer Institute’s Office of Marketing Research and Evaluation and OCCAM conducted usability testing with nine cancer survivors. Each participant was asked to comment on the design, functionality, and content of two versions of the patient education workbook. Two versions of the workbook were tested to provide OCCAM with feedback on which design, layout, image selection, and content resonated most with the intended audience.

Nearly all participants felt OCCAM’s initiative would be useful for tracking CAM use, and also for engaging in conversations with their providers. Among the participants, the favorite workbook page was the medication log, which asks a person to think about all of the medications they are taking including prescriptions, over the counter medications, and vitamins, herbs and dietary supplements. One participant commented, “this is good because some people don’t see herbs as different and it’s good to break [this list] into three categories,” while another participant stated, “I don’t think of dietary supplements as medicine.”

Since the workbook was designed for both health care providers and patients, OCCAM also sought feedback from a variety of health care providers. Among the health care providers surveyed, a majority felt this resource would be helpful for patients who expressed an interest in CAM therapies. Many reiterated the importance of knowing all medications and supplements a patient uses, and felt the medication log would be the most utilized resource among health care providers.

Two rounds of pretesting were conducted to obtain feedback, which was representative of the patient and health care provider populations. Pretesting was conducted until the trends observed in the patient and provider populations mirrored one another. Among those who provided feedback, the majority felt OCCAM’s publication was simple, organized, and helpful in fostering CAM conversations and would be a useful resource both during and after cancer treatments.

Talking About Complementary and Alternative Medicine With Your Health Care Provider: A Workbook and Tips was designed to complement NCI’s existing patient education resource, Thinking About Complementary & Alterative Medicine: A Guide for People with Cancer (http://www.cancer.gov/cancertopics/cam/thinking-about-CAM). This book provides questions to ask your doctor about CAM, tips on how to choose the therapies and practitioners that are right for you, and resources for finding more information about CAM. Together, these resources encourage patients and providers to communicate about complementary and alternative medicine use both during and after cancer treatments and to recognize the importance of involving a patient as an active participant in decisions about their treatment plans.

We encourage both patients and health care providers to download this new workbook to use during office visits. It may also be added to an office waiting room library. Patients are encouraged to use these sheets prior to an appointment when they are interested in discussing CAM. They are a skillful way to organize one’s thoughts and get ready for dialogues with a health care professional.