A Multicenter Comparison of Complementary and Alternative Medicine (CAM) Discussions in Oncology Care: The Role of Time, Patient-Centeredness, and Practice Context
A Multicenter Comparison of Complementary and Alternative Medicine (CAM) Discussions in Oncology Care: The Role of Time, Patient-Centeredness, and Practice Context
复制标题
DOI：
10.1634/theoncologist.2019-0093
复制
发表时间：
2019-11-01
期刊：
影响因子：
5.8
通讯作者：
Roter, Debra L.
中科院分区：
文献类型：
--
作者：
Tilburt, Jon;Yost, Kathleen J.;Roter, Debra L.
背景很少有人知道如何补充和替代医学（CAM）在癌症治疗中的讨论在不同的设置在美国的方法在两个实践附属于一个学术医疗中心在南部加州（SoCal），一个在上中西部（UM），我们音频记录的患者与临床医生的互动在内科肿瘤门诊的做法。我们统计了CAM相关对话的频率和持续时间。我们使用Roter交互分析系统对记录进行编码。我们使用卡方检验对分类变量进行双变量分析，使用广义线性模型对连续变量进行分析，以检查对话特征、实践环境和人群特征与CAM讨论发生率之间的相关性，然后使用多变量模型对临床医生聚类进行调整。结果61名临床医生和529例患者参与了研究。62 529（12%）的互动包括CAM的讨论，在南加州大学的做法比在其他设置中观察到的显着更多。包括CAM的访问平均长6分钟，CAM内容平均持续78秒。在关联的双变量检验中，包含CAM的对话包括来自临床医生和患者的更多心理社会陈述、更高的以患者为中心、更积极的患者和临床医生影响以及更大的患者参与度。在一个多变量模型中，包括显着的双变量项，包含CAM的对话与较高的以患者为中心，略长的访问，并在南加州大学网站独立相关。结论肿瘤学中CAM相关讨论的频率在不同研究中心之间差异很大。包括CAM讨论的访视时间更长，更以患者为中心。医学研究所和美国临床肿瘤学会呼吁对补充和替代医学（CAM）进行更开放的讨论。但是，人们对人口特征和护理环境在这些讨论的频率和性质中可能发挥的作用知之甚少。目前的数据特征的实际对话在实践中补充了一个更大的文献的基础上，患者和临床医生自我报告CAM披露和使用。结果发现，CAM讨论在学术肿瘤学访问的实践背景下显着不同，大多数是由病人发起的，他们可能会发生更多的访问时间存在的生活方式，自我护理和心理社会问题。
Background Little is known about how complementary and alternative medicine (CAM) is discussed in cancer care across varied settings in the U.S. Methods In two practices affiliated with one academic medical center in southern California (SoCal), and one in the upper Midwest (UM), we audio-recorded patient-clinician interactions in medical oncology outpatient practices. We counted the frequency and duration of CAM-related conversations. We coded recordings using the Roter Interaction Analysis System. We used chi-square tests for bivariate analysis of categorical variables and generalized linear models for continuous variables to examine associations between dialogue characteristics, practice setting, and population characteristics with the occurrence of CAM discussion in each setting followed by multivariate models adjusting for clinician clustering. Results Sixty-one clinicians and 529 patients participated. Sixty-two of 529 (12%) interactions included CAM discussions, with significantly more observed in the SoCal university practice than in the other settings. Visits that included CAM were on average 6 minutes longer, with CAM content lasting an average of 78 seconds. In bivariate tests of association, conversations containing CAM included more psychosocial statements from both clinicians and patients, higher patient-centeredness, more positive patient and clinician affect, and greater patient engagement. In a multivariable model including significant bivariate terms, conversations containing CAM were independently associated with higher patient-centeredness, slightly longer visits, and being at the SoCal university site. Conclusion The frequency of CAM-related discussion in oncology varied substantially across sites. Visits that included CAM discussion were longer and more patient centered. Implications for Practice The Institute of Medicine and the American Society of Clinical Oncology have called for more open discussions of complementary and alternative medicine (CAM). But little is known about the role population characteristics and care contexts may play in the frequency and nature of those discussions. The present data characterizing actual conversations in practice complements a much larger literature based on patient and clinician self-report about CAM disclosure and use. It was found that CAM discussions in academic oncology visits varied significantly by practice context, that the majority were initiated by the patient, and that they may occur more when visit time exists for lifestyle, self-care, and psychosocial concerns.