Saxe Gordon A, Madlensky Lisa, Kealey Sheila, Wu David P H, Freeman Karen L, Pierce John P
Department of Family and Preventive Medicine, Moores UCSD Cancer Center, Cancer Prevention and Control, University of California San Diego, La Jolla, CA 92093-0901, USA.
Integr Cancer Ther. 2008 Sep;7(3):122-9. doi: 10.1177/1534735408323081.
Physician awareness of their patients' use of complementary and alternative medicine (CAM) is crucial, particularly in the setting of a potentially life-threatening disease such as cancer. The potential for harmful treatment interactions may be greatest when a patient sees a CAM practitioner--perceived as a physician-like authority figure--but does not disclose this to their physician. Therefore, this study investigated the extent of nondisclosure in a large cohort of cancer patients.
CAM use in participants of the UCSD Women's Healthy Eating and Living (WHEL) Study, a multicenter study of the effect of diet and lifestyle on disease-free and overall survival in women aged 18-70 years who had completed treatment for invasive breast cancer between 1995 and 2000, is investigated. Data regarding CAM use and disclosure were collected via a telephone-administered questionnaire in 2003-2004. This questionnaire asked about different CAM modalities, including those requiring a "skilled CAM practitioner" (acupuncturist, chiropractor, homeopath, or naturopath) for administration. Demographic data were obtained at the WHEL baseline clinic interview. Modality-specific disclosure rates were determined and a comparison of demographic variables of disclosers versus nondisclosers was conducted using 2 tests for categorical variables, and t tests for continuous variables.
Of 3088 total WHEL participants, 2527 completed the CAM questionnaire. Of these, 2017 reported using some form of CAM. Of these, 300 received treatment from an acupuncturist, chiropractor, homeopath, or naturopath and also provided information on whether or not they disclosed this care to their conventional physician. The highest disclosure rate was for naturopathy (85%), followed by homeopathy (74%), acupuncture (71%), and chiropractic (47%). Among demographic characteristics, only education (P=.047) and study site (P=.039) were associated with disclosure. College graduates and postgraduates, in particular, were more likely to disclose CAM use to their physicians than those with lesser education.
Overall, moderately high rates of physician disclosure of CAM use for all modalities except chiropractic were observed. Education and study site associations suggest that disclosure may be greater when CAM use is more prevalent and possibly more socially accepted. These findings underscore the importance of open, destigmatized patient--physician communication regarding CAM use.
医生了解患者使用补充和替代医学（CAM）的情况至关重要，尤其是在癌症这种可能危及生命的疾病背景下。当患者去看被视为类似医生权威人物的CAM从业者，但未向自己的医生透露这一情况时，有害治疗相互作用的可能性可能最大。因此，本研究调查了一大群癌症患者中未披露情况的程度。
对加州大学圣地亚哥分校女性健康饮食与生活（WHEL）研究的参与者使用CAM的情况进行调查，该研究是一项多中心研究，旨在探讨饮食和生活方式对1995年至2000年间完成浸润性乳腺癌治疗的18 - 70岁女性无病生存期和总生存期的影响。关于CAM使用和披露的数据在2003 - 2004年通过电话调查问卷收集。该问卷询问了不同的CAM方式，包括那些需要“熟练的CAM从业者”（针灸师、脊椎按摩师、顺势疗法医生或自然疗法医生）进行治疗的方式。人口统计学数据在WHEL基线诊所访谈时获取。确定了特定方式的披露率，并使用分类变量的两种检验方法以及连续变量的t检验方法，对披露者与未披露者的人口统计学变量进行了比较。
在WHEL的3088名总参与者中，2527人完成了CAM问卷。其中，2017人报告使用了某种形式的CAM。其中，300人接受了针灸师、脊椎按摩师、顺势疗法医生或自然疗法医生的治疗，并提供了他们是否向常规医生披露这种治疗的信息。披露率最高的是自然疗法（85%），其次是顺势疗法（74%）、针灸（71%）和脊椎按摩疗法（47%）。在人口统计学特征中，只有教育程度（P = 0.047）和研究地点（P = 0.039）与披露情况有关。特别是大学毕业生和研究生比受教育程度较低的人更有可能向医生披露使用CAM的情况。
总体而言，除脊椎按摩疗法外，所有方式的CAM使用向医生披露的比例都处于中等偏高水平。教育程度和研究地点的关联表明，当CAM的使用更为普遍且可能在社会上更易被接受时，披露情况可能会更多。这些发现强调了就CAM使用进行开放、消除污名化的医患沟通的重要性。
