College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
BC Cancer, Vancouver, BC, Canada.
J Natl Cancer Inst. 2022 Jan 11;114(1):25-37. doi: 10.1093/jnci/djab048.
Complementary and alternative medicine (CAM) use is common among individuals with cancer, but many choose not to discuss CAM with health-care providers (HCPs). Moreover, there is variability in the provision of evidence-informed decision making about CAM use. A clinical practice guideline was developed to standardize how oncology HCPs address CAM use as well as to inform how individuals with cancer can be supported in making evidence-informed decisions about CAM. An integrative review of the literature, from inception to December 31, 2018, was conducted in MEDLINE, EMBASE, PsychINFO, CINAHL, and AMED databases. Eligible articles included oncology HCPs' practice related to discussing, assessing, documenting, providing decision support, or offering information about CAM. Two authors independently searched the literature, and selected articles were summarized. Recommendations for clinical practice were formulated from the appraised evidence and clinical experiences of the research team. An expert panel reviewed the guideline for usability and appropriateness and recommendations were finalized. The majority of the 30 studies eligible for inclusion were either observational or qualitative, with only 3 being reviews and 3 being experimental. From the literature, 7 practice recommendations were formulated for oncology HCPs regarding how to address CAM use by individuals with cancer, including communicating, assessing, educating, decision coaching, documenting, active monitoring, and adverse event reporting. It is imperative for safe and comprehensive care that oncology HCPs address CAM use as part of standard practice. This clinical practice guideline offers directions on how to support evidence-informed decision making about CAM among individuals with cancer.
补充和替代医学（CAM）在癌症患者中很常见，但许多人选择不与医疗保健提供者（HCPs）讨论 CAM。此外，在提供有关 CAM 使用的循证决策方面存在差异。制定了临床实践指南，以规范肿瘤学 HCP 如何解决 CAM 使用问题，并告知癌症患者如何支持他们就 CAM 使用做出循证决策。对 2018 年 12 月 31 日之前的 MEDLINE、EMBASE、PsychINFO、CINAHL 和 AMED 数据库中的文献进行了综合回顾。符合条件的文章包括与讨论、评估、记录、提供决策支持或提供有关 CAM 信息相关的肿瘤学 HCP 实践。两名作者独立搜索文献，并总结了选定的文章。从评估证据和研究团队的临床经验中制定了临床实践建议。一个专家小组审查了指南的可用性和适当性，并最终确定了建议。符合纳入标准的 30 项研究中，大多数是观察性或定性的，只有 3 项是综述，3 项是实验性的。从文献中，为肿瘤学 HCPs 制定了 7 条关于如何解决癌症患者 CAM 使用的实践建议，包括沟通、评估、教育、决策指导、记录、主动监测和不良事件报告。为了确保安全和全面的护理，肿瘤学 HCPs 将 CAM 使用作为标准实践的一部分。本临床实践指南为支持癌症患者对 CAM 使用进行循证决策提供了方向。
