P04.35
Purpose: Cancer patients frequently seek out but often fail to disclose use of CAM to their treating clinicians. Little is known about the dynamics of clinical deliberations about CAM and factors influencing those deliberations when it is discussed. Purpose: To describe the fundamental dynamics of CAM deliberations that occur between patients and clinicians during routine cancer care consultations.
Methods: We audio-recorded clinical interactions between 23 medical oncology clinicians and a cross-sectional sample of 187 unique medical oncology patients at a NCI-funded comprehensive cancer center. We transcribed and have begun analyzing recordings using qualitative content analysis to identify themes about the circumstances and dynamics surrounding CAM discussions. In addition to audio recordings, we also conducted chart review to analyze how CAM discussions were reported.
Results: We analyzed any conversation including any mention of CAM. We classified conversations into five major categories developed by consensus: who initiated (the clinician, the patient, and the companion), what is discussed (the nature of CAM and its implications), the extent of discussion (briefly mentioned, mentioned and discussed, and extensively discussed), how is it discussed (as general information or treatment plan, the tone of the conversation – dismissive or inviting), and discussed but not mentioned in the chart. Out of 25 CAM discussions, 17 were patient-initiated, 6 were clinician-initiated, and 2 were companion-initiated. Among all these conversations, 13 were briefly mentioned, 10 were mentioned and discussed, and only 2 were extensively discussed. Most of the ‘mentioned and discussed’ and ‘extensively discussed’ instances are the clinician-initiated discussions. In 6 of the 25 discussions, CAM discussed but not mentioned in chart reviews. Further preliminary themes exploring how it is discussed will be presented.
Conclusion: 25 of the 187 medical oncology encounters include CAM. Half were mentioned without discussion. Only 2 included extensive conversation.
Contact: Ashok Kumbamu, kumbamu.ashok@mayo.edu
