Because the use of complementary alternative medicine (CAM) is increasing, health professionals need to find ways to decrease the communication gap with patients who use it, Virginia Tilden, D.N.Sc., says. A lack of communication could reduce the effectiveness of prescription drugs and cause drug interactions with potentially serious side effects.
“Health professionals need to routinely ask patients if they use complementary or alternative medicine in a non-threatening, non-judgmental way so the patient will be honest,” said Dr. Tilden, dean of the UNMC College of Nursing, and specialist in end-of-life care. “It’s important to talk with our patients and tone our criticism down to elicit from patients what they’re doing rather than what they think we want to hear.”
CAM is defined as a group of diverse medical and health care systems, practices and products that are not presently considered to be part of conventional medicine, according to the National Center for Complementary and Alternative Medicine, a center of the National Institutes of Health.
Acupuncture, echinacea, antioxidants, black cohosh, homeopathy, chondroitin and St. John’s Wort are just some of the things considered to be complementary or alternative medicine.
In patients who are dying, it’s also important health professionals and patients communicate about CAM. Dr. Tilden and her colleagues specializing in end-of-life care conducted a study to find out the prevalence of CAM used by those in the last six months of life. The answers surprised them.
In their study findings published in the Journal of Alternative and Complementary Medicine, titled, “Complementary and Alternative Therapy Use at End-of-Life in Community Settings,” the researchers found a high prevalence of people used CAM to relieve difficult and uncomfortable symptoms of cancer, such as pain and constipation. The study was funded by the National Institute of Nursing Research, Family Perceptions of Community-Based Dying, and the Robert Wood Johnson Foundation.
Dr. Tilden and her former colleagues at the Center for Ethics in Health Care, Oregon Health & Science University in Portland, Ore., interviewed 423 family members or caregivers who took care of those at the end-of-life. Family and caregivers reported almost 54 percent of those at the end-of-life used CAM. Researchers also were surprised to learn of those in the group under age 65, about 75 percent had used complementary alternative medicine.
“Use in this group foretells the future,” Dr. Tilden said. “As baby-boomers age, bringing their familiarity with CAM into end-of-life, palliative care, health providers caring for dying patients will need to recognize patients’ self-care practices.”
She said recent surveys reflect medical and nursing professionals are just beginning to give some thought to complementary and alternative medicine.
“Health professionals need to be aware that complementary and alternative medicine use for control of symptoms at the end-of-life, especially for things like cancer, is likely,” said Dr. Tilden. “Many times, patients taking prescription medications won’t report their use of complementary and alternative medicine because of their fear of criticism and fear that the health professional may dissuade them from using them.”
Because care of patients during the end-of-life is primarily designed to relieve symptoms, not to cure, it is important health professionals know if treatments they’re prescribing may interact with non-prescription treatments patients may be using.
“Health professionals care a lot about symptom management but need to better coordinate and understand the use of complementary and alternative medicine. This is important so what people are taking doesn’t interact with drugs we prescribe, and so we can do a better job of counseling and guiding our patients,” Dr. Tilden said.
“If we tell our patients not to take herbal supplements, for example, it’s not going to change what our patients are doing, all it’s going to change is they won’t tell us…they won’t talk to us. I’m not out championing alternative medicine. It’s that we have a large percent of Americans using CAM, which is here to stay.”
Although some scientific evidence exists regarding some CAM therapies, for most there are questions such as safety and effectiveness yet to be answered through well-designed scientific studies.
Dr. Tilden said the results of the study conducted in Oregon can apply across the United States due to the trend of CAM use. “People are much more comfortable with incorporating complementary alternative medicine. The implication is the same in Nebraska as anywhere else,” she said.
According to a nationwide government survey conducted in 2002, 36 percent of U.S. adults aged 18 years and over use some form of complementary and alternative medicine.
The NIH survey also found 55 percent of adults said they were most likely to use CAM because they believed that it would help them when combined with conventional medical treatments; 50 percent thought CAM would be interesting to try; 26 percent used CAM because a conventional medical professional suggested they try it; and 13 percent used CAM because they felt that conventional medicine was too expensive.