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Communication about complementary medicine in oncology.
Mentink, M.D.C. Communication about complementary medicine in oncology. Nijmegen: Radboud University Press, 2024. 212 p. Proefschrift van de Radboud Universiteit Nijmegen
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In dit proefschrift worden de volgende onderzoeksvragen beantwoord:
1. Hoe wordt complementaire zorg besproken in de oncologische zorg in Nederland en wat zijn de belemmerende en bevorderende factoren voor communicatie die worden ervaren door patiënten, oncologische
zorgverleners en complementaire behandelaars?
We onderzochten daadwerkelijke gesprekken over complementaire zorg tussen patiënten en zorgverleners door het observeren en coderen van 80 audio-opnames van oncologische consulten in zes verschillende ziekenhuizen in Nederland
2. Welke complementaire zorg is effectief en veilig voor patiënten met kanker? Om deze onderzoeksvraag te beantwoorden, beoordeelden we honderd systematische reviews die rapporteerden over het effect van een complementaire therapie op patiëntgerapporteerde uitkomstmaten. Twaalf verschillende complementaire
therapieën werden geïncludeerd, zoals kruidengeneeskunde, acupunctuur en yoga.
3. Hoe kunnen patiënten met kanker worden ondersteund bij het bespreken van complementaire zorg met hun
oncologisch zorgverlener?
In hoofdstuk IV wordt beschreven dat er een paar belangrijke belemmerende factoren naar voren kwamen die patiënten kunnen ervaren bij het bespreken van complementaire zorg. Zo zijn niet alle patiënten met kanker zich bewust van het bestaan van complementaire zorg of het belang van het bespreken van complementair zorggebruik met de zorgverlener. Daarnaast zijn niet alle patiënten met kanker assertief genoeg om het onderwerp te introduceren, vooral wanneer ze geconfronteerd worden met een sceptische zorgverlener. Om ook laaggeletterde patiënten te ondersteunen bij het bespreken van complementaire zorg, is het belangrijk om visuele met tekstuele informatie te combineren. Met deze kennis hebben we twee hulpmiddelen ontwikkeld om patiënten met kanker te ondersteunen in de communicatie over complementaire zorg: een gesprekshulp en een slideshow. De gesprekshulp heeft als doel om gesprekken over complementaire zorg te stimuleren en richting te geven door patiënten te voorzien van een reeks voorbeeldvragen die ze kunnen stellen aan hun zorgverlener. De slideshow laat patiënten op een visuele manier zien waarom het belangrijk is om complementair zorggebruik te bespreken met de zorgverlener. De twee hulpmiddelen werden geëvalueerd aan de hand van een online vragenlijst van 15 items die werd ingevuld door 144 patiënten met kanker.
1. Hoe wordt complementaire zorg besproken in de oncologische zorg in Nederland en wat zijn de belemmerende en bevorderende factoren voor communicatie die worden ervaren door patiënten, oncologische
zorgverleners en complementaire behandelaars?
We onderzochten daadwerkelijke gesprekken over complementaire zorg tussen patiënten en zorgverleners door het observeren en coderen van 80 audio-opnames van oncologische consulten in zes verschillende ziekenhuizen in Nederland
2. Welke complementaire zorg is effectief en veilig voor patiënten met kanker? Om deze onderzoeksvraag te beantwoorden, beoordeelden we honderd systematische reviews die rapporteerden over het effect van een complementaire therapie op patiëntgerapporteerde uitkomstmaten. Twaalf verschillende complementaire
therapieën werden geïncludeerd, zoals kruidengeneeskunde, acupunctuur en yoga.
3. Hoe kunnen patiënten met kanker worden ondersteund bij het bespreken van complementaire zorg met hun
oncologisch zorgverlener?
In hoofdstuk IV wordt beschreven dat er een paar belangrijke belemmerende factoren naar voren kwamen die patiënten kunnen ervaren bij het bespreken van complementaire zorg. Zo zijn niet alle patiënten met kanker zich bewust van het bestaan van complementaire zorg of het belang van het bespreken van complementair zorggebruik met de zorgverlener. Daarnaast zijn niet alle patiënten met kanker assertief genoeg om het onderwerp te introduceren, vooral wanneer ze geconfronteerd worden met een sceptische zorgverlener. Om ook laaggeletterde patiënten te ondersteunen bij het bespreken van complementaire zorg, is het belangrijk om visuele met tekstuele informatie te combineren. Met deze kennis hebben we twee hulpmiddelen ontwikkeld om patiënten met kanker te ondersteunen in de communicatie over complementaire zorg: een gesprekshulp en een slideshow. De gesprekshulp heeft als doel om gesprekken over complementaire zorg te stimuleren en richting te geven door patiënten te voorzien van een reeks voorbeeldvragen die ze kunnen stellen aan hun zorgverlener. De slideshow laat patiënten op een visuele manier zien waarom het belangrijk is om complementair zorggebruik te bespreken met de zorgverlener. De twee hulpmiddelen werden geëvalueerd aan de hand van een online vragenlijst van 15 items die werd ingevuld door 144 patiënten met kanker.
In this thesis, we aimed to explore and strengthen communication about complementary medicine in oncology to ensure safe, effective and patient-centred cancer care. The main research questions addressed are as follows:
1. How is complementary medicine discussed in oncology care in the Netherlands and what are the barriers to and facilitators of communication experienced by patients, healthcare providers and complementary medicine practitioners?
Actual conversations about complementary medicine between patients and healthcare providers were examined by observing and coding 80 audio-recordings of oncology consultations conducted in six different hospitals in the Netherlands. Complementary medicine was referenced in 44% of the consultations and these references primarily considered lifestyle-related modalities (e.g., exercise, diet). The topic of complementary medicine was, in most instances (62%), introduced by patients. Patients who did ask a specific question about complementary medicine always received a response from their healthcare provider. When patients did not ask a specific question but solely mentioned complementary medicine, healthcare providers rarely further elaborated on the topic. Important aspects of complementary medicine, such as safety and effectiveness, were seldom touched upon during the consultations. Both patients and healthcare providers verbalized neutral to positive attitudes towards the referenced complementary medicine modalities.
2. Which complementary therapies are effective and safe for patients with cancer?
To answer this research question, one-hundred systematic reviews on the effects of complementary therapies on cancer patient-reported outcomes were assessed. Twelve different complementary therapies, such as herbal medicine, acupuncture and yoga, were included. Although evidence for several therapy-outcome combinations remains inconclusive, the results indicate that some complementary therapies have the potential to improve patient-reported outcomes. Examples include acupuncture to relieve pain, music interventions to reduce anxiety and yoga to improve cancer-related fatigue. Side-effects associated with complementary therapy use, such as bruising related to acupuncture treatment or cramps related to yoga practice, were generally mild. Forty out of 100 included systematic reviews did not report on safety. Additionally, several of the included systematic reviews inadequately assessed the causes and impact of bias in their interpretation of the results.
3. How can patients with cancer be supported in discussing complementary medicine with their healthcare provider?
As described in Chapter IV, a few key barriers emerged for patients to discuss complementary medicine with their healthcare provider. For example, not all patients with cancer are aware of the existence of complementary medicine or the importance of discussing its use with their healthcare provider. In addition, not all patients with cancer are assertive enough to introduce the topic of complementary medicine to their healthcare provider, especially when faced with scepticism. To include lower-literate patients, visual information should complement textual information. With this knowledge, we developed two tools to support patients with cancer in communication about complementary medicine: a question prompt sheet and a slideshow. The question prompt sheet aims to stimulate and guide conversations about complementary medicine by providing a set of question
prompts to patients for different situations in which they may find themselves. The second tool consists of a slideshow that visually presents patients with the relevance of discussing complementary medicine use with their healthcare provider. The tools were evaluated by means of an online 15-item questionnaire that was completed by 144 patients with cancer. The tools were generally well received by the participants. The content and layout of the tools were perceived as acceptable, and approximately half of the participants found the tool useful. The other half of the participants had no intention to use the tools. The most frequently mentioned reasons for not using the tool were 1) being able to discuss complementary medicine without support, 2) not being interested in complementary medicine, or 3) not wanting to discuss the topic with their healthcare provider. The participants considered the tools especially useful for fellow patients.
1. How is complementary medicine discussed in oncology care in the Netherlands and what are the barriers to and facilitators of communication experienced by patients, healthcare providers and complementary medicine practitioners?
Actual conversations about complementary medicine between patients and healthcare providers were examined by observing and coding 80 audio-recordings of oncology consultations conducted in six different hospitals in the Netherlands. Complementary medicine was referenced in 44% of the consultations and these references primarily considered lifestyle-related modalities (e.g., exercise, diet). The topic of complementary medicine was, in most instances (62%), introduced by patients. Patients who did ask a specific question about complementary medicine always received a response from their healthcare provider. When patients did not ask a specific question but solely mentioned complementary medicine, healthcare providers rarely further elaborated on the topic. Important aspects of complementary medicine, such as safety and effectiveness, were seldom touched upon during the consultations. Both patients and healthcare providers verbalized neutral to positive attitudes towards the referenced complementary medicine modalities.
2. Which complementary therapies are effective and safe for patients with cancer?
To answer this research question, one-hundred systematic reviews on the effects of complementary therapies on cancer patient-reported outcomes were assessed. Twelve different complementary therapies, such as herbal medicine, acupuncture and yoga, were included. Although evidence for several therapy-outcome combinations remains inconclusive, the results indicate that some complementary therapies have the potential to improve patient-reported outcomes. Examples include acupuncture to relieve pain, music interventions to reduce anxiety and yoga to improve cancer-related fatigue. Side-effects associated with complementary therapy use, such as bruising related to acupuncture treatment or cramps related to yoga practice, were generally mild. Forty out of 100 included systematic reviews did not report on safety. Additionally, several of the included systematic reviews inadequately assessed the causes and impact of bias in their interpretation of the results.
3. How can patients with cancer be supported in discussing complementary medicine with their healthcare provider?
As described in Chapter IV, a few key barriers emerged for patients to discuss complementary medicine with their healthcare provider. For example, not all patients with cancer are aware of the existence of complementary medicine or the importance of discussing its use with their healthcare provider. In addition, not all patients with cancer are assertive enough to introduce the topic of complementary medicine to their healthcare provider, especially when faced with scepticism. To include lower-literate patients, visual information should complement textual information. With this knowledge, we developed two tools to support patients with cancer in communication about complementary medicine: a question prompt sheet and a slideshow. The question prompt sheet aims to stimulate and guide conversations about complementary medicine by providing a set of question
prompts to patients for different situations in which they may find themselves. The second tool consists of a slideshow that visually presents patients with the relevance of discussing complementary medicine use with their healthcare provider. The tools were evaluated by means of an online 15-item questionnaire that was completed by 144 patients with cancer. The tools were generally well received by the participants. The content and layout of the tools were perceived as acceptable, and approximately half of the participants found the tool useful. The other half of the participants had no intention to use the tools. The most frequently mentioned reasons for not using the tool were 1) being able to discuss complementary medicine without support, 2) not being interested in complementary medicine, or 3) not wanting to discuss the topic with their healthcare provider. The participants considered the tools especially useful for fellow patients.