Background
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Compare knowledge and attitudes of health care providers with no training in complementary modalities to that of health care providers with training in complementary modalities about the risks for patients who combine complementary modalities with conventional treatment in cancer care. We consider both direct and indirect risk.
Method
Participants
Data collection
Questionnaire content
Data collection procedures
Measures
Professional, personal and clinical practice characteristics
Total (n = 466) | Medical Doctor (n = 142) | Nurse (n = 69) | Provider with dual training (n = 32) | Complementary therapist (n = 223) | ||||||
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Acupuncture | 233 | 50.5 | 27 | 19 | 17 | 25 | 26 | 81.3 | 163 | 74.4 |
Homeopathy | 73 | 16.3 | 18 | 12.8 | 1 | 1.5 | 2 | 6.9 | 52 | 24.3 |
Healing | 86 | 18.9 | 12 | 8.6 | 9 | 13.4 | 8 | 26.7 | 57 | 26.3 |
Thai Chi and Chi gong | 86 | 18.8 | 5 | 3.5 | 3 | 4.4 | 11 | 36.7 | 67 | 30.7 |
Aromatherapy | 73 | 15.9 | 3 | 2.1 | 9 | 13.2 | 4 | 13.8 | 57 | 25.9 |
Yoga | 136 | 29.6 | 27 | 19 | 19 | 28.4 | 12 | 40 | 78 | 35.3 |
Mindfullness | 163 | 35.8 | 41 | 29.1 | 22 | 33.3 | 13 | 43.3 | 87 | 39.9 |
Reflexology | 101 | 22 | 2 | 1.4 | 3 | 4.5 | 4 | 12.9 | 92 | 41.8 |
Chinese herbal medicine | 36 | 7.9 | 2 | 1.4 | 1 | 1.5 | 6 | 20.7 | 27 | 12.3 |
Herbal medicine other than Chineese | 26 | 5.8 | 3 | 2.2 | 0 | 0 | 1 | 3.4 | 22 | 10.2 |
Naprapathy | 56 | 12.3 | 10 | 7.1 | 3 | 4.4 | 3 | 10.3 | 40 | 18.3 |
Osteopathy | 58 | 12.7 | 11 | 7.9 | 2 | 2.9 | 4 | 13.3 | 41 | 18.7 |
Massage | 219 | 48.1 | 34 | 24.5 | 19 | 28.8 | 19 | 59.4 | 147 | 67.4 |
Direct risk
Indirect risk
Statistical analysis
Results
Demographics
Direct risk
Total (n = 466) | Medical doctor (n = 142) | Nurse (n = 69) | Providers with dual training (n = 32) | Complementary therapist (n = 223) | p-value | ||||||
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n | % | n | % | n | % | n | % | n | % | ||
Gender | < 0.001* | ||||||||||
Male | 108 | 27.5 | 69 | 51.5 | 3 | 12.5 | 36 | 19.3 | |||
Female | 285 | 72.5 | 65 | 48.5 | 48 | 100 | 21 | 87.5 | 151 | 80.7 | |
Missing | 73 | 8 | 21 | 8 | 36 | ||||||
Age. years | < 0.001** | ||||||||||
Mean age | 373 | 48.7 | 127 | 45.4 | 45 | 51.2 | 24 | 52.2 | 177 | 50.1 | |
Missing | 93 | 15 | 24 | 8 | 46 | ||||||
Education | < 0.001^ | ||||||||||
Compulsory | 2 | 0.5 | 2 | 1.1 | |||||||
Middle level | 33 | 8.4 | 33 | 17.6 | |||||||
University up to 4 years | 112 | 28.4 | 23 | 46.9 | 11 | 44 | 78 | 41.7 | |||
University more than 4 years/PhD | 248 | 62.8 | 134 | 100 | 26 | 53.1 | 14 | 56 | 74 | 39.6 | |
Missing | 71 | 8 | 20 | 7 | 36 | ||||||
Profession* | |||||||||||
Oncology doctor | 27 | 5.8 | 27 | 100 | |||||||
Family physician | 118 | 25.3 | 116 | 99.1 | 2 a | 1.8 | |||||
Oncology nurse | 89 | 19.1 | 69 | 77.5 | 20 | 22.5 | |||||
Acupuncturist | 150 | 32.2 | 25 | 16.7 | 125 | 83.3 | |||||
Massage therapist | 82 | 17.6 | 6 | 7.3 | 76 | 92.7 | |||||
Reflexologist/zonetherapist | 35 | 7.5 | 1 | 2.9 | 34 | 97.1 | |||||
Clinical practice | < 0.001^ | ||||||||||
Full time health provider | 287 | 72.1 | 121 | 89.6 | 38 | 77.6 | 18 | 72 | 110 | 58.2 | |
Part time health provider | 92 | 23.1 | 11 | 8.1 | 10 | 20.4 | 5 | 20 | 66 | 34.9 | |
Other (students or retired persons) | 19 | 4.8 | 3 | 2.2 | 1 | 2 | 2 | 8 | 13 | 6.9 | |
Missing | 68 | 7 | 20 | 7 | 34 | ||||||
Patient visits per week | < 0.001* | ||||||||||
1-19 patients | 131 | 33.8 | 10 | 7.6 | 27 | 57.4 | 4 | 16 | 90 | 48.6 | |
20–39 patients | 121 | 31.2 | 28 | 21.4 | 17 | 36.2 | 5 | 20 | 71 | 38.4 | |
40 or more patients | 136 | 35.1 | 93 | 71 | 3 | 6.4 | 16 | 64 | 24 | 13 | |
Missing | 78 | 11 | 22 | 7 | 38 | ||||||
Cancer patient visits per week | < 0.001^ | ||||||||||
1–19 cancer patients | 361 | 92.1 | 125 | 92.6 | 31 | 64.6 | 23 | 92 | 182 | 98.9 | |
20 and more patients | 31 | 7.9 | 10 | 7.4 | 17 | 35.4 | 2 | 8 | 2 | 1.1 | |
Missing | 74 | 7 | 21 | 7 | 39 | ||||||
Location | 0.005* | ||||||||||
Rural area | 118 | 29.7 | 56 | 41.5 | 7 | 14.6 | 3 | 12 | 52 | 27.5 | |
Small city. Village (up to 50.000 inhabitants) | 153 | 38.5 | 44 | 32.6 | 23 | 47.9 | 12 | 48 | 74 | 39.2 | |
Large city (> 50.000 inhabitants) | 126 | 31.7 | 35 | 25.9 | 18 | 37.5 | 10 | 40 | 63 | 33.3 | |
Missing | 69 | 7 | 21 | 7 | 34 |
Indirect risk
Total | Medical doctor (n = 142) | Nurse (n = 69) | Provider with dual training n = 32) | Complementary therapist (n = 223) | p-value | ||||||
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Complementary modalities can cause adverse effects^^ | < 0.001* | ||||||||||
Yes | 376 | 82.1 | 134 | 94.4 | 64 | 92.8 | 27 | 87.1 | 151 | 69.9 | |
Complementary modalities can cause harmful interactions with conventional treatments | < 0.001* | ||||||||||
Yes | 265 | 59.2 | 105 | 76.6 | 55 | 84.6 | 16 | 51.6 | 89 | 41.4 | |
Treated patiens for whom a complementary modality was effective | < 0.001* | ||||||||||
Yes | 239 | 60.8 | 32 | 24.2 | 27 | 49.1 | 25 | 96.2 | 155 | 86.1 | |
Treated patients for whom a complementary modality was harmful | < 0.001* | ||||||||||
Yes | 97 | 24.7 | 51 | 38.3 | 27 | 51.9 | 3 | 11.5 | 16 | 8.8 | |
Combining complementary and conventional treatments increases patient risk | < 0.001* | ||||||||||
Yes | 240 | 62.8 | 101 | 77.7 | 49 | 92.5 | 14 | 58.3 | 76 | 43.4 |
Total | Medical doctor (n = 142) | Nurse (n = 69) | Provider with dual training (n = 32) | Complementary therapist (n = 223) | p-value | ||||||
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Whether complementary modalities should be subjected to more scientific testing^^ | |||||||||||
Yes | 302 | 71.6 | 119 | 88.8 | 54 | 88.5 | 15 | 55.6 | 114 | 57 | < 0.001* |
Most important factor for recommending a complementary modality | < 0.001^ | ||||||||||
Evidence for safety | 209 | 49.1 | 52 | 38.2 | 37 | 59.7 | 12 | 44.4 | 108 | 53.7 | |
Evidence for efficacy | 169 | 39.7 | 55 | 40.4 | 25 | 40.3 | 14 | 51.9 | 75 | 37.3 | |
Evidence does not matter | 22 | 5.2 | 5 | 3.7 | 0 | 0 | 0 | 0 | 17 | 8.5 | |
Double responses | 26 | 6.1 | 24 | 17.6 | 0 | 0 | 1 | 3.7 | 1 | 0.5 | |
Sufficient efficacy evidence to recommend a complementary modality | < 0.001^ | ||||||||||
No or weak evidence for efficacy | 39 | 9.3 | 9 | 6.6 | 3 | 4.9 | 2 | 7.4 | 25 | 12.9 | |
Moderate evidence for efficacy | 151 | 36.1 | 37 | 27.2 | 11 | 18 | 17 | 63 | 86 | 44.3 | |
Strong evidence for efficacy | 168 | 40.2 | 66 | 48.5 | 39 | 63.9 | 7 | 25.9 | 56 | 28.9 | |
Would never recommend | 60 | 14.4 | 24 | 17.6 | 8 | 13.1 | 1 | 3.7 | 27 | 13.9 | |
Sufficient evidece for safety | < 0.001^ | ||||||||||
No or weak evidence for safety | 12 | 2.9 | 3 | 2.2 | 0 | 0 | 1 | 3.7 | 8 | 4.1 | |
Moderate evidence for safety | 57 | 13.6 | 4 | 3 | 3 | 4.8 | 7 | 25.9 | 43 | 22.1 | |
Strong evidence for safety | 309 | 73.7 | 108 | 80 | 52 | 83.9 | 18 | 66.7 | 131 | 67.2 | |
Would never recommend | 41 | 9.8 | 20 | 14.8 | 7 | 11.3 | 1 | 3.7 | 13 | 6.7 | |
Number of complementary modality care patients who delayed or declined conventional treatment | < 0.001* | ||||||||||
No patients | 337 | 80 | 95 | 70.4 | 30 | 49.2 | 25 | 96.2 | 187 | 94 | |
One or more patients | 84 | 20 | 40 | 29.6 | 31 | 50.8 | 1 | 3.8 | 12 | 6 | |
How the providers would address a complementary modality patient who delayed or declined conventional treatment | |||||||||||
Have not experienced | 206 | 44.2 | 52 | 36.6 | 15 | 21.7 | 12 | 38.7 | 127 | 58.8 | < 0.001* |
Respect the patient’s choice | 157 | 33.7 | 57 | 40.1 | 35 | 50.7 | 11 | 35.5 | 54 | 25.0 | < 0.001* |
Try to convince patient | 127 | 27.3 | 65 | 45.8 | 13 | 18.8 | 7 | 22.6 | 42 | 19.4 | < 0.001* |
Encourage patient soliciting a second opinion | 150 | 32.2 | 34 | 23.9 | 24 | 34.8 | 12 | 38.7 | 80 | 37.0 | 0.122* |
Ask family members to intervene | 9 | 1.9 | 7 | 4.9 | 2 | 2.9 | 0 | 0.0 | 0 | 0.0 | 0.003^ |
Inform patient of consequences of not receiving conventional treatment | 203 | 43.6 | 91 | 64.1 | 42 | 60.9 | 10 | 32.3 | 60 | 27.8 | < 0.001* |
Approve of patient combining complementary and conventional treatments | < 0.001^ | ||||||||||
Never | 23 | 5.9 | 12 | 9 | 3 | 5.8 | 0 | 0 | 8 | 4.5 | |
Sometimes | 147 | 37.8 | 84 | 63.2 | 31 | 59.6 | 6 | 24 | 26 | 14.5 | |
Often | 107 | 27.5 | 27 | 20.3 | 9 | 17.3 | 8 | 32 | 63 | 35.2 | |
Always | 112 | 28.8 | 10 | 7.5 | 9 | 17.3 | 11 | 44 | 82 | 45.8 | |
Asking patients if they consider risks of combining complementary and conventional treatments | < 0.001* | ||||||||||
Never | 153 | 39.2 | 54 | 40.3 | 17 | 30.4 | 11 | 44 | 71 | 40.6 | |
Sometimes | 147 | 37.7 | 59 | 44 | 31 | 55.4 | 11 | 44 | 46 | 26.3 | |
Often/always | 90 | 23.1 | 21 | 15.7 | 8 | 14.3 | 3 | 12 | 58 | 33.1 | |
Advice given to patients who ask about complementary modalities | < 0.001^ | ||||||||||
Discourage use | 14 | 3.6 | 10 | 7.5 | 2 | 3.6 | 0 | 0 | 2 | 1.1 | |
Encourage use | 100 | 25.8 | 3 | 2.3 | 4 | 7.3 | 11 | 42.3 | 82 | 47.1 | |
Neither | 177 | 45.6 | 81 | 60.9 | 30 | 54.5 | 10 | 38.5 | 56 | 32.2 | |
Other | 97 | 25 | 39 | 29.3 | 19 | 34.5 | 5 | 19.2 | 34 | 19.5 | |
Advice given to patients who ask about conventional treatment | |||||||||||
Discourage use | 2 | 0.5 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 1.1 | 0.005^ |
Encourage use | 308 | 78.2 | 116 | 86.6 | 42 | 77.8 | 21 | 84 | 129 | 71.3 | |
Neither discourage nor encourage | 46 | 11.7 | 5 | 3.7 | 6 | 11.1 | 4 | 16 | 31 | 17.1 | |
Other | 38 | 9.6 | 13 | 9.7 | 6 | 11.1 | 0 | 0 | 19 | 10.5 | |
Complementary modalities are dangerous because they delay conventional treatments | < 0.001* | ||||||||||
Yes | 178 | 47.6 | 100 | 78.1 | 35 | 71.4 | 6 | 24 | 37 | 21.5 |