Article Figures & Data
Figures
- Figure 1.
Study methods. Stages of data collection with interspersed immersion/ crystallization analytic steps.
Tables
Clinic Staff (n=41) Patient Interviews (n=93) Clinician Interviews (n=14) Clinician Focus Group (n=5) Patient-Video Review Interviews (n=21) NP=nurse-practitioner; PA=physician’s assistant. Characteristics Sex, female 38 72 4 2 18 Ethnicity Hispanic – 40 – – 10 Non-Hispanic white – 5 – – 1 Native American – 48 – – 10 Age, years <18 – 4 – – 0 18–30 – 28 – – 7 31–44 – 23 – – 5 45–59 – 18 – – 3 60+ – 18 – – 3 Missing – 2 – – 3 Education <High school – 29 – – – High school – 26 – – – >High school – 35 – – – Missing – 3 – – – Practice specialty Family physicians – – 9 4 – Pediatricians – – 1 0 – Internists – – 2 0 – Midlevel (PA, NP) – – 2 1 – Institutional setting Indian Health Service 22 39 6 0 10 Community Health Center 19 54 8 4 11 University of New Mexico 0 0 0 1 0 Patients Clinicians TM/CAM = traditional medicine and complementary and alternative medicine. Need to perceive openness Need to demonstrate openness Need to perceive respect Need to demonstrate respect Need to perceive interest Need to demonstrate interest Use driven by cultural identity Need to initiate discussion Use driven by family history Can ask about TM/CAM in acute setting Use driven by proximity to home Can still be clinical and evidence-based Do not have outward characteristics Need not be content experts
Supplemental Appendixes
Supplemental Appendix 1. Clinic Staff Interview Guide; Supplemental Appendix 2. Patient Interview Guide; Supplemental Appendix 3. Clinician Interview Guide; Supplemental Appendix 4: Video Vignette Text and Interview Questions
Files in this Data Supplement:
- Supplemental data: Appendixes 1-4 - PDF file, 4 pages, 154KB
The Article in Brief
'They Don't Ask Me So I Don't Tell Them': Patient-Clinician Communication About Traditional, Complementary, and Alternative Medicine
Brian M. Shelley and colleagues
Background Although the use of traditional, complementary, and alternative medicine (TM/CAM) is widespread, clinicians and patients often don't discuss patients' TM/CAM use. This study explores factors that encourage or discourage communication between clinicians and patients about TM/CAM.
What This Study Found Three main themes help determine whether and how patients and clinicians communicate about TM/CAM: acceptance/nonjudgment, initiation of communication, and safety/efficacy concerns. Most patients who use TM/CAM expect the clinician to initiate discussion of it. It is easier for patients to discuss TM/CAM if the clinician initiates the discussion in a nonjudgmental, accepting way. Discussion is limited by clinicians' belief that there is little TM/CAM use among their patients, lack of understanding about TM/CAM, and limited time in the patient visit. Many clinicians are skeptical about TM/CAM safety and effectiveness.
Implications
- Clinicians should initiate discussion of TM/CAM with their patients, but they do not have to be experts in TM/CAM therapies. Instead, they should demonstrate interest, nonjudgment, and honesty about their limited knowledge.
- The study findings provide the foundation for a model of improved patient-clinician communication about TM/CAM. Future research should look at how implementing such a model will affect patient care, satisfaction, and trust, and how clinicians can better integrate the different types of care their patients utilize.
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