’They Don’t Ask Me So I Don’t Tell Them’: Patient-Clinician Communication About Traditional, Complementary, and Alternative Medicine

Brian M. Shelley; Andrew L. Sussman; Robert L. Williams; Alissa R. Segal; Benjamin F. Crabtree

doi:10.1370/afm.947

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Figure 1.
Study methods. Stages of data collection with interspersed immersion/ crystallization analytic steps.

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Table 1.

Demographic Characteristics of All Participants

	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

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Table 2.

Model of Enhanced Communication Around TM/CAM in New Mexico

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

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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

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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.