Complementary and alternative medicine: The importance of doctor-patient communication

The definition of complementary, alternative, and integrative medicine (CAIM) remains dynamic and complex despite a steady increase in the popularity/usage of CAIM therapies across the globe. A lack of consistency in how these terms are defined remains a challenge for researchers, clinicians, and national and international organizations (e.g., World Health Organization, National Center for Complementary and Integrative Health) alike. In the present article, we provide a brief history of the use of these terminologies, and then outline the process we took to develop and create an operational definition of complementary, alternative, and integrative medicine. Our operational definition is the first to be informed by a systematic search of four quality-assessed information resource types, ultimately yielding 604 unique CAIM therapies. We then developed a single search string for the most common bibliographic databases using the finalized operational definition list of CAIM therapies. These CAIM therapies were searched against the Therapeutic Research Center's “Natural Medicines” database for all 604 therapies, whereby each item's scientific name and/or synonym was included as a keyword or phrase in the search string. While the current definition is not without limitations and ongoing debates still surround the field, this work is arguably a steppingstone towards enabling increased collaboration and communication amongst healthcare clinicians, researchers, and the public. This operational definition provides a foundation for developing well-coordinated research efforts that will assist in the acceptance and understanding of this field, while also focusing on adopting knowledge translation techniques and efforts for further research advancement and use.

Complementary and alternative medicine (CAM) consists of various medical practices and products not recognized as a part of conventional medicine. There are few studies on CAMs used for childhood epilepsy. We aimed to determine the prevalence and socio-demographic factors affecting CAM use in children with epilepsy.

This is a cross-sectional prospective descriptive study. The study included all parents who agreed to participate and had children with epilepsy. The data was collected using a questionnaire developed from a literature review of CAM use in pediatric epilepsy patients.

A total of 219 parent–child pairs were included in the study. Seventy-five participants had one or more comorbid disorders. 55.3% of participating children with epilepsy were taking more than one antiseizure medication (ASM). 30.1% of parents reported using some form of CAM for their children in the previous year. Only 60.6% of parents discussed their CAM decision with their child's doctor before using it. Univariate analysis showed that the patient's age, presence of comorbid disorders, duration of ASM, and family history of epilepsy were statistically significant predictors for CAM use. However, the presence of comorbidities was the only significant predictor of CAM use in logistic regression.

Even though most parents believe CAMs have no effect on their children with epilepsy, they frequently use them. We propose that the predictors identified in this study can help to identify potential CAM users. Since most parents do not report the use of CAM, physicians should routinely inquire about CAM use.

To explore the experiences, approaches, and challenges of physicians consulting patients about experimental stem cell and regenerative medicine interventions (SCRIs).

From August 21, 2018, through July 30, 2019, semistructured interviews of 25 specialists in cardiology, ophthalmology, orthopedics, pulmonology, and neurology were conducted and qualitatively analyzed using modified grounded theory.

All specialists used informational approaches to counsel patients, especially orthopedists. Informational approaches included explaining stem cell science, sharing risks, and providing principles. Several specialists also used relational counseling approaches including emphasizing that physicians want what is best for patients, acknowledging suffering, reassuring continued care, empathizing with patients and families, and underscoring that patients have the final decision. Many specialists reported being comfortable with the conversation, although some were less comfortable and several noted challenges in the consultation including wanting to support a patient’s decision but worrying about harms from unproven SCRIs, navigating family pressure, and addressing stem cell hype and unrealistic expectations. Specialists also desired that additional resources be available for them and patients.

Physicians relied more heavily on providing patients with information about SCRIs than using relational counseling approaches. Efforts should be directed at helping physicians address the informational and relational needs of patients, including providing tools and resources that inform physicians about the unproven SCRI industry, building skills in empathic communication, and the creation and dissemination of evidence-based resources to offer patients.

The use of massage therapy is common, especially in patients with musculoskeletal pain. The purpose of this study was to examine the prevalence, utilization, socio-demographic and health-related predictors of massage practitioner consultations in the US population.

Cross-sectional data from the 2012 National Health Interview Survey for adults (n = 34,525).

Prevalence of massage practitioner utilization were 12.8% (lifetime) and 6.8% (last 12 months). Compared to non-users, those who used massage in the last year were more likely: female, at least high school educated, annual income ≥ US$ 15,000, diagnosed with spinal pain or arthritis, report moderate physical activity level as compared to low level, and consume alcohol as compared to being abstinent. Massage was mainly used for general wellness or disease prevention (56.3%), but also for specific, typically musculoskeletal, health problems (41.9%) for which 85.2% reported massage helped to some or a great deal. Most (59.1%) did not disclose massage use to their health care provider, despite 69.4% reporting massage therapy combined with medical treatment would be helpful.

Approximately 7% (15.4 million) of US adults used massage therapy in the past year, mainly for general disease prevention, wellness or musculoskeletal pain. The majority of respondents reported positive outcomes of massage on specific health problems and overall well-being. Massage utilization was rarely covered by health insurance. Despite the majority of massage users considered massage therapy combined with medical care helpful, most did not disclose massage therapy use to their health care provider.

Parents of pediatric patients with chronic conditions such as epilepsy increasingly opt for complementary and alternative medicine (CAM). However, data on the pattern and reasons of CAM use in childhood epilepsy are scarce. The objectives of this study were as follows: first, to characterize CAM use among pediatric patients with epilepsy by assessing its spectrum, prevalence, costs, and frequency of use; second, to evaluate the influence of CAM use on compliance and satisfaction with conventional care as well as to explore parent–child neurologist communication concerning CAM; and third, to investigate predictors of CAM use.

A postal survey was administered to all parents of pediatric outpatients with epilepsy aged 6 to 12, who have received treatment at the neuropediatric outpatient clinic of the University Children's Hospital Heidelberg between 2007 and 2009.

One hundred thirty-two of the 297 distributed questionnaires were suitable for inclusion in statistical analysis (44.7%). Forty-nine participants indicated that their children used CAM during the previous year (37.1%). Thirty different types of CAM were used, with homeopathy (55.1%), osteopathy (24.5%), and kinesiology (16.3%) being the most commonly named. A mean of 86€ (0€–500€) and 3 h (1 h–30 h) per month was committed to CAM treatment. Only 53% of the users informed their child neurologist of the additional CAM treatment, while 85.6% of all parents wished to discuss CAM options with their child neurologist. Seventy-five percent of users considered the CAM treatment effective. Among the participants most likely to seek CAM treatment are parents whose children show a long duration of epileptic symptoms, parents who make use of CAM treatment themselves, and parents who value a holistic and natural treatment approach.

A substantial portion of pediatric patients with epilepsy receive CAM treatment. The high prevalence of use and significant level of financial and time resources spent on CAM indicate the high importance of these treatment options for parents. On the other hand, communication concerning CAM with the child neurologist is largely insufficient despite the wish to speak about CAM. Complementary and alternative medicine users' high compliance with conventional treatment and high perceived effectiveness of CAM support an integrative approach to CAM for pediatric patients with epilepsy. Our study implies that in addition to open parent–child neurologist communication, active inquiry on CAM treatments is necessary to enable informed decision making by parents and to establish the suitability of CAM treatment for the patient. Reliable predictors for CAM use, which allow for improved identification of patients with a high likelihood to receive CAM treatment, are the duration of the illness, use of CAM by the parents themselves, and the desire of the parents to receive a holistic and natural treatment for their child.