Knowledge, attitudes and practices of health professionals toward complementary and alternative medicine in cancer care – a systematic review

ABSTRACT

Background: Cancer patients’ disclosure rate of their complementary and alternative medicine (CAM) use to health professionals is low, mainly attributed to health professionals’ attitude toward CAM. Thus, we aimed to identify and compare the knowledge, attitudes and practices of doctors, nurses and pharmacists regarding CAM use in cancer patients.

Method: The databases AMED, CINAHL, Embase, Emcare, Medline, PubMed, Scopus and Web of Science were searched for surveys of health professionals published between 2008 and 2020.

Results: The knowledge of CAM in cancer care was generally poor for all three professions in the included studies, although how knowledge was assessed showed large variability. Doctors were found to dismiss or discourage CAM use out of concerns for side-effects and interactions. Nurses were generally positive and supportive toward CAM use by cancer patients. Pharmacists were neutral toward CAM, but believed they should be a reliable source of information for patients. All professions felt a major barrier to discussions with patients about CAMs was a lack of evidence of their safety and efficacy. Studies of all three professions also showed a general desire for more education regarding CAM.

Conclusions: The review suggests that doctors, nurses and pharmacists may lack appropriate knowledge to inform CAM use in a cancer care setting, which determines their attitude, influences practice and potentially impacts patient outcomes. Our findings indicate that increased access to research-based education on CAM would strengthen health practitioners’ confidence in discussing CAM with cancer patients, which would lead to more disclosure and safer therapeutic decision making.

KEYWORDS:

• Complementary medicine
• integrative medicine
• cancer
• knowledge
• attitudes
• practices

Acknowledgements

The authors would like to acknowledge the support of the Pharmacy discipline in the College of Medicine and Dentistry at James Cook University, Townsville.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval

Ethical approval was not required as this is a review article.

Notes

1 The * indicates a truncation or wildcard in the search string.

Additional information

Funding

The corresponding author was supported through an Australian Government Research Training Program Scholarship (Department of Education, Australian Government).

Notes on contributors

Martin R. Keene

Martin R. Keene is currently a PhD candidate in the College of Medicine and Dentistry at James Cook University in Australia. His research is focussed on the complementary and alternative medicines in cancer patients and the attitudes and practices of health professionals in oncology care regarding these medicines. Martin is an experienced clinical pharmacist having working in hospitals across Australia, ranging from metropolitan through to regional areas. He has a strong background in the biomedical sciences having completed an honours degree in biochemistry and has worked as research assistant in the Cooperative Research Centre for Chronic Inflammatory Diseases.

Ian M. Heslop

Associate Professor Ian M. Heslop initially qualified in the UK and worked as a drug information and clinical pharmacist in a number of English and Scottish Hospitals before migrating to North Queensland, Australia in 1996. He was involved in the inception of the Pharmacy program at James Cook University in 1999 and switched to academic pharmacy full-time in 2003. He is currently the Acting Academic Head of Pharmacy at James Cook University. His research interests include Travel Health, Infectious Diseases and Antimicrobial Stewardship and Extended Clinical Roles for Pharmacists.

Sabe S. Sabesan

Professor Sabe S. Sabesan is the director of the department of medical oncology at the Townsville Cancer Centre, Townsville Hospital and Health Services and the Clinical Dean, College of Medicine and Dentistry of the James Cook University. He has designed, implemented and published on various teleoncology models to enhance rural access to cancer services closer to home. In collaboration with Clinical Oncology Society of Australia (COSA), he led the development of the teleoncology guidelines and the Australasian Teletrial model. As the chair of the QH State-wide Teletrial Working Group and Co-chair of the Australian Teletrial Consortium of COSA, he has been leading the implementation of the teletrial model in Queensland and across Australia.

Beverley D. Glass

Beverley D. Glass, currently Professor of Pharmacy in the College of Medicine and Dentistry at James Cook University has published over 120 peer reviewed papers and presented her research outcomes at over 60 conferences (including, invited presentations and plenary lectures at both National and International Conferences) over the last 10 years. She has supervised a total of over 25 Honours Students in Pharmacy and Chemistry and 25 Masters (by Research) and PhD students. While her research efforts have been focused in the areas of Drug Formulation, Stability and Analysis, in the last 3 years she has utilized her expertise in the underpinning pharmaceutical sciences to begin to research Complementary and Alternative Medicines (CAMs). This research into the use of CAMs by different patient groups including in the areas of cardiovascular health, depression and pain and cancer has highlighted the need for the education and training of health professionals in CAMs in order to integrate these therapies safely into conventional practice to achieve better outcomes for patients.