Knight CAM

							CAM: What Your Patients Want
You To Know But Are Afraid to
          Tell You


  Leslie A. Knight, LtCol, USAF, MC, FS
              Offutt AFB, NE
                  Definition

   Medical interventions not taught widely at
    US medical schools nor generally available
    at US hospitals (Eisenberg/NIH)
   Personal therapies, relaxation therapies,
    chiropractic, healing therapies, commercial
    weight loss programs/self-style diets, self
    help/support, hypnosis/biofeedback
                 Overview

   Definition
   Who uses CAM and for what?
   Physician attitudes
   What do our patients want?
   The ethics of recommending (or not!) CAM
                Who Uses CAM?
   Women- 44%
   White- 45%
   Middle aged or older- >50%
       Adolescents- 79% lifetime (48% prev. month)
   College education- 49%
   Income- >50K- 53%
   Divorced or separated- 60%
   Rural vs urban?
          What CAM is used?

   ANY CAM- 52% lifetime/44% last yr
   Personal- 28% lifetime use
   Relaxation- 26%
   Chiropractor- 20%
   Healing- 5%
   Weight loss/self help- 12%
   Hypnosis/biofeedback- 2%
           Why is CAM Used?

   Stay healthy
   Musculoskeletal health
   Cardiovascular/Hormonal/Metabolic
     Satisfaction with Various CAM
                Therapies
   Healing- 79%; 89% recommend
   Self Help- 74%; 88% recommend
   Life style diets- 72%; 82% recommend
   Relaxation- 64%; 92% recommend
   Chiro- 63%; 86% recommend
   Personal therapies- 62%; 88% recommend
           Physician Attitudes
   94% believe their patients use CAM
   Few consistently ask about CAM
   Most clinicians recommend CAM to pts
   Positive attitude assoc. with clinician
    comfort in advising patients
   Rec. biofeedback (39%), life-style diet/self
    help/relaxation (33%)
   Least likely to rec. healing (7%)
             Patient Attitudes

   Cancer patients- >50% use, most don’t
    tell physician
   Most likely to tell physician about self help
    (43%), life-style diets/commercial wt loss
    (35/33%), Chiro (34%), personal
    therapies (26%)
                Physician Involvement
                                No.
                                 of     % Physicians   % Patients    % Physicians
                                CAM        Who          Who Told      Unaware of
                                User   Recommended     Provider of   Patient's CAM
Type of CAM Therapy              s       CAM Use        CAM Use           Use
Personal therapies (including   425       15.2%          25.8%          62.9%
home remedies, herbal
medicine, homeopathy, or
vitamin therapy)
Relaxation techniques           399       31.4%          18.1%          56.2%
(including massage therapy,
imagery, or visualization)

Chiropractors                   314       24.7%          34.1%          49.6%



Healing (including healers,      73        7.4%          21.3%          72.9%
spiritual, healing, Native
American healers, or energy
healing)
            Physician Involvement (con’t)
                   No. of   % Physicians Who   % Patients Who       % Physicians
Type of CAM        CAM       Recommended       Told Provider of       Unaware of
Therapy            Users        CAM Use           CAM Use         Patient's CAM Use

Commercial
weight loss
programs            68           16.6%              33.2%              55.7%



Life-style diets    65           33.2%              35.2%              43.3%


Self-help
groups              41           33.4%              42.7%              38.2%


Hypnosis or
biofeedback         29           39.3%              12.1%              53.4%



Any CAM use         801          23.7%              25.7%              56.8%
    What Does Your Patient Want?

   Collaboration and control
   Understand treatment information
   Maintain hope
   Trust physician
   BOTTOM LINE:
       Patients are afraid to tell you things they think
        you’ll disapprove of (did you need me to tell you that?!)
                   Ethics
   Severity and acuteness of illness
   Treatment by conventional therapies
   Invasiveness
   Associated toxicities
   Side effects of conventional therapies
   Evidence regarding desired CAM treatment
                 Conclusion
   Most patients are using CAM
   Most physicians want to recommend CAM,
    but tend to only recommend therapies
    with little potential for harm
   Elucidate and clarify patient’s core beliefs
   Patients are more likely to share their
    practices if they believe the physician will
    approve