Complementary medicine use often not disclosed to medical providers

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Research reveals that 1 in 3 complementary medicine (CM) users do not disclose their use of these medicines to their medical providers, posing significant direct and indirect risks of adverse effects and harm due to unsafe concurrent use of CM and conventional medicine use.

The first international systematic review conducted by researchers at the Australian Research Centre in Complementary and Integrative Medicine provides an update on the prevalence and characteristics of disclosure of CM use to medical providers since previous research conducted in 2003.

“This figure has hardly changed since the last review of the topic 13 years ago. This is despite the fact that the authors of every paper included in our review called for improved communication between doctors and patients to facilitate better disclosure,” says lead author and PhD candidate Hope Foley.

The study found that disclosure of CM use to medical providers is influenced by the providers’ communication style. Perceived provider knowledge of CM use was reported to be a barrier to discussions about CM use in clinical consultations. When the actual response of the provider to disclosure of CM use was explored by researchers, negative or discouraging responses were reported by less than 20% of disclosers or were not reported at all. Positive or encouraging responses to disclosure of CM use by a medical doctor were reported by a substantial proportion of respondents and neutral responses from medical providers were also common.

More than 67% of participants agreed that disclosure was important.

“Patient autonomy and preference are important features of person-centred care to be considered by medical providers alongside safety and treatment outcomes in their patient management,” the authors write.

On a global public health level, the World Health Organisation recognises the importance of integrated care which encompasses CM. Yet public health policies and procedures often create barriers to effective integration, limiting appropriate management of concurrent use and access to the recognised benefits of integrated care.”

“As CM becomes more separate from mainstream health services, disclosure is only going to become more and more important for public safety.”

The researchers conclude that in the context of contemporary person-centred health care models, discussions and subsequent disclosure of CM use may be facilitated by direct inquiry about CM use by providers.

“This is a topic which should be treated with gravity,” the researchers say. “Disclosure of CM use is central to wider patient management and care in contemporary clinical settings, particularly for primary care providers acting as gatekeeper in their patients’ care.”

Abstract
Concomitant complementary medicine (CM) and conventional medicine use is frequent and carries potential risks. Yet, CM users frequently neglect to disclose CM use to medical providers. Our systematic review examines rates of and reasons for CM use disclosure to medical providers. Observational studies published 2003–2016 were searched (AMED, CINAHL, MEDLINE, PsycINFO). Eighty-six papers reporting disclosure rates and/or reasons for disclosure/non-disclosure of CM use to medical providers were reviewed. Fourteen were selected for meta-analysis of disclosure rates of biologically-based CM. Overall disclosure rates varied (7–80%). Meta-analysis revealed a 33% disclosure rate (95%CI: 24% to 43%) for biologically-based CM. Reasons for non-disclosure included lack of inquiry from medical providers, fear of provider disapproval, perception of disclosure as unimportant, belief providers lacked CM knowledge, lacking time, and belief CM was safe. Reasons for disclosure included inquiry from medical providers, belief providers would support CM use, belief disclosure was important for safety, and belief providers would give advice about CM. Disclosure appears to be influenced by the nature of patient-provider communication. However, inconsistent definitions of CM and lack of a standard measure for disclosure created substantial heterogeneity between studies. Disclosure of CM use to medical providers must be encouraged for safe, effective patient care.

Authors
H Foley, A Steel, H Cramer, J Wardle, J Adams

University of Technology Sydney material
Scientific Reports abstract


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