Use of decision aid to improve informed decision-making and communication with physicians on the use of oral complementa
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ORIGINAL ARTICLE
Use of decision aid to improve informed decision-making and communication with physicians on the use of oral complementary and alternative medicine (CAM) among cancer patients on chemotherapy treatment: a randomised controlled trial Wan-Qin Chong 1
&
Maria Jannet Mogro 1 & Asrie Arsad 2 & Bee-Choo Tai 3 & Soo-Chin Lee 1,4
Received: 24 July 2020 / Accepted: 30 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Complementary and alternative medicine (CAM) is often used by cancer patients and is concerning as concomitant oral CAM and chemotherapy use may result in adverse interactions and toxicities. We hypothesise that a decision aid (DA) may promote informed and rational use of oral CAM during chemotherapy, and increase patients’ discussion with their oncologists on CAM use. Methods We randomised 240 patients initiating chemotherapy to receive DA or none. Questionnaires were administered at randomisation (visit 1), 1 month (visit 2) and 3 months (visit 3). The primary endpoint was the decisional conflict score (DCS) for decision made on CAM use during chemotherapy. Secondary endpoints include patients’ decision regret score (DRS) on CAM use, CAM uptake, discussion with oncologists on CAM usage, and difference in quality of life (QoL) score between CAM and non-CAM users at visit 3. Results There was no difference in the mean DCS (mean difference 2.7 [95 CI − 2.9 to 8.3, p = 0.345]) and DRS (mean difference − 0.3 [95% CI − 6.3 to 5.8, p = 0.926]) between the two arms. There was a reduction in odds of CAM usage in the intervention arm compared to control arm (OR = 0.36, 95% CI 0.17 to 0.78, p = 0.009), but there was no difference in discussion with oncologists on CAM usage (OR = 0.46, 95% CI 0.07 to 3.01, p = 0.419), or in the QoL between CAM and non-CAM users. Conclusion Our DA did not reduce DCS among cancer patients on chemotherapy. DA that provides more evidence-based information on CAM, and non-judgemental discussion initiated by oncologists to discuss CAM, may improve its effectiveness. Keywords Supportive care . Complementary and alternative medicine (CAM) . Decision aid . Quality of life (QoL)
Introduction Complementary and alternative medicine (CAM) is a group of healthcare practices and products that are not considered * Wan-Qin Chong [email protected] 1
Department of Haematology-Oncology, National University Cancer Institute, Singapore, 1E Lower Kent Ridge Road, Singapore 119228, Singapore
2
Department of Medicine, National University Hospital, Singapore, Singapore
3
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
4
Cancer Science Institute of Singapore, Singapore, Singapore
conventional medicine [1]. Globally, CAM is widely used among cancer patients as they sought ways to improve their survival or improve their quality of life during cancer treatment. The prevalence of CAM use is estimated to be 30–50% in the West and appears to be rising over the years [2–4], while it is reported to
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