Advising Cancer Patients on Natural Health Products

Abstract

Spanish

French

BACKGROUND:

Many patients with cancer (45–60%) use natural health products (NHPs). Pharmacists often find it difficult to advise these patients effectively.

OBJECTIVE:

To explore pharmacists' perceptions of the information needed to advise cancer patients on NHPs and develop a structured counseling approach.

METHODS:

A qualitative study was conducted using a focus group of pharmacists from an integrated cancer care organization in Canada. The outcome measures were the definitions of and reasons for the information needed to advise patients on NHPs and a counseling approach using laymen terms.

RESULTS:

Eight focus group sessions took place, from which 6 categories of information emerged: role of the advisor, evaluation of evidence, assessment of efficacy, assessment of toxicity, monitoring parameters, and provision of a closure. A patient counseling approach was developed based on this information.

CONCLUSIONS:

The findings provided a description of and rationale for categories of information needed to advise cancer patients on NHPs. A structured, step-by-step approach to counseling these patients was developed.

Keywords

cancer complementary therapies counseling evidence-based medicine patient education

Get full access to this article

View all access options for this article.

References

Boon

Stewart

Kennard

Gray

Sawka

Brown

Use of complementary/alternative medicine by breast cancer survivors in Ontario: Prevalence and perceptions. J Clin Oncol 2000;18:2515–21.

2 Richardson

Sanders

Palmer

Greisinger

Singletary

. Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. J Clin Oncol 2000;18:2505–14.

3 Gulian

Barnes

Francis

. Types and preferred sources of information concerning herbal medicinal products: Face-to-face interviews with users of herbal medicinal products (abstract). Int J Pharm Pract 2002;10(suppl):R33.

4 Barnes

Mills

Abbot

Willoughby

Ernst

. Different standards for reporting ADRs to herbal remedies and conventional OTC medicines: Face-to-face interviews with 515 users of herbal remedies. Br J Clin Pharmacol 1998;45:496–500.

Gray

Greenberg

Fitch

Voros

Chart

Labrecque

A strategy for informing patients and health professionals about unconventional cancer therapies. J Cancer Educ 1998;13:31–8.

6 Kaegi

. A patient's guide to choosing unconventional therapies. CMAJ 1998;158:1161–5.

7 Charnock

Shepperd

Needham

Gann

. DISCERN: An instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health 1999;53:105–11.

8National Center for Complementary and Alternative Medicine (NCCAM). NCCAM publication no. D156. What is complementary and alternative medicine (CAM)? May 2002. http://nccam.nih.gov/health/whatiscam (accessed 2003 Feb 12).

9 Eisenberg

. Advising patients who seek alternative medical therapies. Ann Intern Med 1997;127:61–9.

10.

10 Weiger

Smith

Boon

Richardson

Kaptchuk

Eisenberg

. Advising patients who seek complementary and alternative medical therapies for cancer. Ann Intern Med 2002;137:889–903.

11.

Sandler

Brazdziunas

Cooley

Gonzalez de Pijem

Hirsch

Kastner

Counseling families who choose complementary and alternative medicine for their child with chronic illness or disability. Pediatrics 2001;107:598–601.

12.

12 Dawson

Manderson

Tallo

. A manual for the use of focus group. Boston, MA: International Nutrition Foundation for Developing Countries, 1993.

13.

13 Pohar

Taylor

SCM

. Ambulatory patient satisfaction with cancer treatment education (abstract). J Oncol Pharm Pract 2000;6:31.

14.

14 Mays

Pope

. Qualitative research: Observational methods in health care settings. BMJ 1995;311:182–4.

15.

15Alternative Medicine Task Force. Information paper: the role of the pharmacist with respect to complementary/alternative medicine 1999. Ottawa: Canadian Society of Hospital Pharmacists, 2001.

16.

16 Labriola

Livingston

. Possible interactions between dietary antioxidants and chemotherapy. Oncology (Huntingt) 1999;13:1003–8; discussion 1008, 1011–2.

17.

17College Council. External policy EP-26: pharmacist distribution of alternative and complementary health products. Vancouver: College of Pharmacists of British Columbia, approved 12 June 1998, revised 2 November 2001.

18.

18 Kaufman

. ABC of learning and teaching in medicine: Applying educational theory in practice. BMJ 2003;326:213–6.

19.

19 Kehoe

Katz

. Health behaviors and pharmacotherapy. Ann Pharmacother 1998;32:1076–86. DOI 10.1345/aph.17418.

20.

20 Partridge

Avorn

Wang

Winer

. Adherence to therapy with oral antineoplastic agents. J Natl Cancer Inst 2002;94:652–61.

21.

21 Passalacqua

Campione

Caminiti

Salvagni

Barilli

Bella

. Patients' opinions, feelings, and attitudes after a campaign to promote the Di Bella therapy. Lancet 1999;353:1310–4.

22.

erratum 1999;353:2078.

23.

22 Walker

. Evaluation of the ability of several herbal resources to answer questions about herbal products asked in drug information centers. Pharmacotherapy 2002;22:1611–5.

24.

23 Mishel

Hostetter

King

Graham

. Predictors of psychosocial adjustment in patients newly diagnosed with gynecological cancer. Cancer Nurs 1984;7:291–9.

25.

24 Gotay

Dumitriu

. Health food store recommendations for breast cancer patients. Arch Fam Med 2000;9:692–9.

26.

25 Calder

Issenman

Cawdron

. Health information provided by retail health food outlets. Can J Gastroenterol 2000;14:767–71.

Advising Cancer Patients on Natural Health Products— A Structured Approach