Having Evidence-Based Discussions on CAM

Trusted Sources of CAM Evidence

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BOSTON—With complementary and alternative medicine (CAM) becoming increasingly popular among patients with cancer, it is important for oncology nurses to familiarize themselves with the evidence for and against various CAM therapies. As a nurse involved with CAM for more than 30 years, Judith Fouladbakhsh, PhD, APRN, AHN-BC, believes these therapies can be used to promote health and wellness.

Fouladbakhsh, who is assistant professor, Wayne State University, Detroit, Michigan, said it is important for nurses to stay educated on CAM therapies because many patients are already using them when they present for care. “Cancer patients and survivors are among the highest users of CAM therapies,” she said, “and we have seen the growth of integrative medicine within cancer centers where these therapies are offered.”

A University of Pennsylvania School of Medicine study published in the March issue of the Journal of Cancer Survivorship backs this up. The survey showed that 65% of cancer survivors had used CAM during their lifetime versus 53% of patients without cancer. Patients offer various reasons for using CAM, including a desire to improve their quality of life or provide a greater sense of control over their disease, cultural reasons, dissatisfaction with conventional care, and the desire for natural treatment options.

Some oncologists are not well informed on CAM therapies and avoid discussing them with patients. Oncology nurses, who typically play an active role in educating patients, might hesitate to broach the topic of CAM out of concern that their employer does not consider it within the scope of their services. As evidence emerges that CAM therapies benefit certain patients, attitudes have begun to shift.

“Oncologists have become more open to the therapies that have an evidence base as they seek means of symptom management for their patients,” said Fouladbakhsh. “I was recently contacted by an oncologist interested in the physiological mechanism of yoga, and several others have joined my yoga research team.”

Symptom management is an area where certain CAM therapies show tremendous promise. Many people—with and without cancer—turn to CAM therapies to relieve pain. “Several CAM therapies have established evidence supporting use for pain management and relief,” Fouladbakhsh said, singling out acupuncture, yoga for low back pain, and chiropractic services.

Preserving or enhancing the well-being of patients is an important element of nursing. Shutting the door on dialogue about CAM therapies can hinder the nurse’s ability to provide patients with the best care. Some CAM therapies are harmful or become harmful when used with conventional treatment, others are ineffective but costly, and still others provide much-needed relief. Patients need guidance on determining into which category a CAM therapy they are using or would like to use falls.

Before nurses have these conversations with patients and their families, they need to be knowledgeable about the evidence surrounding various CAM therapies and practices. After becoming educated on CAM therapies, Fouladbakhsh said, “nurses must assess use and may be able to incorporate appropriate therapies into the plan of care.” During the educational session, Lynda Balneaves, RN, PhD, associate professor, and her colleague, Tracy Truant, RN, MSN, professional practice leader, both from the University of British Columbia School of Nursing, Vancouver, suggested using a customized version of the Situation, Choices, Objectives, People, Evaluation, Decision (SCOPED) decision-support tool and provided an example available for download at www.ons.org/CNECentral/Confrences/Congress/2011.

Important factors to consider in helping the patient assess a CAM therapy or practice are its effects on quality of life, relationships, and overall health; the patient’s ability to commit the time, cost, and energy needed to pursue the therapy or practice; and whether it is compatible with the patient’s overall objectives.

CAM education is never completed. Data are released regularly that update what is known about existing practices or that propose new ones. Word-of-mouth CAM therapies routinely surface in the media and on the Internet. To continue helping patients make safe, educated decisions on CAM use requires nurses to remain proactive in keeping abreast with the evidence on CAM therapies.

This educational session involved collaboration between the Oncology Nursing Society Complementary & Integrative Therapies Special Interest Group (SIG) and the Canadian Association of Nurses in Oncology CAM SIG.