Assessing clinician familiarity with integrative oncology and uptake of an electronic medical record–based education resource.

Abstract

e21001 Background: Integrative oncology is the practice of incorporating complementary and alternative medicine (CAM) into the conventional care of cancer. CAM encompasses a broad realm of treatment modalities, ranging from nutrition and exercise to acupuncture, supplements, and behavioral therapy. Few oncologists discuss CAM with their patients while patients under-report their usage of these treatments to their oncologists. Our project aim was to assess clinician familiarity with integrative oncology and to improve education on the topic using a clinician-facing tool accessible through the electronic medical record (EMR). Methods: We distributed a survey from May through July 2023 to assess attitudes towards CAM and practice patterns at an academic oncology department. Respondents used a five-point Likert scale to rate their understanding of CAM, role in counseling patients on CAM, and factors affecting their discussion of such topics. We created EMR-accessible clinician guides which reviewed the evidence base for common complementary treatments in breast, colon, and lung cancer. Results: Fifteen of 64 (23%) affiliated oncologists completed the survey. Eleven (73%) respondents agreed or strongly agreed that it is their responsibility to learn about CAM. Fourteen (93%) respondents agreed or strongly agreed that it is their responsibility to ask patients about CAM usage, although two-thirds of respondents initiated conversations about CAM “sometimes” or less. Six (40%) felt comfortable providing resources on CAM to their patients. Respondents reported greatest awareness of the evidence for exercise and psychotherapy (average rating 3.8 out of 5; higher is more familiar) and least awareness for supplements (average 3.2). The factors most strongly affecting respondents’ practices of discussing CAM with patients were a lack of credible resources and fear that supplements might replace conventional cancer treatment. Ten (67%) respondents reported that patients undergoing active treatment often or always ask about CAM and nine (60%) reported that survivors often or always ask about CAM. Three practicing oncologists and two fellows had added our clinical guides to their EMR shortcuts six months after their introduction. Conclusions: Certain forms of CAM remain controversial within oncology practice. Although oncologists in our department reported a sense of responsibility to understand and counsel patients on CAM, multiple barriers impeded physician comfort with the topic and uptake of a novel educational resource was limited. Patients undergoing active treatment and survivors alike asked clinicians about CAM, which suggests it is an important area of competence for oncologists regardless of treatment phase.