Disclosure of complementary medicine use to medical providers: a systematic review and meta-analysis

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

doi:10.1038/s41598-018-38279-8

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.

Highlights

Health care seeking invariably involves choices regarding the use of what can often be many competing health care services, treatments and providers from both within and beyond the public health care system
A previous review of the literature pertaining to complementary medicine (CM) use disclosure to medical providers published in 2004 identified twelve papers published between 1997–2002 reporting a CM disclosure rate of 23–90% alongside key factors - patient concern about possible negative response from their medical provider, patient perception that
The rate of disclosure regarding CM use to medical providers remains low and it appears that disclosure is still a major challenge facing health care providers

Summary

Introduction

Health care seeking invariably involves choices regarding the use of what can often be many competing health care services, treatments and providers from both within and beyond the public health care system. Serious adverse effects and harm from CM appear relatively rare but substantial associated direct and indirect risks remain[10,11], regarding ingestive biologically-based CM (such as herbal medicines or supplements)[12,13,14], which may be obtained from unreliable sources, self-prescribed or consumed without professional supervision[11,15]. Exacerbating such risks is an absence of both awareness of concurrent CM and conventional medicine use, and of procedures ensuring appropriate oversight of concurrent use[11]. Disclosure has been increasingly identified as a central challenge facing patient management amidst concurrent use over the last 13 years[21,22] but no systematic review or meta-analysis has been conducted on this topic over this recent period

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