Unadjusted associations between patient, clinician, visit, conversation characteristics, and practice context with CAM discussion among 529 patients and 61 clinicians at three academic oncology practice contexts in southern California and the upper Midwest
| Characteristicsa . | CAM discussed (n = 62), n (%) . | CAM not discussed (n = 467), n (%) . | p valueb . |
|---|---|---|---|
| Clinician type | .13 | ||
| MD consultant | 33 (53.2) | 219 (46.9) | |
| MD fellow | 11 (17.7) | 159 (34.1) | |
| NP | 18 (29.0) | 89 (19.1) | |
| Clinician sex, female | 30 (48.4) | 188 (40.3) | .42 |
| Clinician age >40 years | 27 (43.6) | 291 (62.3) | .035 |
| Clinician race/ethnicity | .93 | ||
| Non‐Hispanic white | 40 (64.5) | 311 (66.6) | |
| Non‐Hispanic black | 1 (1.6) | 8 (1.7) | |
| Non‐Hispanic Asian | 13 (21.0) | 106 (22.7) | |
| Non‐Hispanic other | 2 (3.2) | 14 (3.0) | |
| Hispanic | 6 (9.7) | 28 (6.0) | |
| Clinician practice years | |||
| Median (interquartile range) | 15.8 (11.0) | 13.1 (10.0) | .21 |
| 11 (7–28) | 10 (5–18) | ||
| Training in communication | 12 (19.4) | 126 (27.0) | .46 |
| Patient sex, female | 44 (71.0) | 264 (56.5) | .06 |
| Patient age | 57.4 (12.0) | 59.2 (13.5) | .36 |
| Patient health literacyc | .04 | ||
| Inadequate health literacy | 8 (13.8) | 139 (30.2) | |
| Adequate health literacy | 50 (86.2) | 321 (69.8) | |
| Country of originc | .19 | ||
| United States | 50 (84.8) | 337 (72.6) | |
| Mexico | 4 (6.8) | 64 (13.8) | |
| Other country | 5 (8.5) | 63 (13.6) | |
| Patient race/ethnicityc | .07 | ||
| Non‐Hispanic white | 49 (83.1) | 316 (68.3) | |
| Non‐Hispanic black | 1 (1.7) | 8 (1.7) | |
| Non‐Hispanic Asian | 1 (1.7) | 20 (4.3) | |
| Non‐Hispanic other | 1 (1.7) | 7 (1.5) | |
| Hispanic | 7 (11.9) | 112 (24.2) | |
| Clinician and patient have same race | 34 (54.8) | 274 (58.7) | .78 |
| Patient cancer care continuumc | .37 | ||
| Initial diagnosis | 4 (6.5) | 26 (5.6) | |
| Early initial treatment | 7 (11.3) | 36 (7.8) | |
| Mid initial treatment | 17 (27.4) | 95 (20.5) | |
| Post‐treatment/survivorship/remission | 21 (33.9) | 161 (34.7) | |
| Recurrence, undergoing treatment | 10 (16.1) | 127 (27.4) | |
| End‐stage disease | 3 (4.8) | 19 (4.1) | |
| Patient tumor location | .12 | ||
| Patient tumor location: breast | 28 (45.2) | 125 (26.8) | |
| Gastrointestinal | 18 (29.0) | 180 (38.5) | |
| Other | 16 (25.8) | 162 (34.7) | |
| Patient satisfaction | |||
| Patient satisfaction: strongly agree | 57 (93.4) | 418 (90.5) | .61 |
| Visit length, minutes | |||
| Mean (SD) | 28.6 (18.3) | 22.5 (14.4) | .002 |
| Median (interquartile range) | 24.9 (14.6–36.2) | 19.2 (12.2–29) | |
| Psychosocial statements – cliniciand | |||
| Mean (SD) | 13.9 (15.8) | 6.6 (12.2) | .0003 |
| Median (interquartile range) | 9.5 (2–19) | 2.0 (0–8) | |
| Medical statements – cliniciand | |||
| Mean (SD) | 115.5 (90.7) | 104.2 (96.0) | .32 |
| Median (interquartile range) | 92.5 (50–167) | 72.5 (39–135) | |
| Psychosocial statements – patientd | |||
| Mean (SD) | 41.5 (46.7) | 20.8 (28.3) | .0001 |
| Median (interquartile range) | 28.0 (15–57) | 12.0 (5–26) | |
| Medical statements – patientd | |||
| Mean (SD) | 83.5 (57.3) | 63.4 (55.2) | .76 |
| Median (interquartile range) | 69.5 (43–103) | 52.0 (27–85) | |
| Patient‐centerednessd | 0.8 (0.4) | 0.6 (0.3) | .0003 |
| Global affect | |||
| Clinician positivee: interest, warmth, engagement, sympathetic, respectfulness, interactivity | 4.6 (0.7) | 4.3 (0.6) | .008 |
| Patient positivee: warmth, sympathetic, respectful | 4.1 (0.7) | 3.8 (0.6) | .006 |
| Patient engagemente: dominant, interactivity engagement | 4.2 (0.8) | 3.8 (0.7) | .0004 |
| Patient negativee: distressed, depression | 1.2 (0.5) | 1.2 (0.5) | .81 |
| Study site | .03 | ||
| Upper Midwest | 36 (11.0) | 291 (89.0) | |
| SoCal university | 17 (22.7) | 58 (77.3) | |
| SoCal county | 9 (7.1) | 118 (92.9) |
| Characteristicsa . | CAM discussed (n = 62), n (%) . | CAM not discussed (n = 467), n (%) . | p valueb . |
|---|---|---|---|
| Clinician type | .13 | ||
| MD consultant | 33 (53.2) | 219 (46.9) | |
| MD fellow | 11 (17.7) | 159 (34.1) | |
| NP | 18 (29.0) | 89 (19.1) | |
| Clinician sex, female | 30 (48.4) | 188 (40.3) | .42 |
| Clinician age >40 years | 27 (43.6) | 291 (62.3) | .035 |
| Clinician race/ethnicity | .93 | ||
| Non‐Hispanic white | 40 (64.5) | 311 (66.6) | |
| Non‐Hispanic black | 1 (1.6) | 8 (1.7) | |
| Non‐Hispanic Asian | 13 (21.0) | 106 (22.7) | |
| Non‐Hispanic other | 2 (3.2) | 14 (3.0) | |
| Hispanic | 6 (9.7) | 28 (6.0) | |
| Clinician practice years | |||
| Median (interquartile range) | 15.8 (11.0) | 13.1 (10.0) | .21 |
| 11 (7–28) | 10 (5–18) | ||
| Training in communication | 12 (19.4) | 126 (27.0) | .46 |
| Patient sex, female | 44 (71.0) | 264 (56.5) | .06 |
| Patient age | 57.4 (12.0) | 59.2 (13.5) | .36 |
| Patient health literacyc | .04 | ||
| Inadequate health literacy | 8 (13.8) | 139 (30.2) | |
| Adequate health literacy | 50 (86.2) | 321 (69.8) | |
| Country of originc | .19 | ||
| United States | 50 (84.8) | 337 (72.6) | |
| Mexico | 4 (6.8) | 64 (13.8) | |
| Other country | 5 (8.5) | 63 (13.6) | |
| Patient race/ethnicityc | .07 | ||
| Non‐Hispanic white | 49 (83.1) | 316 (68.3) | |
| Non‐Hispanic black | 1 (1.7) | 8 (1.7) | |
| Non‐Hispanic Asian | 1 (1.7) | 20 (4.3) | |
| Non‐Hispanic other | 1 (1.7) | 7 (1.5) | |
| Hispanic | 7 (11.9) | 112 (24.2) | |
| Clinician and patient have same race | 34 (54.8) | 274 (58.7) | .78 |
| Patient cancer care continuumc | .37 | ||
| Initial diagnosis | 4 (6.5) | 26 (5.6) | |
| Early initial treatment | 7 (11.3) | 36 (7.8) | |
| Mid initial treatment | 17 (27.4) | 95 (20.5) | |
| Post‐treatment/survivorship/remission | 21 (33.9) | 161 (34.7) | |
| Recurrence, undergoing treatment | 10 (16.1) | 127 (27.4) | |
| End‐stage disease | 3 (4.8) | 19 (4.1) | |
| Patient tumor location | .12 | ||
| Patient tumor location: breast | 28 (45.2) | 125 (26.8) | |
| Gastrointestinal | 18 (29.0) | 180 (38.5) | |
| Other | 16 (25.8) | 162 (34.7) | |
| Patient satisfaction | |||
| Patient satisfaction: strongly agree | 57 (93.4) | 418 (90.5) | .61 |
| Visit length, minutes | |||
| Mean (SD) | 28.6 (18.3) | 22.5 (14.4) | .002 |
| Median (interquartile range) | 24.9 (14.6–36.2) | 19.2 (12.2–29) | |
| Psychosocial statements – cliniciand | |||
| Mean (SD) | 13.9 (15.8) | 6.6 (12.2) | .0003 |
| Median (interquartile range) | 9.5 (2–19) | 2.0 (0–8) | |
| Medical statements – cliniciand | |||
| Mean (SD) | 115.5 (90.7) | 104.2 (96.0) | .32 |
| Median (interquartile range) | 92.5 (50–167) | 72.5 (39–135) | |
| Psychosocial statements – patientd | |||
| Mean (SD) | 41.5 (46.7) | 20.8 (28.3) | .0001 |
| Median (interquartile range) | 28.0 (15–57) | 12.0 (5–26) | |
| Medical statements – patientd | |||
| Mean (SD) | 83.5 (57.3) | 63.4 (55.2) | .76 |
| Median (interquartile range) | 69.5 (43–103) | 52.0 (27–85) | |
| Patient‐centerednessd | 0.8 (0.4) | 0.6 (0.3) | .0003 |
| Global affect | |||
| Clinician positivee: interest, warmth, engagement, sympathetic, respectfulness, interactivity | 4.6 (0.7) | 4.3 (0.6) | .008 |
| Patient positivee: warmth, sympathetic, respectful | 4.1 (0.7) | 3.8 (0.6) | .006 |
| Patient engagemente: dominant, interactivity engagement | 4.2 (0.8) | 3.8 (0.7) | .0004 |
| Patient negativee: distressed, depression | 1.2 (0.5) | 1.2 (0.5) | .81 |
| Study site | .03 | ||
| Upper Midwest | 36 (11.0) | 291 (89.0) | |
| SoCal university | 17 (22.7) | 58 (77.3) | |
| SoCal county | 9 (7.1) | 118 (92.9) |
aContinuous values represented by mean (SD); median and interquartile range shown as well if appropriate.
bLogistic modeling performed with a random effect of clinician.
cMissing values not included in calculation of percentage.
dMissing values where CAM was not discussed (n = 5).
eEncounters where CAM was not discussed are missing values (doctor positive, n = 5; patient positive, n = 8; engagement, n = 9; negative, n = 8).
Abbreviations: CAM, complementary and alternative medicine; SoCal, southern California.
Unadjusted associations between patient, clinician, visit, conversation characteristics, and practice context with CAM discussion among 529 patients and 61 clinicians at three academic oncology practice contexts in southern California and the upper Midwest
| Characteristicsa . | CAM discussed (n = 62), n (%) . | CAM not discussed (n = 467), n (%) . | p valueb . |
|---|---|---|---|
| Clinician type | .13 | ||
| MD consultant | 33 (53.2) | 219 (46.9) | |
| MD fellow | 11 (17.7) | 159 (34.1) | |
| NP | 18 (29.0) | 89 (19.1) | |
| Clinician sex, female | 30 (48.4) | 188 (40.3) | .42 |
| Clinician age >40 years | 27 (43.6) | 291 (62.3) | .035 |
| Clinician race/ethnicity | .93 | ||
| Non‐Hispanic white | 40 (64.5) | 311 (66.6) | |
| Non‐Hispanic black | 1 (1.6) | 8 (1.7) | |
| Non‐Hispanic Asian | 13 (21.0) | 106 (22.7) | |
| Non‐Hispanic other | 2 (3.2) | 14 (3.0) | |
| Hispanic | 6 (9.7) | 28 (6.0) | |
| Clinician practice years | |||
| Median (interquartile range) | 15.8 (11.0) | 13.1 (10.0) | .21 |
| 11 (7–28) | 10 (5–18) | ||
| Training in communication | 12 (19.4) | 126 (27.0) | .46 |
| Patient sex, female | 44 (71.0) | 264 (56.5) | .06 |
| Patient age | 57.4 (12.0) | 59.2 (13.5) | .36 |
| Patient health literacyc | .04 | ||
| Inadequate health literacy | 8 (13.8) | 139 (30.2) | |
| Adequate health literacy | 50 (86.2) | 321 (69.8) | |
| Country of originc | .19 | ||
| United States | 50 (84.8) | 337 (72.6) | |
| Mexico | 4 (6.8) | 64 (13.8) | |
| Other country | 5 (8.5) | 63 (13.6) | |
| Patient race/ethnicityc | .07 | ||
| Non‐Hispanic white | 49 (83.1) | 316 (68.3) | |
| Non‐Hispanic black | 1 (1.7) | 8 (1.7) | |
| Non‐Hispanic Asian | 1 (1.7) | 20 (4.3) | |
| Non‐Hispanic other | 1 (1.7) | 7 (1.5) | |
| Hispanic | 7 (11.9) | 112 (24.2) | |
| Clinician and patient have same race | 34 (54.8) | 274 (58.7) | .78 |
| Patient cancer care continuumc | .37 | ||
| Initial diagnosis | 4 (6.5) | 26 (5.6) | |
| Early initial treatment | 7 (11.3) | 36 (7.8) | |
| Mid initial treatment | 17 (27.4) | 95 (20.5) | |
| Post‐treatment/survivorship/remission | 21 (33.9) | 161 (34.7) | |
| Recurrence, undergoing treatment | 10 (16.1) | 127 (27.4) | |
| End‐stage disease | 3 (4.8) | 19 (4.1) | |
| Patient tumor location | .12 | ||
| Patient tumor location: breast | 28 (45.2) | 125 (26.8) | |
| Gastrointestinal | 18 (29.0) | 180 (38.5) | |
| Other | 16 (25.8) | 162 (34.7) | |
| Patient satisfaction | |||
| Patient satisfaction: strongly agree | 57 (93.4) | 418 (90.5) | .61 |
| Visit length, minutes | |||
| Mean (SD) | 28.6 (18.3) | 22.5 (14.4) | .002 |
| Median (interquartile range) | 24.9 (14.6–36.2) | 19.2 (12.2–29) | |
| Psychosocial statements – cliniciand | |||
| Mean (SD) | 13.9 (15.8) | 6.6 (12.2) | .0003 |
| Median (interquartile range) | 9.5 (2–19) | 2.0 (0–8) | |
| Medical statements – cliniciand | |||
| Mean (SD) | 115.5 (90.7) | 104.2 (96.0) | .32 |
| Median (interquartile range) | 92.5 (50–167) | 72.5 (39–135) | |
| Psychosocial statements – patientd | |||
| Mean (SD) | 41.5 (46.7) | 20.8 (28.3) | .0001 |
| Median (interquartile range) | 28.0 (15–57) | 12.0 (5–26) | |
| Medical statements – patientd | |||
| Mean (SD) | 83.5 (57.3) | 63.4 (55.2) | .76 |
| Median (interquartile range) | 69.5 (43–103) | 52.0 (27–85) | |
| Patient‐centerednessd | 0.8 (0.4) | 0.6 (0.3) | .0003 |
| Global affect | |||
| Clinician positivee: interest, warmth, engagement, sympathetic, respectfulness, interactivity | 4.6 (0.7) | 4.3 (0.6) | .008 |
| Patient positivee: warmth, sympathetic, respectful | 4.1 (0.7) | 3.8 (0.6) | .006 |
| Patient engagemente: dominant, interactivity engagement | 4.2 (0.8) | 3.8 (0.7) | .0004 |
| Patient negativee: distressed, depression | 1.2 (0.5) | 1.2 (0.5) | .81 |
| Study site | .03 | ||
| Upper Midwest | 36 (11.0) | 291 (89.0) | |
| SoCal university | 17 (22.7) | 58 (77.3) | |
| SoCal county | 9 (7.1) | 118 (92.9) |
| Characteristicsa . | CAM discussed (n = 62), n (%) . | CAM not discussed (n = 467), n (%) . | p valueb . |
|---|---|---|---|
| Clinician type | .13 | ||
| MD consultant | 33 (53.2) | 219 (46.9) | |
| MD fellow | 11 (17.7) | 159 (34.1) | |
| NP | 18 (29.0) | 89 (19.1) | |
| Clinician sex, female | 30 (48.4) | 188 (40.3) | .42 |
| Clinician age >40 years | 27 (43.6) | 291 (62.3) | .035 |
| Clinician race/ethnicity | .93 | ||
| Non‐Hispanic white | 40 (64.5) | 311 (66.6) | |
| Non‐Hispanic black | 1 (1.6) | 8 (1.7) | |
| Non‐Hispanic Asian | 13 (21.0) | 106 (22.7) | |
| Non‐Hispanic other | 2 (3.2) | 14 (3.0) | |
| Hispanic | 6 (9.7) | 28 (6.0) | |
| Clinician practice years | |||
| Median (interquartile range) | 15.8 (11.0) | 13.1 (10.0) | .21 |
| 11 (7–28) | 10 (5–18) | ||
| Training in communication | 12 (19.4) | 126 (27.0) | .46 |
| Patient sex, female | 44 (71.0) | 264 (56.5) | .06 |
| Patient age | 57.4 (12.0) | 59.2 (13.5) | .36 |
| Patient health literacyc | .04 | ||
| Inadequate health literacy | 8 (13.8) | 139 (30.2) | |
| Adequate health literacy | 50 (86.2) | 321 (69.8) | |
| Country of originc | .19 | ||
| United States | 50 (84.8) | 337 (72.6) | |
| Mexico | 4 (6.8) | 64 (13.8) | |
| Other country | 5 (8.5) | 63 (13.6) | |
| Patient race/ethnicityc | .07 | ||
| Non‐Hispanic white | 49 (83.1) | 316 (68.3) | |
| Non‐Hispanic black | 1 (1.7) | 8 (1.7) | |
| Non‐Hispanic Asian | 1 (1.7) | 20 (4.3) | |
| Non‐Hispanic other | 1 (1.7) | 7 (1.5) | |
| Hispanic | 7 (11.9) | 112 (24.2) | |
| Clinician and patient have same race | 34 (54.8) | 274 (58.7) | .78 |
| Patient cancer care continuumc | .37 | ||
| Initial diagnosis | 4 (6.5) | 26 (5.6) | |
| Early initial treatment | 7 (11.3) | 36 (7.8) | |
| Mid initial treatment | 17 (27.4) | 95 (20.5) | |
| Post‐treatment/survivorship/remission | 21 (33.9) | 161 (34.7) | |
| Recurrence, undergoing treatment | 10 (16.1) | 127 (27.4) | |
| End‐stage disease | 3 (4.8) | 19 (4.1) | |
| Patient tumor location | .12 | ||
| Patient tumor location: breast | 28 (45.2) | 125 (26.8) | |
| Gastrointestinal | 18 (29.0) | 180 (38.5) | |
| Other | 16 (25.8) | 162 (34.7) | |
| Patient satisfaction | |||
| Patient satisfaction: strongly agree | 57 (93.4) | 418 (90.5) | .61 |
| Visit length, minutes | |||
| Mean (SD) | 28.6 (18.3) | 22.5 (14.4) | .002 |
| Median (interquartile range) | 24.9 (14.6–36.2) | 19.2 (12.2–29) | |
| Psychosocial statements – cliniciand | |||
| Mean (SD) | 13.9 (15.8) | 6.6 (12.2) | .0003 |
| Median (interquartile range) | 9.5 (2–19) | 2.0 (0–8) | |
| Medical statements – cliniciand | |||
| Mean (SD) | 115.5 (90.7) | 104.2 (96.0) | .32 |
| Median (interquartile range) | 92.5 (50–167) | 72.5 (39–135) | |
| Psychosocial statements – patientd | |||
| Mean (SD) | 41.5 (46.7) | 20.8 (28.3) | .0001 |
| Median (interquartile range) | 28.0 (15–57) | 12.0 (5–26) | |
| Medical statements – patientd | |||
| Mean (SD) | 83.5 (57.3) | 63.4 (55.2) | .76 |
| Median (interquartile range) | 69.5 (43–103) | 52.0 (27–85) | |
| Patient‐centerednessd | 0.8 (0.4) | 0.6 (0.3) | .0003 |
| Global affect | |||
| Clinician positivee: interest, warmth, engagement, sympathetic, respectfulness, interactivity | 4.6 (0.7) | 4.3 (0.6) | .008 |
| Patient positivee: warmth, sympathetic, respectful | 4.1 (0.7) | 3.8 (0.6) | .006 |
| Patient engagemente: dominant, interactivity engagement | 4.2 (0.8) | 3.8 (0.7) | .0004 |
| Patient negativee: distressed, depression | 1.2 (0.5) | 1.2 (0.5) | .81 |
| Study site | .03 | ||
| Upper Midwest | 36 (11.0) | 291 (89.0) | |
| SoCal university | 17 (22.7) | 58 (77.3) | |
| SoCal county | 9 (7.1) | 118 (92.9) |
aContinuous values represented by mean (SD); median and interquartile range shown as well if appropriate.
bLogistic modeling performed with a random effect of clinician.
cMissing values not included in calculation of percentage.
dMissing values where CAM was not discussed (n = 5).
eEncounters where CAM was not discussed are missing values (doctor positive, n = 5; patient positive, n = 8; engagement, n = 9; negative, n = 8).
Abbreviations: CAM, complementary and alternative medicine; SoCal, southern California.
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