Missed Opportunities: A Mixed-Methods Analysis of CAM Discussions and Practices in the Management of Pain in Oncology.

CONTEXT: Treatment of pain in cancer is a clinical priority. Many cancer patients seek and use complementary and alternative medicine (CAM) therapies.

OBJECTIVES: The aim of this study was to describe the role CAM plays in oncology, clinicians' approaches to pain management and its alignment with patient preference and self-care.

METHODS: We used quantitative criteria to identify patients with high, self-reported pain and reduced quality of life. For these patients, we merged quantitative and qualitative data from encounter audio recordings, patient surveys, and the medical record.

RESULTS: We identified 32 patients (72% women, average age 60) experiencing significantly symptomatic pain at enrollment. Merged themes were 1) Restricted and defined roles: Oncology clinicians suggested and documented cancer-specific approaches to pain management. Patients often (17, 53%) used CAM but rarely desired to discuss it in their encounters. 2) Proactive patients in setting of neutrality: Pain management strategies were considered in 22 instances. CAM was mentioned in 4 (18%) of these discussions but only after patient initiation. Clinicians took a neutral stance. 3) Missed opportunities for person-centered CAM discussions and management: Most (88%) patients were receiving conventional pain medications at enrollment or had them added or escalated during follow-up. Some patients in pain expressed preferences for avoiding opioids. One patient reported wishing CAM would have been discussed after an encounter in which it was not.

CONCLUSION: Bringing CAM discussions into the oncology encounter may facilitate a stronger patient-clinician partnership and a more open and safe understanding of pain-related CAM use.