Absent and Discordant Electronic Health Record Documentation of Complementary and Alternative Medicine in Cancer Care

Daniela L. Stan, Dietlind L. Wahner-Roedler, Kathleen J Yost, Thomas Jamie O'Byrne, Megan E. Branda, Aaron L. Leppin, Jon C Tilburt

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives: Many patients with cancer use complementary and alternative medicine (CAM), but the quality of CAM documentation in their electronic health records (EHRs) is unknown. The authors aimed to describe (i) the prevalence and types of CAM used after cancer diagnosis and the influence of oncologists on CAM use, as per patients' self-report, and (ii) the prevalence of CAM documentation in the EHR and its consistency with self-reported usage. Design: Patient and provider surveys and chart review. Settings/Location: Medical oncology practices at one institution. Subjects: Patients with cancer at oncologist visits. Outcome measures: Patient self-reported rate of 3-month postvisit CAM use; provider EHR documentation of CAM use or discussion and its concordance with patient self-report. Results: Among 327 patients enrolled, 248 responded to the 3-month postvisit survey. Of these, 158 reported CAM use after diagnosis (63.7%). CAM users were younger (p < 0.001) and had a higher percentage of women (p = 0.03) than nonusers. Modalities most commonly used were supplements (62.6%), special diets (38.6%), chiropractor (28.4%), and massage (28.4%). CAM was used to improve well-being (68.7%), manage adverse effects (35.5%), and fight cancer (22.9%). Oncologists suggested CAM in 22.5% of instances of use. CAM use/discussion was documented for 58.2% of self-reported CAM users. Of the documented modalities, EHR and self-report were concordant for only 8.2%. CAM documentation was associated with physician provider (p = 0.03), older patients (p = 0.01), and treatment with radiation (p = 0.03) or surgery (p = 0.001). After adjusting for other factors, patients with breast cancer or "other" tumor category were four times more likely than patients with gastrointestinal cancer to have CAM use documentation (odds ratio [95% confidence interval]: 4.41 [1.48-13.10]; 3.76 [1.42-9.99], respectively). Conclusions: Most patients with cancer use CAM after diagnosis, yet EHR documentation is complete for very few. Oncologists should inquire about, document, and discuss CAM benefits and harm or refer patients to CAM specialists.

Original languageEnglish (US)
Pages (from-to)988-995
Number of pages8
JournalJournal of Alternative and Complementary Medicine
Volume24
Issue number9-10
DOIs
StatePublished - Sep 1 2018

Fingerprint

Electronic Health Records
Complementary Therapies
Documentation
Neoplasms
Self Report

Keywords

  • CAM
  • complementary and alternative medicine
  • EHR, oncology

ASJC Scopus subject areas

  • Complementary and alternative medicine

Cite this

Absent and Discordant Electronic Health Record Documentation of Complementary and Alternative Medicine in Cancer Care. / Stan, Daniela L.; Wahner-Roedler, Dietlind L.; Yost, Kathleen J; O'Byrne, Thomas Jamie; Branda, Megan E.; Leppin, Aaron L.; Tilburt, Jon C.

In: Journal of Alternative and Complementary Medicine, Vol. 24, No. 9-10, 01.09.2018, p. 988-995.

Research output: Contribution to journalArticle

Stan, Daniela L. ; Wahner-Roedler, Dietlind L. ; Yost, Kathleen J ; O'Byrne, Thomas Jamie ; Branda, Megan E. ; Leppin, Aaron L. ; Tilburt, Jon C. / Absent and Discordant Electronic Health Record Documentation of Complementary and Alternative Medicine in Cancer Care. In: Journal of Alternative and Complementary Medicine. 2018 ; Vol. 24, No. 9-10. pp. 988-995.
@article{42a5da58aa5e4beaa2b562ec757367ed,
title = "Absent and Discordant Electronic Health Record Documentation of Complementary and Alternative Medicine in Cancer Care",
abstract = "Objectives: Many patients with cancer use complementary and alternative medicine (CAM), but the quality of CAM documentation in their electronic health records (EHRs) is unknown. The authors aimed to describe (i) the prevalence and types of CAM used after cancer diagnosis and the influence of oncologists on CAM use, as per patients' self-report, and (ii) the prevalence of CAM documentation in the EHR and its consistency with self-reported usage. Design: Patient and provider surveys and chart review. Settings/Location: Medical oncology practices at one institution. Subjects: Patients with cancer at oncologist visits. Outcome measures: Patient self-reported rate of 3-month postvisit CAM use; provider EHR documentation of CAM use or discussion and its concordance with patient self-report. Results: Among 327 patients enrolled, 248 responded to the 3-month postvisit survey. Of these, 158 reported CAM use after diagnosis (63.7{\%}). CAM users were younger (p < 0.001) and had a higher percentage of women (p = 0.03) than nonusers. Modalities most commonly used were supplements (62.6{\%}), special diets (38.6{\%}), chiropractor (28.4{\%}), and massage (28.4{\%}). CAM was used to improve well-being (68.7{\%}), manage adverse effects (35.5{\%}), and fight cancer (22.9{\%}). Oncologists suggested CAM in 22.5{\%} of instances of use. CAM use/discussion was documented for 58.2{\%} of self-reported CAM users. Of the documented modalities, EHR and self-report were concordant for only 8.2{\%}. CAM documentation was associated with physician provider (p = 0.03), older patients (p = 0.01), and treatment with radiation (p = 0.03) or surgery (p = 0.001). After adjusting for other factors, patients with breast cancer or {"}other{"} tumor category were four times more likely than patients with gastrointestinal cancer to have CAM use documentation (odds ratio [95{\%} confidence interval]: 4.41 [1.48-13.10]; 3.76 [1.42-9.99], respectively). Conclusions: Most patients with cancer use CAM after diagnosis, yet EHR documentation is complete for very few. Oncologists should inquire about, document, and discuss CAM benefits and harm or refer patients to CAM specialists.",
keywords = "CAM, complementary and alternative medicine, EHR, oncology",
author = "Stan, {Daniela L.} and Wahner-Roedler, {Dietlind L.} and Yost, {Kathleen J} and O'Byrne, {Thomas Jamie} and Branda, {Megan E.} and Leppin, {Aaron L.} and Tilburt, {Jon C}",
year = "2018",
month = "9",
day = "1",
doi = "10.1089/acm.2018.0141",
language = "English (US)",
volume = "24",
pages = "988--995",
journal = "Journal of Alternative and Complementary Medicine",
issn = "1075-5535",
publisher = "Mary Ann Liebert Inc.",
number = "9-10",

}

TY - JOUR

T1 - Absent and Discordant Electronic Health Record Documentation of Complementary and Alternative Medicine in Cancer Care

AU - Stan, Daniela L.

AU - Wahner-Roedler, Dietlind L.

AU - Yost, Kathleen J

AU - O'Byrne, Thomas Jamie

AU - Branda, Megan E.

AU - Leppin, Aaron L.

AU - Tilburt, Jon C

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Objectives: Many patients with cancer use complementary and alternative medicine (CAM), but the quality of CAM documentation in their electronic health records (EHRs) is unknown. The authors aimed to describe (i) the prevalence and types of CAM used after cancer diagnosis and the influence of oncologists on CAM use, as per patients' self-report, and (ii) the prevalence of CAM documentation in the EHR and its consistency with self-reported usage. Design: Patient and provider surveys and chart review. Settings/Location: Medical oncology practices at one institution. Subjects: Patients with cancer at oncologist visits. Outcome measures: Patient self-reported rate of 3-month postvisit CAM use; provider EHR documentation of CAM use or discussion and its concordance with patient self-report. Results: Among 327 patients enrolled, 248 responded to the 3-month postvisit survey. Of these, 158 reported CAM use after diagnosis (63.7%). CAM users were younger (p < 0.001) and had a higher percentage of women (p = 0.03) than nonusers. Modalities most commonly used were supplements (62.6%), special diets (38.6%), chiropractor (28.4%), and massage (28.4%). CAM was used to improve well-being (68.7%), manage adverse effects (35.5%), and fight cancer (22.9%). Oncologists suggested CAM in 22.5% of instances of use. CAM use/discussion was documented for 58.2% of self-reported CAM users. Of the documented modalities, EHR and self-report were concordant for only 8.2%. CAM documentation was associated with physician provider (p = 0.03), older patients (p = 0.01), and treatment with radiation (p = 0.03) or surgery (p = 0.001). After adjusting for other factors, patients with breast cancer or "other" tumor category were four times more likely than patients with gastrointestinal cancer to have CAM use documentation (odds ratio [95% confidence interval]: 4.41 [1.48-13.10]; 3.76 [1.42-9.99], respectively). Conclusions: Most patients with cancer use CAM after diagnosis, yet EHR documentation is complete for very few. Oncologists should inquire about, document, and discuss CAM benefits and harm or refer patients to CAM specialists.

AB - Objectives: Many patients with cancer use complementary and alternative medicine (CAM), but the quality of CAM documentation in their electronic health records (EHRs) is unknown. The authors aimed to describe (i) the prevalence and types of CAM used after cancer diagnosis and the influence of oncologists on CAM use, as per patients' self-report, and (ii) the prevalence of CAM documentation in the EHR and its consistency with self-reported usage. Design: Patient and provider surveys and chart review. Settings/Location: Medical oncology practices at one institution. Subjects: Patients with cancer at oncologist visits. Outcome measures: Patient self-reported rate of 3-month postvisit CAM use; provider EHR documentation of CAM use or discussion and its concordance with patient self-report. Results: Among 327 patients enrolled, 248 responded to the 3-month postvisit survey. Of these, 158 reported CAM use after diagnosis (63.7%). CAM users were younger (p < 0.001) and had a higher percentage of women (p = 0.03) than nonusers. Modalities most commonly used were supplements (62.6%), special diets (38.6%), chiropractor (28.4%), and massage (28.4%). CAM was used to improve well-being (68.7%), manage adverse effects (35.5%), and fight cancer (22.9%). Oncologists suggested CAM in 22.5% of instances of use. CAM use/discussion was documented for 58.2% of self-reported CAM users. Of the documented modalities, EHR and self-report were concordant for only 8.2%. CAM documentation was associated with physician provider (p = 0.03), older patients (p = 0.01), and treatment with radiation (p = 0.03) or surgery (p = 0.001). After adjusting for other factors, patients with breast cancer or "other" tumor category were four times more likely than patients with gastrointestinal cancer to have CAM use documentation (odds ratio [95% confidence interval]: 4.41 [1.48-13.10]; 3.76 [1.42-9.99], respectively). Conclusions: Most patients with cancer use CAM after diagnosis, yet EHR documentation is complete for very few. Oncologists should inquire about, document, and discuss CAM benefits and harm or refer patients to CAM specialists.

KW - CAM

KW - complementary and alternative medicine

KW - EHR, oncology

UR - http://www.scopus.com/inward/record.url?scp=85054007942&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054007942&partnerID=8YFLogxK

U2 - 10.1089/acm.2018.0141

DO - 10.1089/acm.2018.0141

M3 - Article

C2 - 30247970

AN - SCOPUS:85054007942

VL - 24

SP - 988

EP - 995

JO - Journal of Alternative and Complementary Medicine

JF - Journal of Alternative and Complementary Medicine

SN - 1075-5535

IS - 9-10

ER -