Information and Communication About CAM Research and Decisionmaking About CAM Use

The ultimate impact of the National Center for Complementary and Alternative Medicine's (NCCAM) research efforts rests on communication. If the research is to lead to informed use of safe and effective complementary and alternative medicine (CAM) modalities—and rejection of interventions lacking safety or efficacy—it is important to ensure that consumers, health care providers, and health policymakers are aware of the results of NCCAM's investment in science. The public law establishing NCCAM recognized the importance of disseminating information on the safety and efficacy of CAM products and practices to NCCAM's multiple stakeholders. Over the years, various programs and activities have focused efforts on the general public, CAM and integrative medicine schools and organizations, conventional medical education and research organizations, the community of CAM practitioners, conventional health care providers, patient and health advocacy groups, the media, Congress, and a variety of international groups.

Since its creation as an independent Center in 1998, NCCAM has developed strategic plans (2000-2004; 2005-2009) to help guide the implementation of its complex legislative mandate, including its communications efforts. This third strategic planning process has the advantage of a decade of experience on which to base new approaches and strategies. This provides an opportunity to ensure optimal alignment of NCCAM's communications strategies with need and assess what we know about how the public makes decisions about CAM use, and how health care providers incorporate CAM modalities into their practices.

This paper provides a brief overview of what is known about consumer practice and health care provider knowledge about CAM research, and NCCAM's current communications activities. It also seeks comment regarding these findings and NCCAM's future communications strategies.

What Is Known About CAM Use and Health Care Provider Knowledge?

The Public. The most comprehensive picture of Americans' use of CAM comes from the 2002 and 2007 National Health Interview Surveys (NHIS).[1] Across both surveys CAM use remained generally constant, with approximately 38 percent of adults reporting use of some form of CAM. NHIS data also have provided insights into reasons for CAM use, which fall into two approximately equal categories: 1) treating a variety of health problems, particularly chronic pain and other difficult symptoms and 2) promoting general health and wellness.

Notably, the NHIS data suggest that most "out-of-pocket" spending by consumers on CAM is for "self-care" that is not specifically recommended or administered by a health care provider. For this reason, particularly careful consideration must be given to the availability to the general public of accurate and timely information concerning the safety and efficacy—or lack thereof—of CAM interventions and to the role of NCCAM and other Federal agencies in developing and disseminating such information. This is a particularly important matter for NCCAM, given the enormous quantity of information about CAM now available on the Internet, and the highly variable objectivity, scientific validity, and timeliness of that information.

Communication Between Providers and Patients/Clients. To ensure safe and integrated care, health care providers need to be aware of what CAM practices their patients are using. A 2006 NCCAM/AARP survey of individuals age 50 or older revealed that while more than two-thirds of respondents used some form of CAM, less than one-third of CAM users had talked to their physicians about their CAM use. The reasons given for not doing so were that respondents did not know they should speak to their physicians about their CAM use and that their physicians never asked. Many of the respondents also reported simultaneous use of multiple pharmaceuticals and dietary supplements, exposing a potential lack of integrated care.

Providers. A paper in the April 13, 2009, Archives of Internal Medicine[2] demonstrates the challenges involved in effective dissemination of the knowledge and application of CAM research in clinical practice. The study focused on awareness of two major NCCAM-funded clinical trials that studied acupuncture or glucosamine/chondroitin for treatment of osteoarthritis of the knee. In sum, approximately one in four clinicians was aware of the two trials. The 1,561 clinicians surveyed included acupuncturists, naturopaths, internists, and rheumatologists. A majority of respondents said they were "moderately confident" in their ability to interpret research literature; few said they were "very confident." Physicians were much more likely than CAM providers to consider research results very important or "very useful" in their clinical decisionmaking. CAM providers were more likely than physicians to say that patient preferences were very important. In addition, CAM providers were much more likely than physicians to rank research results as "least important," whereas physicians were much more likely to rate patient preferences as least important. Awareness of CAM clinical trials was greatest among respondents with research experience, confidence in their ability to interpret results, and favorable opinions about the role of research in their practice.

NCCAM's Communications Activities

NCCAM's communications channels and products are designed to inform the public, health professionals, researchers, the news media, and other stakeholders about the Center's research programs and their results and the general state of CAM research. They are intended to provide the best, most accurate, evidence-based information in formats accessible to a wide array of audiences. In carrying out its various communication activities, NCCAM coordinates and collaborates with institutes, centers, and offices across the National Institutes of Health (NIH), as well as other Federal and private-sector agencies. Notable examples include close working relationships with the National Library of Medicine (NLM), the NIH Office of Dietary Supplements, and the National Cancer Institute.

Key communications products include the following:

The NCCAM Clearinghouse is the public's point of contact for information about CAM and NCCAM's research activities. Services include a toll-free information line, publications, database searches, and referrals to other Federal resources. The Clearinghouse disseminates CAM information that is science-based. It does not provide medical referrals, advice, or recommendations for specific CAM practices. In addition, NCCAM's public liaison function supports and facilitates outreach to and cooperative efforts with professional organizations, advocacy groups, and the public through exhibits, stakeholder meetings, and media outreach.

Challenges

Several unique challenges facing NCCAM's communication efforts include the enormous quantity and highly variable quality of information about CAM that is readily available in the public domain, the diversity of the practitioner stakeholder community, and the myriad and often conflicting points of view about CAM or the state of evidence regarding CAM interventions.

INVITATION: PUBLIC COMMENT

NCCAM invites comment from its stakeholder community and other interested parties on the points raised in this brief summary document. Of particular interest are comments on:


[1] http://nccam.nih.gov/news/camstats

[2] Tilbert JC, Curlin FA, Kaptchuk TJ, et al. Alternative medicine research in clinical practice: a U.S. national survey. Archives of Internal Medicine. 2009;169(7):670–677.