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Knowledge, attitudes and practices of health professionals toward complementary and alternative medicine in cancer care – a systematic review

ABSTRACT Background: Cancer patients’ disclosure rate of their complementary and alternative medicine (CAM) use to health professionals is low, mainly attributed to health professionals’ attitude toward CAM. Thus, we aimed to identify and compare the knowledge, attitudes and practices of doctors, nurses and pharmacists regarding CAM use in cancer patients. Method: The databases AMED, CINAHL, Embase, Emcare, Medline, PubMed, Scopus and Web of Science were searched for surveys of health professionals published between 2008 and 2020. Results: The knowledge of CAM in cancer care was generally poor for all three professions in the included studies, although how knowledge was assessed showed large variability. Doctors were found to dismiss or discourage CAM use out of concerns for side-effects and interactions. Nurses were generally positive and supportive toward CAM use by cancer patients. Pharmacists were neutral toward CAM, but believed they should be a reliable source of information for patients. All professions felt a major barrier to discussions with patients about CAMs was a lack of evidence of their safety and efficacy. Studies of all three professions also showed a general desire for more education regarding CAM. Conclusions: The review suggests that doctors, nurses and pharmacists may lack appropriate knowledge to inform CAM use in a cancer care setting, which determines their attitude, influences practice and potentially impacts patient outcomes. Our findings indicate that increased access to research-based education on CAM would strengthen health practitioners’ confidence in discussing CAM with cancer patients, which would lead to more disclosure and safer therapeutic decision making.