Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3663
Peer-review started: September 10, 2014
First decision: November 14, 2014
Revised: December 24, 2014
Accepted: January 21, 2015
Article in press: January 21, 2015
Published online: March 28, 2015
AIM: To examine the frequency of regular complementary and alternative therapy (CAM) use in three Australian cohorts of contrasting care setting and geography, and identify independent attitudinal and psychological predictors of CAM use across all cohorts.
METHODS: A cross sectional questionnaire was administered to inflammatory bowel disease (IBD) patients in 3 separate cohorts which differed by geographical region and care setting. Demographics and frequency of regular CAM use were assessed, along with attitudes towards IBD medication and psychological parameters such as anxiety, depression, personality traits and quality of life (QOL), and compared across cohorts. Independent attitudinal and psychological predictors of CAM use were determined using binary logistic regression analysis.
RESULTS: In 473 respondents (mean age 50.3 years, 60.2% female) regular CAM use was reported by 45.4%, and did not vary between cohorts. Only 54.1% of users disclosed CAM use to their doctor. Independent predictors of CAM use which confirm those reported previously were: covert conventional medication dose reduction (P < 0.001), seeking psychological treatment (P < 0.001), adverse effects of conventional medication (P = 0.043), and higher QOL (P < 0.001). Newly identified predictors were CAM use by family or friends (P < 0.001), dissatisfaction with patient-doctor communication (P < 0.001), and lower depression scores (P < 0.001).
CONCLUSION: In addition to previously identified predictors of CAM use, these data show that physician attention to communication and the patient-doctor relationship is important as these factors influence CAM use. Patient reluctance to discuss CAM with physicians may promote greater reliance on social contacts to influence CAM decisions.
Core tip: Complementary medicine use is widespread in inflammatory bowel disease, and potentially deleterious to treatment outcomes. Whilst demographic and clinical predictors of complementary and alternative therapy (CAM) are well established, attitudinal influences are under explored. This study demonstrates that the specific aspect of patient doctor relationship most influencing CAM use is quality of doctor communication. The other newly identified predictor of CAM use is its use by family and friends. This finding enables valuable insight suggesting that in the absence of good doctor communication, inflammatory bowel disease patients seek advice from unqualified sources such as family and friends.