Reasons Why Herbal Users Do or Do Not Tell Their Physicians about Their Use: A Survey of Adult Ohio Residents

Abstract

Over the past several years, there has been a considerable rise in the availability of herbal products and other natural supplements, which are subject to limited FDA regulation. 1 Over 500 herbs are marketed in the US as bulk plants or a portion of plants, as well as teas, powders, liquids, extracts, tablets, and capsules. In addition, multi-ingredient products are proliferating and are easily available in supermarkets, grocery stores, drugstores, health food stores, and through the Internet. 2 Mass media marketing efforts by herbal companies, including television features and large-scale advertisements have increased consumer access to information about the availability of these products. Thus, it is not surprising that many herbal products have made their way into patients' selfprescribed therapy, often resulting in harm to the patient.Researchers have extensively examined the trend of herbal use among the general population of the US. Reports on rates of herbal use range from 1.8% to 77%, depending upon the focus of the study (herbal use 3-9 vs complementary and alternative medicine use 10-14 ), recall time frame (past month, 12 months, or ever), and the population under study (health maintenance organization, 6 specific disease condition, 7 general population 8,10,12 ). The results of these studies indicate 2 important aspects of herbal use. First, many patients use herbal products in conjunction with prescription medication because they believe that herbal products are "natural" and safe. 3-5 Second, there is little communication between patients and healthcare professionals about patients' herbal product use. Studies suggest that over 70% of people using these agents Background: Several studies have reported lack of patient-physician communication regarding herbal use. However, reasons for this lack of communication are not well understood.Objective: To determine, explore, and identify reasons for lack of patient-physician communication about herbal use.Methods: Using a cross-sectional design, a systematic sample of 1,000 adult Ohio residents was surveyed through a 29 item questionnaire. Survey items were adapted from earlier instruments evaluating complementary and alternative use. Descriptive and univariate statistics were run using SPSS version 10.0.Results: Of 210 usable responses, almost half (47.6%) of the participants reported that they were either currently using herbal products or had used them in the past, with 1 in 16 using herbal products daily. Fortyeight percent of these respondents indicated that they had never had a discussion with their physician about using herbal medicines. A similar percentage (45%) of individuals using herbal agents had not told their physicians about any of the products they used. The top 3 reasons for informing physicians of herbal use were that the physician needs to be aware of all of the products used, the physician may know whether herbals work, and the physician understands the interactions of herbals with prescribed drugs. The main reason that patients did not ...

Disclosure of complementary medicine use to medical providers: a systematic review and meta-analysis

“…While the final selection of research spanned twenty countries, just under half of the studies (n = 40) were conducted in the United States (US) 31–35,37,40,41,43–54,56,57,60,76,79,80,87–91,94,100,101,105,107,108,112–114 . Settings were diverse with data collection occurring primarily in general practice or hospital clinics 34–38,41,43,55,58,61–64,66,68,69,74,76–79,81,82,86,87,92,97,98,101,103,106,107,109,111,112,114–116 , face-to-face in participants’ households 33,39,46–50,52–54,67,70,72,84,85,88–91,93,94,100,102,104 , or by telephone and/or mail 31,40,45,51,56,57,59,65,73,75,95,96,108,110 . Less common settings included CM clinics 34,42,68 , retail outlets 60,…”

“…Participants were predominantly adults with a small number of studies focussed on older adults 44,57,65,94,95,105,110,113,114 , children 45,58,63,68,73,97,103,106,115,116 , adolescents 41,97 , or all age groups 61,99,112 . More than half of the studies included users of various types of CM (n = 45) 31,35,36,38,41–43,50,51,54,57–59,61–63,65,66,68,72,73,75,76,80–82,85,88,89,96,97,102–113,115,116 , while others were limited to users of specific types of CM such as herbs and/or supplements 32–34,37,44–47,52,53,55,56,60,64,67,69–71,74,77–79,83,86,87,92–95,98–101,109,114 , yoga 48,91 , tai chi 49,90 , mind-body medicine 40 , practitioner-provided CM 39 , or local traditional medicine 84 .…”

“…Almost half of the selected studies (n = 40) used a convenience sampling method 32,34–37,41–44,55,58,60–64,66,68,69,74,76–82,86,87,92,97,101,103,106,107,109,111,114–116 . However, twenty-two studies used a nationally representative sample 31,39,40,46–54,59,73,85,89–91,94,96,100,110 , while others applied some method of probability randomisation 38,56,65,75,84,88,99 , stratification 33,45,57,67,70,72,93,108 , weighting 71,104,113 , or purposiveness 95,98,102,105,112 during sampling. Table 4 provides full details of the study characteristics identified from the reviewed literature.…”

“…Parameters used for defining and measuring disclosure also varied, with the most common parameters outlined as participant disclosure of their use of CM within the last twelve months to a medical provider (n = 30) 31–33,36,38,40,45–50,52,54,57,62,65,67,68,70,71,73,81,82,84,85,87,88,95,100,115,116 . Others studies examined participants’ disclosure to a medical provider of their current CM use 35,74,77–79,83,98,109,111 , use within the last month 34,53,69,86 , use within the last 24 months 50,51 , had always/usually/sometimes/never disclosed 39,59,60,66,72,110 , had ever discussed their CM use with a conventional provider 37,43,64,75,76 , had partially or fully disclosed their CM use 56,114 , had disclosed when asked 41 , had discussed before use 92 , reported rates of disclosure per episode of use 89 , or how the patient felt about disclosing 80,112 . A number of papers did not explicitly define their parameters for measuring disclosure 42,44,55,58,61,63,90,91,93,94,96,97,99,101–108,113 .…”

“…Twenty-five studies reported participant reasons for non-disclosure 36,37,42,54–57,59,67,76–79,83–85,90,92,98,105,107,110–113 , and four reported reasons for disclosure of CM use to medical providers 56,111–113 . The most commonly cited reasons patients gave for non-disclosure were fear of the provider’s disapproval 36,42,54–56,67,76–78,83–85,90,92,105,107,110–113 , followed by the provider not asking 37,42,54–57,59,67,76–78,83,84,90,98,110–113 , the patient perceiving disclosure as unimportant 42,54–57,59,67,76,78,79,84,85,90,92,98,105,107,110 , belief the physician would not have relevant knowledge of CM 36,42,54,56,67,76–78,107,113 , lack of time during consultation or forgetting 36,42,54,56,57,76,78,92,105 , belief that CM was safe and would not interfere with conventional treatment 42,78,…”