{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:28:35Z","timestamp":1790173715777,"version":"4.1.0"},"reference-count":57,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T00:00:00Z","timestamp":1681776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Regional Cancer Centre","award":["2015"],"award-info":[{"award-number":["2015"]}]},{"name":"Stockholm-Gotland, Sweden"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Complementary and alternative medicine (CAM) is a broad set of nonconventional practices used alongside or instead of conventional treatment: The latter poses obvious risks related to cancer prognosis. Patient-physician dialogue about CAM is crucial for patient safety and mutual trust. Little is known about communication in the rare situations when patients decline recommended cancer treatment and consider using CAM. The objective of this study was to explore patients\u2019 and physicians\u2019 experiences from situations when patients decline recommended cancer treatment and consider using CAM.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Semi-structured interviews were carried out with 7 CAM-using cancer patients who had declined some or all conventional treatment as well as 10 physicians from oncology and palliative care. Framework analysis was used.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Regarding treatment choices, there was a dissonance between physicians\u2019 focus on medical reasoning and patients\u2019 expression of complex values. Physicians\u2019 difficulty in understanding patients\u2019 treatment decline was exacerbated when patients considered using CAM, impairing communication even further. Inequalities in roles resulting in power struggles risked pushing both parties toward extreme and inflexible standpoints. Despite these challenges regarding treatment choices and hierarchical roles, both parties considered open and respectful communication as crucial.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study highlights the difficulty of shared decision-making in practice when patients\u2019 and physicians\u2019 views on treatment decisions deviate in clinically challenging situations. Our results point to a need to address the complexity of these situations, pay attention to patients\u2019 values, and improve knowledge among physicians about CAM.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/oncolo\/oyad084","type":"journal-article","created":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T19:06:22Z","timestamp":1681844782000},"page":"e774-e783","source":"Crossref","is-referenced-by-count":16,"title":["Communication About Complementary and Alternative Medicine When Patients Decline Conventional Cancer Treatment: Patients\u2019 and Physicians\u2019 Experiences"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6449-6349","authenticated-orcid":false,"given":"Kathrin","family":"Wode","sequence":"first","affiliation":[{"name":"Department of Radiation Sciences\/Oncology, Ume\u00e5 University , Ume\u00e5 , Sweden"},{"name":"Regional Cancer Centre Stockholm Gotland , Stockholm , Sweden"},{"name":"Department of Nursing, Ume\u00e5 University , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Sharp","sequence":"additional","affiliation":[{"name":"Regional Cancer Centre Stockholm Gotland , Stockholm , Sweden"},{"name":"Department of Nursing, Ume\u00e5 University , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Fransson","sequence":"additional","affiliation":[{"name":"Department of Nursing, Ume\u00e5 University , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna H\u00f6k","family":"Nordberg","sequence":"additional","affiliation":[{"name":"Regional Cancer Centre Stockholm Gotland , Stockholm , Sweden"},{"name":"Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet , Stockholm , Sweden"},{"name":"Department of Physiology and Pharmacology, Karolinska Institutet , Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,4,18]]},"reference":[{"issue":"Suppl 2","key":"2023090805114188000_CIT0001","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1258\/jhsrp.2009.009104","article-title":"Cancer patients\u2019 experiences of using complementary therapies: polarization and integration","volume":"15","author":"Smithson","year":"2010","journal-title":"J Health Serv Res Policy"},{"issue":"1","key":"2023090805114188000_CIT0002","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1093\/jnci\/djab048","article-title":"Addressing complementary and alternative medicine use among individuals with cancer: an integrative review and clinical practice guideline","volume":"114","author":"Balneaves","year":"2022","journal-title":"J Natl Cancer Inst"},{"key":"2023090805114188000_CIT0003","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1634\/theoncologist.2012-0223","article-title":"Cancer patient disclosure and patient-doctor communication of complementary and alternative medicine use: a systematic review","volume":"17","author":"Davis","year":"2012","journal-title":"Oncologist"},{"key":"2023090805114188000_CIT0004","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s12906-019-2452-5","article-title":"Cancer patients\u2019 use of complementary and alternative medicine in Sweden: a cross-sectional study","volume":"19","author":"Wode","year":"2019","journal-title":"BMC Complement Altern Med"},{"key":"2023090805114188000_CIT0005","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1177\/1534735415589984","article-title":"Surveys of cancer patients and cancer health care providers regarding complementary therapy use, communication, and information needs","volume":"14","author":"King","year":"2015","journal-title":"Integr Cancer Ther"},{"key":"2023090805114188000_CIT0006","doi-asserted-by":"crossref","first-page":"110","DOI":"10.5694\/j.1326-5377.2000.tb127933.x","article-title":"Australian oncologists\u2019 \u00adself-reported knowledge and attitudes about non-traditional therapies used by cancer patients","volume":"172","author":"Newell","year":"2000","journal-title":"Med J Aust"},{"key":"2023090805114188000_CIT0007","doi-asserted-by":"crossref","first-page":"3857","DOI":"10.1007\/s00520-016-3205-3","article-title":"Oncologists\u2019 experiences of discussing complementary and alternative treatment options with their cancer patients. 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