The use of CM is becoming increasingly prevalent among individuals with cancer. As a growing number of patients and survivors integrate CM into their treatment plan, it is important that oncology HCPs standardize the assessment and documentation of CM use to promote safety and person-centred care. However, to prepare oncology HCPs to address CM use within their clinical practice, education as well as clinical guidelines and tools are required.
In our study, the implementation of key recommendations from a practice guideline regarding assessment, documentation and education related to CM was found to significantly improve oncology HCPs’ self-reported knowledge about CM, their readiness to provide decision support related to CM, and their willingness to consult other HCPs about CM. Oncology HCPs’ reported attitudes towards CM, and specific clinical practices, including asking individuals with cancer about CM use and making referrals to CM information resources, however, did not significantly change.
Knowledge and Readiness to Support CM Decisions
The positive shift observed in oncology HCPs’ reported knowledge of CM following participation in the education session and the application of a CM assessment form was similar to the findings of Delaney and Manley . In this Australian study of 21 HCPs, comprised mainly of radiation therapists, CM knowledge and documentation of CM improved significantly following an education seminar and the introduction of a standardized CM screening tool . Similarly, in a quasi-experimental study of a CM education intervention among 44 oncology nurses, an improvement in knowledge about CM was found; however, the day-long education session focused specifically on the efficacy and safety CM therapies versus assessing and documenting CM use . Insufficient knowledge about CM is a significant barrier to HCPs’ engagement with individuals with cancer about CM [14, 21, 24, 25, 34]; thus, it is imperative that CM education programs be offered in conjunction with the implementation of practice recommendations across the multidisciplinary oncology healthcare team. Our study, along with previous research [20, 33], suggests that tailored education sessions can improve reported knowledge about CM and potentially change HCPs’ clinical practice related to CM.
Participants in our study also reported a significant improvement in their readiness to support individuals’ CM decisions. This finding corroborates previous research that found oncology HCPs’ readiness to speak to patients about CM and make referrals to a practitioner for CM information or care was enhanced following an education intervention . Improving HCPs’ comfort and confidence in addressing CM may be important, especially in light of previous studies that have found a lack of confidence to be a substantial barrier to patient-clinician communication about CM [14, 18, 25].
Attitudes towards CM
In previous cross-sectional and qualitative studies, oncology HCPs have expressed variable attitudes towards CM; this ranges from being quite negative and dismissive of CM use  to being open and receptive to the potential role of CM in cancer care [37–39]. In our study, oncology HCPs’ attitudes towards CM were invariant, which has been previously found [20, 33], and may be a result of multiple factors. Foremost, participants who took part in our study may have had more positive views of CM, with the average total attitude score at baseline being 80.3 out of 108, and over half reporting personal use of CM. Thus, the lack of change observed may be reflective of a ceiling effect and the pre-existing positive attitudes held by HCPs towards CM. Moreover, there is a growing recognition among oncology HCPs of the potential role of select CM therapies in improving patients’ quality of life, managing cancer- and treatment-related symptoms and side effects, and enhancing overall satisfaction with care [18–22, 24, 34]. CM use among individuals with cancer, however, continues to be a contentious matter in some practice settings  and negative attitudes towards CM can hinder clinical discussions and disclosure of CM use. The provision of CM education to oncology HCPs that addresses their concerns about CM is imperative to promote non-judgemental consultations about CM.
Practices related to CM Use
With regards to oncology HCPs’ clinical practices, we found limited change in how often HCPs asked individuals about their use of CM, provided CM decision support, made referrals to CM resources, and engaged in other clinical activities related to CM. A significant difference, however, was observed in the reported frequency of consultations with another HCP about CM, as well as referrals to CM resources, specifically by HCPs who attended the education session. This result may have been a consequence of the emphasis placed in the education session on the value of consulting other oncology HCPs, such as pharmacists and dietitians, and utilizing available information resources regarding the safety and efficacy of CM use.
Previous studies on oncology HCPs’ clinical practices related to CM have reported more substantial changes to practice behaviours. Delaney and Manley reported a significant proportion of HCPs continued to use a CM screening tool 6 months following completion of an education intervention . As well, Hessig et al. reported oncology nurses as being more likely to recommend specific CM therapies to individuals with cancer following an 8-hour education session . The lack of self-reported practice change observed in our study may have been a consequence of the brief nature of the education intervention (i.e., 30 minutes) and potential reporting biases, as well as how the CM assessment form was implemented in clinical practice. Although over 3,700 assessment forms were completed over the 4-month implementation period, the lack of change in HCPs’ self-reported practices may reflect the fact that some clinics chose to disseminate the assessment form to patients directly, limiting discussions about CM between patients and their HCPs. It is also possible that organizational barriers, such as workload or lack of role clarity regarding CM , may have prevented some HCPs from changing their practice. Further, given the nature of oncology healthcare teams, some HCPs may have not perceived themselves to have the autonomy to proactively address individuals’ CM use . In the future, the use of objective measures of HCPs’ practice behaviour may provide a more accurate representation of clinical practices related to CM. Moreover, the implementation of a CM practice guideline may require a more intensive education program and institutional policies that inform clinical practice.
Strengths and Limitations
This study has several strengths. There was participation across the interdisciplinary oncology healthcare team and treatment areas, with engagement from oncologists, nurses, pharmacists, and other allied health professionals. The brief education intervention was readily accessible to oncology HCPs through in-person sessions, telehealth, and via YouTube. Also, where possible, standardized and psychometrically valid instruments were used to evaluate the study outcomes. Moreover, over 3,700 CM assessment forms were completed, demonstrating the feasibility of assessing CM use within cancer care settings.
Several potential limitations should be considered. This study involved a sample of 31 oncology HCPs from one province in Canada and, therefore, may not be adequately powered to detect changes in self-reported practices. In addition, 30% of the initial sample of 44 consenting HCPs did not complete a follow-up questionnaire for various reasons. Considering this, the study findings may not be generalizable to all oncology HCPs as those who participated in the study may have been more interested or open to CM than those HCPs who chose not to participate, or did not complete the follow-up survey. As well, we did not assess if the observed self-reported changes resulted in a meaningful difference in clinical practice and patient care. In addition, the persistence of the changes observed in this study following the implementation of the practice guideline recommendations is uncertain. Further, while the flexibility in how the CM assessment form was completed (i.e., clinical assessment vs. patient self-report) may have been pragmatic for the uptake in a busy oncology setting, it may have limited HCPs’ practice change and opportunities for dialogue between individuals with cancer and HCPs about CM use.