Communication about Traditional Complementary and Alternative Medicine (TCAM) in childhood cancer: A comparison between Dutch and Indonesian health-care providers at academic hospitals

Objectives: Communication about Traditional Complementary and Alternative Medicine (TCAM) use is
important in both Western and Eastern countries to prevent interference with conventional cancer
treatment. This study compares communication about TCAM of health-care providers (HCP) involved in
childhood cancer care in Netherlands and Indonesia.
Method: Cross-sectional study at Dutch and Indonesian academic hospital using semi-structured
questionnaires.
Results: Overall 342 HCP participated: 119 Dutch and 223 Indonesian HCP (response rate 80% and 87%).
HCP have negative perspectives about TCAM according to more Dutch (80%) than Indonesian (42%) HCP
(p < 0.001). More Dutch (97%) HCP think cancer patients use TCAM than Indonesian (75%) HCP (p = 0.001).
Less Dutch (36%) than Indonesian (65%) HCP ask parents, during routine history taking, if they use TCAM
in their child (p < 0.001). In both settings, most HCP (98%, 90% respectively) consider it important that
parents inform them if their child uses TCAM (p = 0.004). Parents do not disclose their TCAM use to
doctors according to 75% of Dutch and 84% of Indonesian HCP (p = ns). Parents are afraid of receiving less
care from doctors if they disclose their interest in or use of TCAM according to more Indonesian (74%)
than Dutch (42%) HCP (p < 0.001). Parents actually receive less care from doctors if they disclose their
interest in or use of TCAM according to more Indonesian (40%) than Dutch (2%) HCP (p < 0.001). More
Dutch (46%) than Indonesian (30%) HCP never openly discuss TCAM with parents (p = 0.002).
Conclusion: Dutch HCP have more negative perspectives and communicate less openly about TCAM with
parents than Indonesian HCP. In both settings HCP realize that their patients use TCAM and do not
disclose this. Doctors need to initiate and facilitate open discussions about TCAM with parents, without
retributing families after TCAM disclosure