Cancer Misinformation and Use of Complementary and Alternative Therapy (CAM) among Patients with Cancer.

Abstract Patients' exposure to cancer misinformation has grown tremendously. Research has shown that up to 30% of popular social media posts contain inaccurate information. Medical professionals warn that 77% of such posts could potentially lead patients toward harmful and ineffective therapies. The type of misinformation that

exaggerated complementary or alternative therapies (CAM) safety and effectiveness in addressing cancer is particularly concerning. Research indicates that patients who use CAM tend to exhibit lower adherence rates, potentially impacting their overall survival. The prevalence of interest in CAM is substantial, with up to 70% of

patients in the US incorporating CAM into their cancer care. Some patients may be misinformed when they engage with CAM, as up to 30% of them expect CAM to play a substantial role in controlling cancer progression. Despite the widespread dissemination of CAM misinformation and its prevalent use, 20-77% of patients with

cancer make CAM-related decisions without consulting their physicians. The lack of open conversations about CAM undermines opportunities for open information exchange and building trust in patient-provider relationships, which are essential for promoting adherence to standard therapies. To facilitate open conversations about CAM,

we propose a multilevel intervention. Unlike most previous studies that focused on providers or patients only, the proposed intervention targets both parties of the conversation. Informed by the Theory of Planned Behavior, the multilevel intervention provides patients with a question prompt list (CAM-QPL) and equips physicians with

effective conversation strategies through a workshop to facilitate positive and effective CAM conversations. The research will be complemented by focused training for Dr. Fridman in qualitative research, stakeholder engagement methodology, and evaluating multilevel interventions. Dr. Fridman's training goals will be supported

by formal training and her collaborations with an expert in qualitative research and multilevel interventions, Dr. Elston Lafata, an expert in stakeholder engagement research, Dr. Smith, MD, the Director of the Urologic Oncology at UNC Lineberger Cancer Center, and Assistant Professor Johnson, MD an expert in studying the

negative impact of cancer CAM misinformation. The training will enable Dr. Fridman to undertake the following steps: (1) in Aim 1, she will engage providers and patients and use qualitative methods to develop the CAM- QPL. (2) In Aim 2, she will estimate the initial efficacy of the CAM-QPL implemented as a multilevel intervention

with a physician-facing workshop developed by experts in health communication and misinformation. (3) In Aim 3, Dr. Fridman will conduct a qualitative exploration of patient and provider experiences with the multilevel intervention and its revision. This proposal addresses the urgent need for a multilevel intervention to tackle

communication barriers about CAM. By engaging in open conversations with providers, patients will be empowered to navigate the increasing volume of cancer-related information and misinformation and build trusting relationships with providers that will support their adherence to evidence-based treatment options.