INTRODUCTION
Nontraditional healing (NTH) consists of spiritual and religious healing (SRH) and complementary and alternative medicine (CAM). SRH includes faith healing, prayer, and meditation. CAM includes use of nonprescribed medications or behaviors such as supplements, plant-based remedies, and behavioral changes.
CAM and SRH use are increasingly prevalent, with studies reporting that 35-69% of patients use CAM for skin diseases.1 For example, in a 2020 survey, patients with hidradenitis suppurativa (84%), psoriasis (46%), and atopic dermatitis (50%) reported CAM usage.2 However, neither dermatology patient disclosure rates of CAM usage nor prevalence of SRH have been previously studied, though some general healthcare studies have found that 40-60% of patients use SRH.3,4 This study sought to characterize utilization and disclosure rates of SRH and CAM in dermatology.
A 12-question survey (Table 3) was conducted in March 2021 via the SurveyMonkey® (San Mateo, CA) Contribute and Rewards Panels, through which a random sample of 1595 participants was taken out of about 2.5 million representative Americans from across the nation. The survey was piloted by Venkatesh et al in the George Washington University Medical Faculty Associates Dermatology Department.5 Of the 1595 participants surveyed, 1525 completed the survey (96.3% response rate). One screening question was used: “Have you ever seen a dermatologist?” A multivariate logistic model was used to calculate adjusted odds ratios (aOD) and 95% confidence intervals (CI) for demographics associated with NTH usage. All analyses were performed using R (R Foundation for Statistical Computing, Vienna, Austria).
Overall, the 1525 submissions were filtered for the screening question (396), being under <18 years (10), and nonresponse (1), resulting in 1120 submissions for analysis. Of these, 408 (36.4%) reported using NTH to manage skin problems. Age, gender, employment, income, and insurance were significant factors in the odds of NTH usage (Table 1). Those who reported using NTH were asked to describe their relationship with SRH and CAM.
Of the 408 patients who reported using NTH, 406 patients answered the SRH section. Of these participants who used NTH, 78.1% had used SRH for skin conditions; of SRH users, 61.2% had notified their dermatologist of SRH usage (Table 2). Subanalysis of those who “used SRH instead of prescribed medication” revealed that 18.8% did not disclose their substitution behavior to their dermatologist. All 408 patients who reported using NTH answered CAM subquestions, of which 81.9% had used CAM. Of these CAM users, 72.8% notified their dermatologists of their usage. Subanalysis of those who “used CAM instead of prescribed medication” revealed 21.6% did not disclose their substitution behavior to their dermatologist. These data align with existing data on the prevalence of SRH (40–60%) and CAM (35–69%) utilization in healthcare overall.1,2,6
A significant proportion of NTH users substituted SRH (32.7%) and CAM (32.8%) for prescribed dermatological medication. While SRH and CAM may have potential psychological and physiological benefits, medication nonadherence is a leading driver of treatment failure, including increased disease severity, chronicity, mortality, and cost.1,2,7 Nonadherence should be identified and addressed during dermatologist visits to help patients make informed and optimal care decisions. Dermatologists should be sure to explicitly solicit data on adherence behaviors and barriers to adherence.
Moreover, many patients who used NTH did not disclose to their dermatologist usage of SRH (38.8%) and CAM (27.2%). Some CAM have important drug interactions or physiological effects, increasing the importance of accurate patient CAM usage data.8 Dermatologists should work to include NTH questions in history taking, assist patients in evaluating the scientific validity of NTH information, and facilitate disclosure of adherence and NTH behavior by allaying fear of judgment.
Lower SES patients may be disproportionately incentivized to use NTH when facing unaffordable drug prices and cost sharing. Lower income, unemployed, and underinsured/uninsured status were significantly associated with increased NTH usage (Table 1),
CAM and SRH use are increasingly prevalent, with studies reporting that 35-69% of patients use CAM for skin diseases.1 For example, in a 2020 survey, patients with hidradenitis suppurativa (84%), psoriasis (46%), and atopic dermatitis (50%) reported CAM usage.2 However, neither dermatology patient disclosure rates of CAM usage nor prevalence of SRH have been previously studied, though some general healthcare studies have found that 40-60% of patients use SRH.3,4 This study sought to characterize utilization and disclosure rates of SRH and CAM in dermatology.
A 12-question survey (Table 3) was conducted in March 2021 via the SurveyMonkey® (San Mateo, CA) Contribute and Rewards Panels, through which a random sample of 1595 participants was taken out of about 2.5 million representative Americans from across the nation. The survey was piloted by Venkatesh et al in the George Washington University Medical Faculty Associates Dermatology Department.5 Of the 1595 participants surveyed, 1525 completed the survey (96.3% response rate). One screening question was used: “Have you ever seen a dermatologist?” A multivariate logistic model was used to calculate adjusted odds ratios (aOD) and 95% confidence intervals (CI) for demographics associated with NTH usage. All analyses were performed using R (R Foundation for Statistical Computing, Vienna, Austria).
Overall, the 1525 submissions were filtered for the screening question (396), being under <18 years (10), and nonresponse (1), resulting in 1120 submissions for analysis. Of these, 408 (36.4%) reported using NTH to manage skin problems. Age, gender, employment, income, and insurance were significant factors in the odds of NTH usage (Table 1). Those who reported using NTH were asked to describe their relationship with SRH and CAM.
Of the 408 patients who reported using NTH, 406 patients answered the SRH section. Of these participants who used NTH, 78.1% had used SRH for skin conditions; of SRH users, 61.2% had notified their dermatologist of SRH usage (Table 2). Subanalysis of those who “used SRH instead of prescribed medication” revealed that 18.8% did not disclose their substitution behavior to their dermatologist. All 408 patients who reported using NTH answered CAM subquestions, of which 81.9% had used CAM. Of these CAM users, 72.8% notified their dermatologists of their usage. Subanalysis of those who “used CAM instead of prescribed medication” revealed 21.6% did not disclose their substitution behavior to their dermatologist. These data align with existing data on the prevalence of SRH (40–60%) and CAM (35–69%) utilization in healthcare overall.1,2,6
A significant proportion of NTH users substituted SRH (32.7%) and CAM (32.8%) for prescribed dermatological medication. While SRH and CAM may have potential psychological and physiological benefits, medication nonadherence is a leading driver of treatment failure, including increased disease severity, chronicity, mortality, and cost.1,2,7 Nonadherence should be identified and addressed during dermatologist visits to help patients make informed and optimal care decisions. Dermatologists should be sure to explicitly solicit data on adherence behaviors and barriers to adherence.
Moreover, many patients who used NTH did not disclose to their dermatologist usage of SRH (38.8%) and CAM (27.2%). Some CAM have important drug interactions or physiological effects, increasing the importance of accurate patient CAM usage data.8 Dermatologists should work to include NTH questions in history taking, assist patients in evaluating the scientific validity of NTH information, and facilitate disclosure of adherence and NTH behavior by allaying fear of judgment.
Lower SES patients may be disproportionately incentivized to use NTH when facing unaffordable drug prices and cost sharing. Lower income, unemployed, and underinsured/uninsured status were significantly associated with increased NTH usage (Table 1),
