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Off the Beaten Path: Caring for People Engaging in Potentially Unsafe Low Evidence Therapies
John Hammond1, Jill Schneiderhan2, Laura Taylor3
112266University of Michigan Medical School, Ann Arbor, MI, USA.
Summary
Palliative care patients may use potentially unsafe, low-evidence therapies (PULETs). Clinicians must balance patient hope with safety, using communication strategies to maintain therapeutic relationships.
Area of Science:
- Palliative Care
- Integrative Medicine
- Bioethics
Background:
- Many palliative care patients use complementary and alternative medicine (CAM).
- A subset uses therapies with little evidence and high risk (PULETs), often due to unmet needs.
- Dismissing PULETs risks patient alienation and damages the therapeutic alliance.
Approach:
- Define PULETs and differentiate them from typical CAM.
- Review a framework for assessing PULET risk/benefit.
- Examine ethical and legal considerations.
- Present an emotion-based communication strategy.
Key Points:
- PULETs pose unique challenges in palliative care, balancing hope with nonmaleficence and autonomy.
- Clinicians face moral distress when managing PULET use.
- A structured approach to risk assessment and communication is vital.
- Emotion-based communication can foster collaboration.
Conclusions:
- Clinicians need frameworks to evaluate PULETs and guide patient care.
- Effective communication is key to supporting patients using PULETs while ensuring safety.
- Ethical and legal aspects require careful consideration in managing PULETs.
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