food store for breast cancer patients, part 2

food store for breast cancer patients, part 2

Methods

We conducted a field study to determine what health food
store employees recommended to individuals seeking
treatments for breast cancer. We focused on identifying
what products were recommended and the cost of these
products. We also examined the education of these
employees and their knowledge of drug interactions and
adverse effects.

We identified all health food stores in a major Canadian
city through the local business pages and yellow pages of
telephone directories. Further stores were located through
word of mouth. In total, 34 stores met our inclusion criteria
of being a retail NHP sales outlet. We specifically excluded
Asian herbal stores because of language difficulties.

This study received ethical approval by the Canadian
College of Naturopathic Medicine Ethical Review Board
and approved with reference to Office for Protection from
Research Risks Regulations under section 46.116(d).

Procedure

Eight research assistants (six female, two male) of various
ages and appearances were recruited and trained to
portray customers (‘participants-as-observers’). The participants
entered individually into assigned stores; they had
been informed to browse in the store until approached by
an employee. At this time the participants would declare
that their mother has breast cancer. The participants disclosed
information on their mother’s condition, use of
chemotherapy (Tamoxifen) and physician visits, only if
asked. The participants would then ask what the employee
recommended for this condition. All participants followed a
structured, memorized, pretested questionnaire that asked
about product usage, dosage, cost, employee education
and product safety or potential for drug interactions. No
further information about the condition was divulged.

The data gatherers recorded which products were recommended
by natural health food store employees, along
with the recommended dose and price per product as well
as price per month. Data gatherers inquired about safety
issues and drug interactions with each recommended
product. Additionally, they inquired about where the
employee had obtained information on the recommended
products. They also noted whether the employees referred
them on to CAM specialists or recommended that they
consult further with a physician. Additional suggestions by
the employees were recorded.

Full notes on the encounters were recorded immediately
after leaving the store. All data were transcribed according
to the research questions. The research assistants specifically
recorded the various products recommended, including
their costs and dosage. We summarised the data with
descriptive statistics. We have disclosed the results of our
audit to each health food store.

Results

Of the 34 stores that met our inclusion criteria, 27 recommended
NHPs; a total of 33 different products were recommended
(see Table 1). The mean cost of product per
month was $58.09 (CAD) (minimum $5.28, median
$32.99, maximum $600). Twenty-three employees (68%)
did not ask whether the patient took prescription medications.
Fifteen (44%) employees recommended visiting a
healthcare professional; these included: naturopaths (9),
physicians (5) and nutritionists (1). Health food store
employees relied on a variety of sources of information.
Twelve employees (35%) received their information from
books, 5 (15%) from a supplier, 3 (9%) had a formal education
in CAM, 2 (6%) had in-store training and 12 (35%)
did not disclose their sources of information.

Potential adverse effects of recommended products were
discussed by three employees (8.8%). The potential for
drug interactions was discussed by eight employees
(23.5%). Two (5.9%) suggested that the products might
offer the potential for cure. One employee (2.9%) suggested
discontinuing Tamoxifen. Four employees (11.8%)
suggested lifestyle changes and three (8.8%) recommended
books for further reading on the products.