Kidney Cancer Integrative Oncology: Possible Options for Care.

PURPOSE OF REVIEW: This study aims to review how complementary and integrative medicine (CIM), defined as therapies utilizing nutrition, physical activity, herbs, supplements, mind-body therapies, homeopathy, and other non-traditional therapies, can address the prevention, treatment, side effects, and recurrence of kidney cancer. This review discusses advances and discoveries in research, gaps in research, current debates on the subject, and directions for future research. We queried Ovid MEDLINE and PubMed databases using the search terms kidney cancer, integrative medicine, integrative oncology, nutrition, supplements, treatment, prevention, and therapy. Searches were limited to integrative medicine and integrative oncology. We reviewed CIM therapies related to prevention, treatment, side effect mitigation, and recurrence of kidney cancers. RECENT FINDINGS: Search results yielded 211 studies, of which 87 were relevant to this review. Studies related to CIM and kidney cancer were clustered into themes, including nutrition, physical activity, supplements, mind-body therapies, and alternative therapies. This review provides a foundation for utilizing the principles of integrative medicine in the prevention of and care for patients with kidney cancer and the need for further focused research on the effectiveness of CIM in kidney cancers.

"What Should I Eat?"-Addressing Questions and Challenges Related to Nutrition in the Integrative Oncology Setting.

PURPOSE OF REVIEW: This review aims to assess how nutrition can be addressed in the integrative oncology setting, taking into account cancer patients' unmet needs as they relate to nutrition in cancer care and the evidence-based information that is available on this topic. RECENT FINDINGS: During and after cancer treatment, nutrition is an important component of supportive care, for patients and their family members. Current scientific data consistently show that poor nutrition can reduce survival and decrease adherence to cancer treatments. Unfortunately, the limited availability of dietitians makes access to individualized nutrition counseling challenging, and many cancer patients still do not receive adequate nutritional support. As a result, one of the main unmet needs of patients and their families through the whole cancer trajectory is accessible and up-to-date evidence-based nutritional counseling that emphasizes basic healthy nutrition. The popularity of complementary and integrative medicine among patients with cancer makes the integrative oncology setting an excellent avenue for providing such support. A suggested simple approach that utilizes World Cancer Research Fund/American Institute for Cancer Research and American Cancer Society basic information is described. This approach can be easily incorporated into integrative oncology settings, while reserving the role for the registered dietician to address underweight patients, patients with malnutrition, and patients with more complicated dietary situations. The integrative oncology setting is in a unique place in oncology that can be utilized for enhancing dissemination of healthy nutrition information and addressing the unmet needs expressed by patients and families.

Longitudinal Continuity Learning Experiences and Primary Care Career Interest: Outcomes from an Innovative Medical School Curriculum.

BACKGROUND: Medical students in the USA have negative perceptions of primary care careers, which are exacerbated by the hidden curriculum and medical school culture. Longitudinal integrated clerkships (LICs) have shown promise in ameliorating this situation by promoting student/preceptor continuity relationships and helping students maintain empathy. AIM: The aim of this study is to describe the Student Continuity of Practice Experience (SCOPE) program and demonstrate program outcomes using evaluation data from residency match results, course evaluations, and student grades. SETTING: University of Texas Medical Branch, an academic health center in Galveston, Texas. PARTICIPANTS: Undergraduate medical students. PROGRAM DESCRIPTION: Learners participate in a longitudinal curriculum designed to enhance their skills as primary care physicians. They regularly attend continuity clinic, establishing a panel of patients by their third year. Students receive frequent feedback from a faculty mentor on assignments and clinical performance. PROGRAM EVALUATION: SCOPE students have high primary care residency match rates and experience patient continuity rates comparable to an intern. Their interest in primary care increases between years one and three, a departure from typical medical student trends. DISCUSSION: SCOPE appears to promote and maintain primary care career interest in participants and has transferability to other institutions.

Integrative Medicine: Adjunctive Element or Essential Ingredient in Palliative and Supportive Cancer Care?

The aim of supportive cancer care is to actively manage patients' physical, psychologic, and spiritual concerns, independent of prognosis. Complementary and integrative medicine (CIM) is increasingly gaining greater acceptance and support for its beneficial value in supportive cancer care. The utilization of CIM early in the cancer trajectory, during treatment and during survivorship periods, as well as during end of life, addresses a great number of unmet needs that patients affected by cancer raise. In addition, recent research supports the role that CIM has in reducing suffering and distress both physically and emotionally, as well as enhancing well-being in patients affected by cancer and their families. CIM is increasingly seen not only as an adjunctive add-on treatment or perhaps even as a luxury item for the affluent but actually as an important component in supportive cancer care for all patients. It addresses many aspects of care that sometimes are not being addressed with conventional means. With the increase in CIM-related research, as well as the increased clinical experience in oncology programs worldwide, CIM is gradually becoming an essential ingredient in supportive and palliative cancer care. In this narrative review, the authors look systematically at the contribution that CIM has in supportive care in each stage of the cancer trajectory, reflecting the needed role that CIM has in supportive care. The presented data will provide a sampling of the available clinical research for each of the broad stages being described.

Integration of the biopsychosocial model: perspectives of medical students and residents.

PURPOSE: To examine residents' and medical students' attitudes toward the incorporation of psychosocial factors in diagnosis and treatment and to identify barriers to the integration of evidence-based, mind-body methods. METHOD: A random sample of third- and fourth-year medical students and residents was drawn from the Masterfiles of the American Medical Association. A total of 661 medical students and 550 residents completed a survey, assessing attitudes toward the role of psychosocial factors and the clinical application of behavioral/mind-body methods. RESULTS: The response rate was 40%. Whereas a majority of students and residents seem to recognize the need to address psychosocial factors, 30%-40% believe that addressing such factors leads to minimal or no improvements in outcomes. The majority of students and residents reports that their training in these areas was ineffective, yet relatively few indicate interest in receiving further training. Females are more likely to believe in the need to address psychosocial factors. Additional factors associated with greater openness to addressing psychosocial factors include (1) the perception that training in these areas was helpful, and (2) personal use of behavioral/mind-body methods to care for one's own health. CONCLUSIONS: There is a need for more comprehensive training during medical school and residency regarding both the role of psychosocial factors in health and the application of evidence-based, behavioral/mind-body methods. The current health care structure-particularly insufficient time and inadequate reimbursement for addressing psychosocial factors-may be undermining efforts to improve patient care through inconsistent or nonexistent application of the biopsychosocial model.

Creating common ground: collaboration advances among licensed natural healthcare educators.

Content on integrative healthcare and complementary and alternative medicine is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity and interdisciplinary nature of the field.

The health enhancement program at monash university medical school.

Content on integrative healthcare and complementary and alternative medicine is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity, and interdisciplinary nature of the field. Please submit to Dr Sierpina at vssierpi@utmb.edu or Dr Kreitzer at kreit003@umn.edu. Submissions should be no more than 500 to1,500 words. Please include any Web site or other resource that is relevant, as well as contact information.

Transformational learning: an immersion course on the big island of Hawaii.

Content on integrative healthcare and complementary and alternative medicine is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity, and interdisciplinary nature of the field. Please submit to Dr Sierpina at vssierpi@utmb.edu or Dr Kreitzer at kreit003@umn.edu. Submissions should be no more than 500 to 1,500 words. Please include any Web site or other resource that is relevant, as well as contact information.

Barriers, strategies, and lessons learned from complementary and alternative medicine curricular initiatives.

Fifteen U.S. academic programs were the recipients of a National Center for Complementary and Alternative Medicine R25 Education Grant Program to introduce curricular changes in complementary and alternative medicine (CAM) in their institutions. The authors describe the lessons learned during the implementation of these CAM education initiatives. Principal investigators identified these lessons along with discovered barriers and strategies, both those traditionally related to medical and nursing education and those unique to CAM education. Many lessons, barriers, and strategies were common across multiple institutions. Most significant among the barriers were issues such as the resistance by faculty; the curriculum being perceived as too full; presenting CAM content in an evidence-based and even-handed way; providing useful, reliable resources; and developing teaching and assessment tools. Strategies included integration into existing curriculum; creating increased visibility of the curriculum; placing efforts into faculty development; cultivating and nurturing leadership at all levels in the organization, including among students, faculty, and administration; providing access to CAM-related databases through libraries; and fostering efforts to maintain sustainability of newly established CAM curricular elements through institutionalization and embedment into overall educational activities. These lessons, along with some detail on barriers and strategies, are reported and summarized here with the goal that they will be of practical use to other institutions embarking on new CAM education initiatives.

Regaining our humanity through story.

In this issue of Innovations in Integrative Healthcare Education, we are departing from our usual format of spotlighting specific projects or programs in lieu of presenting a more extended piece by MacKenzie on relationship-centered care and narrative medicine. The importance of these topics cannot be overestimated in their role of humanizing the healthcare encounter, improving self-awareness of the practitioner, and creating a space in which the patient feels deeply listened to. A commentary by Dr Michelle Sierpina is also included in this special section to put into context the power of narrative in medicine and in patients' lives. Her recent PhD focused on the power of life stories told by seniors; that research and training enables her to provide a broad and scholarly review of the power of story in relation to MacKenzie's article. In the medical school at University of Texas Medical Branch, we send out first-year medical students in the first couple of months of the first semester to patients' homes to just get their story, not a medical history, as part of a required course on the practice of medicine. Many students find this immensely anxiety provoking, due to the lack of structure and familiar context. However, ultimately they find an opportunity to encounter a real person in a nonclinical setting. A scoring rubric based on the construction and quality of a short story allows us to grade the students objectively. However, a most interesting finding, which we expect to present at the Ottawa Conference in Australia next spring, is the process of personal transformation that such story writing has for students. This is also reported by MacKenzie in her article and in Sierpina's accompanying commentary. The importance of capturing and understanding the patient's story is also a major focus in nurse practitioner programs across the United States, where the art of listening and the importance of patient narratives have long been emphasized. In an integrative assessment of patients, we "make a history" rather than "take a history." This means that we coconstruct with the patient the reality of the medical encounter and the tone and timbre of the healing relationship. By bringing our own culture, beliefs, and values to the exam room and then allowing the patient to share theirs with us, we create a new kind of relationship-centered, patient-centered care model. This allows the strength of the linear standard medical history, chief complaint, history of present illness, past history, social/family history, review of systems, etc, to be informed and enriched by the nonlinear, perhaps circular, patient story. This story making further allows deeper exploration of the patient's life goals as well as their medical goals.(1) It creates increased personalization of the provider-patient relationship and moves from the "I-them" to Buber's "I-thou." Enjoy the article and the accompanying commentary and consider how to implement this kind of care and mindfulness into the education of health professional students and your practice.

Innovations in integrative healthcare education: a healing journey for cancer patients in ontario and an online interdisciplinary CAM course for allied health students in Kentucky.

Content on integrative healthcare and complementary and alternative medicine (CAM) is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity, and interdisciplinary nature of the field.

Innovations in integrative healthcare education: undergraduate holistic studies at San Francisco State University and the CAM in undergraduate medical education project in Canada.

Content on integrative healthcare and complementary and alternative medicine is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity, and interdisciplinary nature of the field. Please submit to Dr Sierpina at vssierpi@utmb.edu or Dr Kreitzer at kreit003@umn.edu. Submissions should be no more than 700 to 800 words. Please include any Web site or other resource that is relevant, as well as contact information.

Goal-Directed Health Care and the chronic pain patient: a new vision of the healing encounter.

We introduce a new way to engage the patient with chronic pain, Goal-Directed Health Care (G-DHC). Identifying the patient's major life goals during the medical interview is the key element of this approach along with connecting these life goals to specific health-related goals. The implementation of G-DHC is a shift in process from the usual focus on disease-related goals such as relief of pain, titrating narcotic refills, and working on condition management to broader, long-term, personal goals. It emphasizes the importance of identifying the global life goals of patients and the reasons they wish to be well for and what they would do with improved health once they had it. Utilizing these life goals as a point of reference, discussion, and motivation makes clearer what specified health goals mean, whether or not the patient is ready to work on them, and most significantly, what the underlying motivation is to participate in their own care. We anticipate such a model of patient-centered care will shift the dynamic of the medical encounter with the patient with chronic pain to one that is ultimately more productive and satisfying for both patient and physician. Illustrations of cases, questions to ask patients, and a detail of the process may allow the reader to adopt this method into their practice.

Glyconutrients: the state of the science and the impact of glycomics.

The science of glycobiology has made rapid strides in the past few decades. A recent development has been the introduction of glyconutrients as nutritional supplements for health support and disease management. This article reviews the basic and clinical science of glyconutrients and presents a brief perspective on the impact of the field of glycomics.

Spirituality and clinical care: exploring developmental changes in nursing and medical students.

OBJECTIVE: This study identifies and assesses changes in spiritual experiences and the perceived importance of spiritual issues in nursing and medical students participating in a Spirituality and Clinical Care course. Students participated in the study by completing two survey instruments: the Spiritual Experience Index-Revised (SEI-R) and the Spiritual Importance (SI) scales. Differences from pretest to posttest by sex and by discipline (medicine vs nursing) and changes in spiritual maturity are assessed and analyzed. RESULTS: Data analyses explored discipline differences, sex differences, and changes in levels of spiritual maturity one year after the two-week course. Students (N = 416) participating in the course reflected a significant increase in perceived importance of spirituality in practice, with females of both disciplines showing greater increases than males, and students in nursing showing greater increases than students in medicine. Female students were more trusting than male students in spiritual measures for support. An interesting finding revealed that both male and female students evidenced reduced dogmatic perceptions over time, with medical students declining more sharply than nursing students. Finally, changes in the levels of spiritual maturity of the students were measured. Students in contrasting developmental groups (n = 127) regressed over time to more dogmatic and underdeveloped levels of spiritual maturity. CONCLUSIONS: Maintenance or advancement of spiritual development was the expected outcome as students began to develop the art of their practice. It was unexpected that students would regress to a more dogmatic or underdeveloped spiritual level. Several explanations for these findings are explored.

Innovations in integrative healthcare education: mind-body faculty development at UCLA and the symposium for portland area research on complementary and alternative medicine.

Content on integrative healthcare and complementary and alternative medicine (CAM) is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity, and interdisciplinary nature of the field. Please submit to Dr. Sierpina at or Dr. Kreitzer at . Submissions should be no more than 700-800 words. Please include any Web site or other resource that is relevant, as well as contact information.

Innovations in integrative health care education.

Content on integrative healthcare and complementary and alternative medicine (CAM) is now being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs all are finding creative and innovative ways to include these approaches into new models of education and practice. In this column, we will spotlight such innovations in integrative health care and CAM education. The goal is to present readers with specific educational interventions that they may wish to adapt into new or ongoing educational efforts at their institution or program. We invite you to submit brief descriptions of efforts in your institutions that reflect the creativity, diversity, and interdisciplinary nature of the field. Please submit to either Dr. Sierpina at vssierpi@utmb.edu or Dr. Kreitzer at. Submissions should be brief, 300 to 400 words, because we plan to synopsize several projects in each issue. We also wish to link the information in the summary to a larger body of information at a Web site or other resource, so please include that information as well as your e-mail contact.