The experience of women in a phase II trial of hypnosis and progressive muscle relaxation for body image: informing future research questions.

This study examines feedback from two interventions, hypnosis and progressive muscle relaxation (PMR), to improve body image in a randomized phase II trial. Eighty-seven women were randomized either to hypnosis or PMR. Sixty-three women (72%) were motivated to write comments about their study experience. These comments were explored in an unplanned qualitative analysis. Thematic analysis generated five themes, suggesting both hypnosis and PMR may improve body image through the ability to relax and manage stress, sleep better, improve mood and create a mind-body connection. Sexual health emerged as a theme for participants in only the hypnosis group which suggests hypnotic suggestions for body image may improve overall sexual health. Additional research is needed to assess this further.

Trends in integrative medicine and health consults: differences between cancer survivors and patients without cancer.

OBJECTIVES: The objectives were to compare patients with and without cancer who sought an integrative health (IH) consult and reasons for seeking a consult. DESIGN: Descriptive cross-sectional study that employed a secondary analysis of an integrative health database supplemented by a retrospective medical record review. SETTING/LOCATION: Integrative Medicine and Health program in a Southwestern United States academic medical center. SUBJECTS: Eight hundred thirty-nine adults over the age of 18 seeking IH consultation. RESULTS: The number of complementary therapies reported prior to consult were not significantly different between groups. The most reported complementary therapies used by cancer survivors were multivitamins, exercise, and turmeric. Patients without cancer reported significantly higher pain levels than cancer survivors. Cancer survivors reported significantly higher energy, sleep levels, overall health, spiritual wellbeing, and significantly better relationships compared to patients without cancer. Cancer survivors reported fatigue and cancer as the top reasons for IH consult. CONCLUSION: Participants without cancer reported higher levels of pain and lower levels of energy, sleep, overall health, spiritual wellbeing, and relationships compared to cancer survivors. However, cancer survivors still reported levels of unmanaged symptoms. Complementary therapy use prior to IMH consult was similar between groups; however, IMH providers recommended more treatments for patients without cancer. Our results highlight that more evidence is needed to guide IMH recommendations, especially for cancer survivors who may still be in treatment. Additionally, our results support evidence-based recommendations that all cancer survivors should be assessed for complementary therapy use and provided counseling by qualified providers on their advantages and limitations.

A Scoping Review of Strategies to Increase Black Enrollment and Retention in Cancer Clinical Trials.

To address health disparities faced by Black patients with cancer, it is critical that researchers conducting cancer clinical trials (CCTs) equitably recruit and retain Black participants, develop strategies toward this aim, and document associated outcomes. This narrative scoping literature review, as part of a larger study, aimed to identify, describe, and categorize strategies and interventions intended to improve the recruitment and retention of Black participants with breast, lung, prostate, colorectal, or multiple myeloma cancer into CCTs. We conducted comprehensive searches in PubMed, Embase, Cochrane Library, PsycInfo, CINAHL, Scopus, and Web of Science with three main concepts: Black persons, neoplasms, and clinical trial recruitment. The search resulted in 1,506 articles, of which 15 met inclusion criteria. Five main categories of recruitment and retention strategies and interventions were identified based on their specific population focus and type of approach: (1) participant identification, (2) provider awareness/resources, (3) focused research staff interventions, (4) patient and community-focused awareness strategies, and (5) participant-directed resources. Thirteen studies had recruitment acceptance rates of over 30%. Eight studies with acceptance rates of ≥ 50% reported implementing ≥ 5 strategies, with an average use of seven strategies across multiple categories. Five studies with acceptance rates ≥ 50% implemented strategies in ≥ 3 categories. Four studies reported retention rates ≥ 74%. Three studies with reported retention rates ≥ 74% used strategies in ≥ 3 categories, and all included strategies aimed at meeting participant needs beyond the study. Our results show that many efforts that aim to increase the recruitment and retention of Black participants into CCTs have great potential, but the most promising strategies use a multiprong approach.

Cautionary study on the effects of pay for performance on quality of care: a pilot randomised controlled trial using standardised patients.

BACKGROUND: Due to the difficulty of studying incentives in practice, there is limited empirical evidence of the full-impact pay-for-performance (P4P) incentive systems. OBJECTIVE: To evaluate the impact of P4P in a controlled, simulated environment. DESIGN: We employed a simulation-based randomised controlled trial with three standardised patients to assess advanced practice providers' performance. Each patient reflected one of the following: (A) indicated for P4P screenings, (B) too young for P4P screenings, or (C) indicated for P4P screenings, but screenings are unrelated to the reason for the visit. Indication was determined by the 2016 Centers for Medicare and Medicaid Services quality measures. INTERVENTION: The P4P group was paid $150 and received a bonus of $10 for meeting each of five outcome measures (breast cancer, colorectal cancer, pneumococcal, tobacco use and depression screenings) for each of the three cases (max $300). The control group received $200. SETTING: Learning resource centre. PARTICIPANTS: 35 advanced practice primary care providers (physician assistants and nurse practitioners) and 105 standardised patient encounters. MEASUREMENTS: Adherence to incentivised outcome measures, interpersonal communication skills, standards of care, and misuse. RESULTS: The Type a patient was more likely to receive indicated P4P screenings in the P4P group (3.82 out of 5 P4P vs 2.94 control, p=0.02), however, received lower overall standards of care under P4P (31.88 P4P vs 37.06 control, p=0.027). The Type b patient was more likely to be prescribed screenings not indicated, but highlighted by P4P: breast cancer screening (47% P4P vs 0% control, p<0.01) and colorectal cancer screening (24% P4P vs 0% control, p=0.03). The P4P group over-reported completion of incentivised measures resulting in overpayment (average of $9.02 per patient). LIMITATIONS: A small sample size and limited variability in patient panel limit the generalisability of findings. CONCLUSIONS: Our findings caution the adoption of P4P by highlighting the unintended consequences of the incentive system.

Integrative Therapies for Cancer-Related Fatigue.

Cancer-related fatigue (CRF) is a common symptom for which cancer patients often use integrative and integrative therapies; however, evidence supporting these therapies is limited. The aim of this review is to provide evidence-based recommendations for integrative interventions during and after cancer treatment for CRF. These recommendations are based on a systematic literature review from 1990 through 2019. Cognitive behavior therapy plus hypnosis and American ginseng can be considered during active treatment, and acupressure, mindfulness-based cognitive therapy, and qigong/tai chi easy can be considered during posttreatment. Coenzyme Q10 and L-carnitine are not recommended during active-treatment. All other integrative therapies for CRF had insufficient evidence to make a recommendation. While there is increasing evidence for integrative therapies for CRF, because of lack of rigorous trials and replication, no therapies could be definitively recommended. Further rigorously designed integrative therapy research is needed and should consider implementation and dissemination.

Ginseng as a Treatment for Fatigue: A Systematic Review.

BACKGROUND: Millions of people with chronic illness suffer from fatigue. Fatigue is a complex, multidimensional symptom with poorly understood causes, wide variations in severity among individuals, and negative effects on multiple domains of daily life. Many patients with fatigue report the use of herbal remedies. Ginseng is one of the most widely used because it is believed to improve energy, physical and emotional health, and well-being. OBJECTIVE: To systematically review the published evidence to evaluate the safety and effectiveness of the two types of Panax ginseng (Asian [Panax ginseng] and American [Panax quinquefolius]) as treatments for fatigue. DESIGN: PubMed, CINAHL (Cumulative Index to Nursing and Allied Health), Ovid MEDLINE, and EMBASE databases were searched using Medical Subject Heading and keyword terms, including ginseng, Panax, ginsenosides, ginsenoside* (wild card), fatigue, fatigue syndrome, cancer-related fatigue, and chronic fatigue. Studies were included if participants had fatigue, had used one of the two Panax ginsengs as an intervention, and had scores from a self-report fatigue measure. Two reviewers independently assessed each article at each review phase and met to develop consensus on included studies. Risk of bias was assessed using version 5.3 of the Cochrane Collaboration Review Manager (RevMan), and results were synthesized in a narrative summary. RESULTS: The search strategy resulted in 149 articles, with 1 additional article located through review of references. After titles, abstracts, and full text were reviewed, 139 articles did not meet inclusion criteria. For the 10 studies reviewed, there was a low risk of adverse events associated with the use of ginseng and modest evidence for its efficacy. CONCLUSIONS: Ginseng is a promising treatment for fatigue. Both American and Asian ginseng may be viable treatments for fatigue in people with chronic illness. Because of ginseng's widespread use, a critical need exists for continued research that is methodologically stronger and that includes more diverse samples before ginseng is adopted as a standard treatment option for fatigue.