Barriers and Facilitators to Integrative Oncology Services in Australia: A Changed Mind Set Required.

Objectives: This study aimed to explore barriers and facilitators to integrative oncology (IO) service provision and access in Australia. Design: The study design was mixed method with two substudies: a cross-sectional national cancer service survey of public and private sectors; and focus group interviews and an online survey of cancer survivors. Triangulation analysis of qualitative and quantitative data was used to identify and interrogate meta-themes. Subjects: The cancer service response rate was 93.2% (n = 275/295); 71/275 (25.8%) provided IO. Thirty-three cancer survivors from Anglo-European, Arabic, Vietnamese, and Chinese backgrounds were interviewed, and 121 survivors answered the online survey. Results: IO gaps were substantial, with no services in many regions and cities; a lack of diversity and availability of therapeutic options, including culturally appropriate services; and a mismatch between the high use of natural health products by survivors and types of IO services provided. Two overlapping meta-themes were identified: "barriers and facilitators" and "peoples and institutions"; each with four subthemes, respectively, "access/provision, affordability/funding, information/evidence, and culture/values" and "cancer survivors, healthcare professionals, organizations, and policies." While affordability/funding was the greatest barrier to survivors and providers, solutions varied (e.g., building a stronger evidence-base, business model advice) and often conflicted (e.g., public verses private sector funding). The most insidious barrier was professional/corporate cultures and values that influenced hospital policies (or lack thereof), conceptions of evidence and the therapeutic alliance. Survivors called for a change of mindset in the culture of medicine and value-based health care. Conclusions: The barriers and facilitators to IO services were more complex than building the evidence-base and demonstrating value to justify funding. To achieve a better alignment of patients' preferences with service provision, providers require more guidance on clinical governance, business models, local service gaps, and interprofessional collaboration. National strategies and funding models are needed to ensure appropriate, equitable IO service provision.

Implementation of Brazil's National Policy on Complementary and Integrative Practices: strengths and weaknesses. / Potencialidades e fragilidades de implantação da Política Nacional de Práticas Integrativas e Complementares.

This narrative review examines the literature on complementary and integrative practices (CIPs) and their incorporation into Brazil's national health system (Sistema Único de Saúde - SUS) in an attempt to understand the strengths and weaknesses of the implementation of the National Policy on Complementary and Integrative Practices in the SUS (PNPIC, acronym in Portuguese). A search was conducted of the MEDLINE, LILACS, and SciELO databases, resulting in final sample of 25 articles. Our analysis identified five key themes in the literature related to the strengths and weaknesses of policy implementation: 1) Professional training in CIPs in the SUS; 2) structuring the provision of CIPs, access, and health promotion; 3) knowledge, access, and acceptance of service users in relation to CIPs; 4) knowledge of SUS professional staff and managers in relation to the PNPIC; and 5) scope and monitoring and evaluation of the PNPIC. In consonance with the conclusions of the PNPIC management reports, the findings provide a deeper insight into policy implementation problems and reinforce the need to empower the actors involved in this process to tackle these challenges.

Esta revisão narrativa tem por objetivo analisar a produção científica sobre as Práticas Integrativas e Complementares (PIC) no Sistema Único de Saúde (SUS) visando compreender as potencialidades e fragilidades do processo de implantação da Política Nacional de Práticas Integrativas e Complementares (PNPIC). Após busca nas bases de dados, 25 artigos foram selecionados e os seus resultados analisados criticamente. Da análise do material emergiram cinco temas principais que explicitaram potencialidades e fragilidades de implantação da política: 1) Formação profissional em PIC para o SUS; 2) Estruturação da oferta em PIC, acesso e promoção da saúde; 3) Conhecimento, acesso e aceitação de usuários em relação às PIC; 4) Conhecimento de profissionais e gestores em relação à PNPIC; e 5) Escopo, monitoramento e avaliação da PNPIC. Os resultados se alinham aos relatórios de gestão da PNPIC aprofundando o conhecimento acerca da implantação da política e reforçando a necessidade de empoderamento dos atores do SUS para o enfrentamento de seus desafios.

Potencialidades e fragilidades de implantação da Política Nacional de Práticas Integrativas e Complementares / Implementation of Brazil's National Policy on Complementary and Integrative Practices: strengths and weaknesses

Resumo Esta revisão narrativa tem por objetivo analisar a produção científica sobre as Práticas Integrativas e Complementares (PIC) no Sistema Único de Saúde (SUS) visando compreender as potencialidades e fragilidades do processo de implantação da Política Nacional de Práticas Integrativas e Complementares (PNPIC). Após busca nas bases de dados, 25 artigos foram selecionados e os seus resultados analisados criticamente. Da análise do material emergiram cinco temas principais que explicitaram potencialidades e fragilidades de implantação da política: 1) Formação profissional em PIC para o SUS; 2) Estruturação da oferta em PIC, acesso e promoção da saúde; 3) Conhecimento, acesso e aceitação de usuários em relação às PIC; 4) Conhecimento de profissionais e gestores em relação à PNPIC; e 5) Escopo, monitoramento e avaliação da PNPIC. Os resultados se alinham aos relatórios de gestão da PNPIC aprofundando o conhecimento acerca da implantação da política e reforçando a necessidade de empoderamento dos atores do SUS para o enfrentamento de seus desafios.

Abstract This narrative review examines the literature on complementary and integrative practices (CIPs) and their incorporation into Brazil's national health system (Sistema Único de Saúde - SUS) in an attempt to understand the strengths and weaknesses of the implementation of the National Policy on Complementary and Integrative Practices in the SUS (PNPIC, acronym in Portuguese). A search was conducted of the MEDLINE, LILACS, and SciELO databases, resulting in final sample of 25 articles. Our analysis identified five key themes in the literature related to the strengths and weaknesses of policy implementation: 1) Professional training in CIPs in the SUS; 2) structuring the provision of CIPs, access, and health promotion; 3) knowledge, access, and acceptance of service users in relation to CIPs; 4) knowledge of SUS professional staff and managers in relation to the PNPIC; and 5) scope and monitoring and evaluation of the PNPIC. In consonance with the conclusions of the PNPIC management reports, the findings provide a deeper insight into policy implementation problems and reinforce the need to empower the actors involved in this process to tackle these challenges.

Integration of Homeopathy and Complementary Medicine in the Tuscan Public Health System and the Experience of the Homeopathic Clinic of the Lucca Hospital.

INTRODUCTION: The healthcare programs of the Region of Tuscany (Italy) have started the process of integration of some types of complementary medicine (CM), including homeopathy, which began in 1996. The Homeopathic Clinic of Lucca was opened in 1998, followed by the Homeopathic Clinic for Women in 2003, and the Clinic for CM and Diet in Oncology in 2013. METHODS: Observational longitudinal studies conducted on 5,877 patients (3,937 in the general clinic, 1,606 in the women's clinic and 334 in oncology) were consecutively examined from 2003 to 2016. The Outcome in Relation to Impact on Daily Living (ORIDL) was generally used to assess outcomes. RESULTS: Comparing the clinical conditions before and after homeopathic treatment, improvement was observed in 88.8% of general medicine patients with follow-up (45.1%); in particular, 68.1% of the patients had a major improvement in or resolution (ORIDL +2, +3, +4) of their condition. In women, an improvement was obtained in 74.1% cases and a major improvement in 61.2%. In cancer patients with homeopathic and integrative treatment, a significant improvement was observed for all the symptoms during anti-cancer therapy, particularly for hot flashes, nausea, depression, asthenia, and anxiety. CONCLUSIONS: These results suggest that homeopathy can effectively be integrated with allopathic medicine and that the Tuscan experience could provide a useful reference for developing national and European regulations on the use of CM and homeopathy in public healthcare.

Evaluating Integrative Cancer Clinics With the Claim Assessment Profile: An Example With the InspireHealth Clinic.

BACKGROUND: The evaluation of freestanding integrative cancer clinical programs is challenging and is rarely done. We have developed an approach called the Claim Assessment Profile (CAP) to identify whether evaluation of a practice is justified, feasible, and likely to provide useful information. OBJECTIVES: A CAP was performed in order to (1) clarify the healing claims at InspireHealth, an integrative oncology treatment program, by defining the most important impacts on its clients; (2) gather information about current research capacity at the clinic; and (3) create a program theory and path model for use in prospective research. STUDY DESIGN/METHODS: This case study design incorporates methods from a variety of rapid assessment approaches. Procedures included site visits to observe the program, structured qualitative interviews with 26 providers and staff, surveys to capture descriptive data about the program, and observational data on program implementation. RESULTS: The InspireHealth program is a well-established, multi-site, thriving integrative oncology clinical practice that focuses on patient support, motivation, and health behavior engagement. It delivers patient-centered care via a standardized treatment protocol. There arehigh levels of research interest from staff and resources by which to conduct research. CONCLUSIONS: This analysis provides the primary descriptive and claims clarification of an integrative oncology treatment program, an evaluation readiness report, a detailed logic model explicating program theory, and a clinical outcomes path model for conducting prospective research. Prospective evaluation of this program would be feasible and valuable, adding to our knowledge base of integrative cancer therapies.

Integrating palliative care into neurology services: what do the professionals say?

OBJECTIVES: Evaluations of new services for palliative care in non-cancer conditions are few. OPTCARE Neuro is a multicentre trial evaluating the effectiveness of short-term integrated palliative care (SIPC) for progressive long-term neurological conditions. Here, we present survey results describing the current levels of collaboration between neurology and palliative care services and exploring the views of professionals towards the new SIPC service. METHODS: Neurology and palliative care teams from six UK trial sites (London, Nottingham, Liverpool, Cardiff, Brighton and Chertsey) were approached via email to complete an online survey. The survey was launched in July 2015 and consisted of multiple choice or open comment questions with responses collected using online forms. RESULTS: 33 neurology and 26 palliative care professionals responded. Collaborations between the two specialties were reported as being 'good/excellent' by 36% of neurology and by 58% of palliative care professionals. However, nearly half (45%) of neurology compared with only 12% of palliative care professionals rated current levels as being 'poor/none'. Both professional groups felt that the new SIPC service would influence future collaborations for the better. However, they identified a number of barriers for the new SIPC service such as resources and clinician awareness. CONCLUSIONS: Our results demonstrate the opportunity to increase collaboration between neurology and palliative care services for people with progressive neurological conditions, and the acceptability of SIPC as a model to support this. TRIAL REGISTRATION NUMBER: ISRCTN18337380; Pre-results.

Medicina Tradicional Complementar e Integrativa: desafios para construir um modelo de avaliação do cuidado / Traditional Complementary and Integrative Medicine: challenges in constructing an evaluation model of care

Resumo A complexidade e a diversidade do que se propõe sob a lógica da Medicina Tradicional Complementar e Integrativa (MTCI) constituem um desafio para os interessados em evidências de sua efetividade. Seu crescimento, oferta e uso justificam a necessidade de construir referenciais metodológicos mais complexos e mais adequados para explicitar a singularidade do cuidado e a diversidade de suas técnicas. Este artigo, partindo de uma revisão narrativa da literatura, visa contribuir para a construção de um modelo de avaliação que, centrado na compreensão da singularidade e nas diversas dimensões do cuidado, busca refletir sobre os desafios de se buscar evidências do êxito terapêutico. O modelo proposto tem como base as abordagens qualitativas em saúde em que experiências dos agentes envolvidos (profissionais e usuários) no processo terapêutico ganham centralidade. Avaliar a efetividade do cuidado significa reconhecer a cadeia de processos interligados e suas diversas dimensões: acolhimento, diálogo, diagnóstico, ação e resultados alcançados.

Abstract The complexity and diversity of what is proposed in Traditional and Complementary Medicine constitute a challenge for those seeking evidence of its effectiveness. Its growth, offer and, use justify the need to build more complex and more appropriate methodological frameworks to explicit the uniqueness of this approach to healthcare and the diversity of its techniques. Based on a narrative review of the recent literature, this article aims to contribute to the construction of an evaluation model, focused on understanding the uniqueness and diverse dimensions of this specific care, seeking to reflect on the challenges and evidences of successful therapy. The proposed model is based on qualitative healthcare approaches, in which the experiences of the involved agents (professionals and users) in the therapeutic process become central. Assessing their effectiveness means recognizing the interconnected processes and their multiple dimensions: host practices, dialogue, diagnosis, action, and outcomes achieved.

Growth of Integrative Medicine at Leading Cancer Centers Between 2009 and 2016: A Systematic Analysis of NCI-Designated Comprehensive Cancer Center Websites.

Background: Cancer centers have increasingly offered integrative medicine therapies in response to their patients' unmet needs. We evaluated the growth of integrative medicine in leading academic cancer centers in the United States as reflected by their public-facing websites. Methods: We performed a systematic review of 45 National Cancer Institute (NCI)-designated comprehensive cancer center websites. Two researchers independently evaluated whether the websites provided information regarding integrative medicine modalities and, if so, whether the services were provided in the same health system. They compared the proportion of cancer centers providing the information on each modality in 2016 with the data from the prior study in 2009. Results: The most common integrative medicine therapies mentioned on the 45 NCI-designated comprehensive cancer center websites were exercise (97.8%) and acupuncture and meditation (88.9% each), followed by yoga (86.7%), massage (84.4%), and music therapy (82.2%). The majority of the websites also provided information on nutrition (95.6%), dietary supplements (93.3%), and herbs (88.9%). The most common therapies offered in the health systems were acupuncture/massage (73.3% each), meditation/yoga (68.9% each), and consultations about nutrition (91.1%), dietary supplements (84.4%), and herbs (66.7%). Compared with 2009, there was a statistically significant increase in the number of websites mentioning acupuncture, dance therapy, healing touch, hypnosis, massage, meditation, Qigong, and yoga (all P < .05). Conclusions: Leading US cancer centers increasingly present integrative medicine content on their websites, and the majority of them provide these services to patients in the same health systems.

[Occlusion: current situation and prospect in view of holistic integrative medicine].

The rise of holistic integrative medicine (HIM) is an inevitable consequence of modern medical development which emphasizes the change from specialization to integration of the most advanced medical knowledge. It does not mean a simple collection of the medical theories, but means the digestion of those theories for the clinical practical application. Because occlusal therapy is characterized as not only a high level of individualization, but also a relation to many stomatology and other disciplines, such as plastic surgery, orthopedics, neurosciences and psychology. It needs the HIM to guide the clinical practice. With undertaking occlusal therapy, to avoid the limitation due to the excessive specialized disciplines, and to provide effective treatment plans for abnormal occlusion induced diseases, it is necessary to develop the discipline of the holistic integrative stomatology.

Mixed Method Study to Investigate Models of Australian Integrative Oncology.

OBJECTIVES: This study explored the models of services and experiences of coordinators and directors engaged in providing complementary and alternative medicine (CAM) or integrative medicine (IM) in oncology centers throughout Australia. DESIGN: Fourteen leaders of IM programs from ten systematically selected Australian oncology centers were interviewed. Participants described their center's service model. Interview transcripts were thematically analyzed to identify underlying themes. Results were merged using the matrix technique for triangulation. RESULTS: Ten oncology centers were reviewed. IM was perceived in the context of supportive care and wellness. IM program types provided included the following: body-mind programs (56%); body-energy programs (23%), and body programs (21%). All programs were outpatient focused, generally did not require a doctors' referral, were freely accessible to cancer patients and carers at no or minimal cost, were centralized by coordinators, and involved volunteers, nurses, allied health practitioners, third parties, and patients in their treatment planning. Interaction between medical and CAM/IM teams was limited and tended to be informal. The underlying structure comprised four main themes: cultural context, human components, systematic components, and resource availability. Human components and resources were considered important in influencing cultural context and systematic components in the IM structure. CONCLUSION: Australian integrative oncology models are based on the concept of wellness and individualized care, focused on patient empowerment and engagement. IM models are generally independent of conventional medical care. Building relationships and trust between stakeholders and open collaboration with conventional medical care will be important to integrate IM into the hospital system. Systemic changes to deliver patient centered care in the provision of IM healthcare will facilitate the incorporation of CAM and IM into cancer services in hospital settings.

Integration of oncology and palliative care: setting a benchmark.

BACKGROUND: Integration of oncology and palliative care (PC) should be the standard model of care for patients with advanced cancer. An expert panel developed criteria that constitute integration. This study determined whether the PC service within this Health Service, which is considered to be fully "integrated", could be benchmarked against these criteria. METHODS: A survey was undertaken to determine the perceived level of integration of oncology and palliative care by all health care professionals (HCPs) within our cancer centre. An objective determination of integration was obtained from chart reviews of deceased patients. Integration was defined as >70% of all respondents answered "agree" or "strongly agree" to each indicator and >70% of patient charts supported each criteria. RESULTS: Thirty-four HCPs participated in the survey (response rate 69%). Over 90% were aware of the outpatient PC clinic, interdisciplinary and consultation team, PC senior leadership, and the acceptance of concurrent anticancer therapy. None of the other criteria met the 70% agreement mark but many respondents lacked the necessary knowledge to respond. The chart review included 67 patients, 92% of whom were seen by the PC team prior to death. The median time from referral to death was 103 days (range 0-1347). The level of agreement across all criteria was below our predefined definition of integration. CONCLUSION: The integration criteria relating to service delivery are medically focused and do not lend themselves to interdisciplinary review. The objective criteria can be audited and serve both as a benchmark and a basis for improvement activities.

Integrative Medicine Strategies for Changing Health Behaviors: Support for Primary Care.

Until system reforms allow adequate time and reimbursement for primary care providers to focus on lifestyle change to prevent and mitigate chronic disease, primary care providers need a manageable, defined role to support lifestyle change. The authors suggest this role is to serve as a catalyst, priming the patient for change; educating and pointing the patient to appropriate, evidence-based resources for additional guidance and hands-on support; and providing ongoing encouragement throughout the long journey of change while patients work more intensely with health coaches or allied health providers.

Women's health and Chinese integrative medicine.

Researchers in the fields of obstetrics, gynecology, and Chinese integrative medicine (CIM) were invited to share their perspectives on the most recent studies.

Healing Environments: Integrative Medicine and Palliative Care in Acute Care Settings.

Conventional medicine is excellent at saving lives; however, it has little to offer to address the physical, mental, and emotional distress associated with life-threatening or life-limiting disease. An integrative approach to palliative care in acute care settings can meet this need by creating healing environments that support patients, families, and health care professionals. Mindful use of language enhances the innate healing response, improves communication, and invites patients and families to participate in their care. Staff should be offered access to skills training to cultivate compassion and mindful practice to enhance both patient and self-care.

[Do's and don'ts in the establishment of an integrative medicine service in the public health care system--challenges and insights].

Although gratifying, it is somewhat misleading to describe the progress made in recent years in the field of integrative medicine just by counting the number of new programs established. This count, albeit ever-increasing, represents only one facet of the complex challenge that should concern us all--the development of a better healthcare system. In the real field, other rules apply. It is not sufficient for new integrative medicine services to survive or even to thrive if this is done in parallel to, or worse off in disconnect from, conventional medicine. The two systems, complementary and alternative medicine (CAM) and allopathic medicine, must collaborate in harmony for the sake of synergy. In order for that to happen, careful prior planning that addresses the multiple interests of the various stakeholders is warranted. This paper describes five key challenges and insights [institutional acceptance, Leadership support, the day after, the human factor, and program evaluation) gained from establishing an integrative oncology section within a tertiary academic medical center in Israel. It includes practical advice and useful tips in the form of do's and don'ts with the hope that these pearls would help others to estabLish and develop their own integrative medicine programs within the unique context of their hospitals and healthcare systems.

Complementary and integrative medicine for older adults in palliative care.

Complementary and Integrative Medicine (CIM) encompasses many diverse therapies, including natural products and mind and body practices. Use of CIM is common and can benefit patients in palliative care. However, because patients in palliative care are often frail and elderly, the clinician should consider a patient's comorbidities before recommending certain therapies, such as natural products. In this article, specific examples of CIM are provided for symptoms commonly seen in palliative care.