Living outliers: experiences, insights and narratives of exceptional survivors of incurable cancer.

AIM: Unexplained prolonged survival given a diagnosis of incurable advanced cancer is a puzzling phenomenon that recently has attracted more scientific research. The purpose of this study was to add to the understanding of how exceptional patients perceive and explain their unusual experience. METHODS: We recruited patients for interviews from a population registry, patients with advanced lung or pancreatic malignancy who experienced exceptional survival. RESULTS & CONCLUSION: In total, 15 participants were interviewed. The main recurrent themes in most of the interviews were patient-doctor communication, family support and the patient's proactive attitude. In this study, patients attribute their longevity to relationships with their doctor and their family - not the type of treatment they received. Further research on this phenomenon is needed.

Teaching complementary medicine at an academic oncology department.

BACKGROUND: The increased use of complementary and alternative medicine (CAM) by patients with cancer is a significant phenomenon in cancer care and suggests the need for increased knowledge by clinicians of these therapies. METHODS: Aiming at bridging the gap in knowledge of the philosophy and practice of major CAM modalities in cancer care, an elective course was offered to physicians and nurses in a large academic center. RESULTS: The course also aimed at providing the tools necessary to establish open and trusting clinician-patient dialogue regarding CAM. CONCLUSIONS: Exposure to the course was successful in improving knowledge and attitudes.

Promoting lifestyle self-awareness among the medical team by the use of an integrated teaching approach: a primary care experience.

OBJECTIVES: Healthy lifestyle is recommended in clinical guidelines for the prevention and treatment of chronic diseases such as cardiovascular disease and diabetes. Research previously identified a gap between lifestyle recommendations and their implementation in clinical practice. In this paper, we describe a pilot educational program aimed to promote providers' awareness of their own lifestyles, and to explore whether increased personal awareness enhances providers' willingness to engage in lifestyle-change discussion with patients. METHODS: Two primary-care urban clinics in Northern Israel participated in the program, which consisted of a series of six biweekly educational sessions, each lasting 2-4 hours. Each session included both knowledge-based and experiential learning based on complementary medicine modalities. Surveys at the end of the program and a year later provided the program evaluation. RESULTS: Thirty-five personnel participated in the program. Thirteen (13) of the 20 participants (65%) reported an attitude change regarding eating habits after the program. At 1-year follow up, 24 of the 27 respondents (89%) stated that they were more aware of their eating habits and of their physical activity compared with precourse status. Twenty-three (23) of 27 respondents (85%) stated that after the program they were better prepared to initiate a conversation with their patients about lifestyle change. CONCLUSIONS: An integrated educational approach based on knowledge-based and complementary and alternative medicine experiential modalities, aimed to facilitate self-awareness, may enhance learners' attitude change. The findings demonstrate readiness of learners to reexamine their lifestyles. Increased self-awareness helped participants to make a positive attitude change regarding eating habits and physical activity and was associated with participants' increased engagement in lifestyle-change discussions with patients. The teaching approach had longstanding effect, noted in the one-year follow-up.

[Complementary medicine research in Israel between the years 1994-2004].

Alternative and complementary medicine (CAM) is gaining the attention of the medical academic community due to increased public use and ongoing concern of efficacy, safety and quality of CAM treatments. The aim of this work was to review the scope of research that was performed in Israel during the past 10 years. We detected 91 works that focus on clinical research: RCT's, pilot studies, comparative studies, surveys of prevalence & patterns of use, and the attitudes of the medical establishment and of medical students. The results of this work indicate considerable progress in the research of CAM within medical establishments in Israel. We believe that future research will benefit from an upgrading of quality of research that will further focus on cost-effectiveness as well as on possible adverse effects of CAM. This goal can be achieved through appropriate research training of MD's and CAM therapists, and by governmental funding of the research.

An approach to teaching primary care physicians how to integrate complementary medicine into their daily practices: a pilot study.

This paper describes a pilot educational approach to integration of complementary and alternative medicine (CAM) into the daily routine of primary care practice. Twelve (12) family practice residents and specialists were assigned to develop an integrative treatment program geared to address the needs of their own patients. In the process, participants were asked to formulate treatment plans by searching resources to find appropriate CAM modalities and consult with CAM practitioners. The effectiveness of the educational process was assessed by questionnaires. The researchers found that providing a short course in advanced integrative medicine improves physician ability to better formulate an individualized treatment plan. This approach of teaching has long-standing results, as noted with a 2-year follow-up evaluation.

Is a biopsychosocial-spiritual approach relevant to cancer treatment? A study of patients and oncology staff members on issues of complementary medicine and spirituality.

BACKGROUND: Complementary and alternative medicine (CAM) is increasingly being used by patients with cancer. OBJECTIVES: Our aim is to compare the attitudes of cancer patients who use CAM to those of nonusers, on issues of CAM, biopsychosocial considerations, and spiritual needs. METHODS: Questionnaires were administered to patients and medical care providers in a tertiary teaching hospital with a comprehensive cancer center. RESULTS: Forty-nine percent of the study patients reported integrating CAM into their conventional care. Health care providers considered psychological and spiritual needs as major reasons for CAM use, while patients considered the familial-social aspect to be more important. CONCLUSIONS: Cancer patients do not correlate CAM use with spiritual concerns but expect their physicians to attend to spiritual themes. Health care providers involved in oncology cancer care should emphasize spiritual as well as CAM themes. The integration of these themes into a biopsychosocial-spiritual approach may enrich the dialogue between patients and health providers.

An approach to educating family practice residents and family physicians about complementary and alternative medicine.

Complementary and alternative medicine (CAM) in the context of medical education is a controversial topic among the medical community. With the increased popularity of complementary and alternative medicine, medical educators are faced with the need of educating physicians so they would become competent to communicate with patients about CAM. As academic medicine shows more interest in CAM, it is critical to develop initiatives to overcome physicians' attitudinal barriers toward CAM and develop an instruction strategy that can address these needs. An approach to educate family practice residents and family physicians about CAM is described in this article. This patient-centered teaching approach hinges on the belief that CAM and family medicine are closely related. It espouses utilizing critical thinking and basing decisions on evidence-based material. The course covered four main topics in CAM: herbal medicine, traditional Chinese medicine (TCM), homeopathy and complementary nutrition. The course had limited objectives of exposing physicians to the common methods in CAM and providing sufficient information, so physicians could provide their patients with an informed, safe and balanced advice. The instructions emphasized the importance of improving physician-patient relationship and enriching the participant both professionally and personally. Results of our study revealed that after the course physicians' referral to CAM became more selective, at the same time, their personal use of CAM also increased. This reflects the increased value of CAM in the physicians' own healthcare, as well as their improved knowledge of appropriate referral patterns. Most importantly, the course increased the physicians' awareness of the psychosocial aspect of clinical problems encountered in family practice and, through the close observation of CAM in practice, gave them an additional viewpoint to better understand the patient-doctor relationship.

Effects of homeopathic intervention on medication consumption in atopic and allergic disorders.

CONTEXT: Allergies are the most common immunologic diseases among the general population. Increasing evidence suggests that the incidence of allergic disorders is rising dramatically. Conventional medicine provides only limited relief and does not offer a complete cure to this health problem. Consequently, patients seek additional approaches and therapies to integrate into their healthcare. Homeopathy is one of the leading complementary modalities used to treat this health problem. OBJECTIVE: This preliminary study assessed the effect of integrating homeopathic treatment in allergic diseases on conventional medication consumption in a health maintenance organization. DESIGN: Retrospective outcome study designed as a before-after trial. SETTING: Patients were studied in a complementary medicine clinic affiliated with an Israeli health maintenance organization. PARTICIPANTS: Forty-eight patients were treated for allergic diseases with homeopathic remedies and conventional medications. MAIN OUTCOME MEASURES: A computerized medication chart for each patient was evaluated for conventional medication consumption 3 months before and 3 months after the homeopathic intervention. Each patient served as his or her own control. RESULTS: Fifty-six percent of patients in this study reduced their use of conventional medication following the homeopathic intervention. Patients who used conventional medications for their allergic disorders reduced their medication expense by an average of 60%, with an average savings of $24 per patient in the 3-month period following the homeopathic intervention. CONCLUSIONS: This retrospective outcome study demonstrates cost savings for an Israeli health maintenance organization. The homeopathic intervention led to a modest but significant reduction in the use of medications commonly used to treat allergic conditions and their complications. Larger controlled studies are needed to verify these findings.