Nurse-guided patient self-treatment in integrative oncology: a randomized controlled trial.

OBJECTIVE: Nurses are increasingly becoming involved in integrative oncology (IO) programs. This study examined the additive effect of nurse-provided guidance for self-administered IO therapies on cancer-related fatigue and quality of life (QoL). METHODS: The study was randomized and controlled, enrolling patients undergoing active oncology treatment with IO interventions for fatigue and other QoL-related outcomes. IO practitioner guidance on self-treatment with manual, relaxation, and/or traditional herbal therapies was provided to patients in both the intervention and control arms. However, patients in the intervention arms also received additional guidance on self-treatment by IO-trained palliative care nurses. All participants were assessed for fatigue and QoL at baseline and at 24-h follow-up, using the Edmonton Symptom Assessment Scale (ESAS) and the Measure Yourself Concerns and Wellbeing (MYCAW) questionnaire tools. RESULTS: Of 353 patients recruited, 187 were randomized to the intervention and 166 to the control group. Both groups had similar demographic and oncology-related characteristics. Patients in the intervention arm reported significantly greater improvement in ESAS scores for fatigue (p = 0.026) and appetite (p = 0.003) when compared to controls. CONCLUSION: The addition of nurse-provided guidance on self-administration of IO treatments to that provided by IO practitioners further reduced short-term scores for fatigue and improved appetite. The relationship between palliative and IO-supportive cancer care requires further study.

Integrative oncology for palliative care nurses: pre-post training evaluation.

OBJECTIVES: Integrative oncology (IO) is increasingly being incorporated in supportive and palliative cancer care. This study examined an IO-palliative care training programme for nurses from community and hospital settings. METHODS: A 120-hour course, attended by 24 palliative care nurses without IO training, included precourse/postcourse questionnaires examining knowledge, attitudes and level of IO-palliative care skills. Qualitative analysis examined precourse and postcourse narratives. RESULTS: Most (18; 75%) completed study questionnaires, with knowledge and attitudes towards IO changing only modestly and IO-related skills significantly for guidance on herbal medicine and lifestyle changes, manual-movement and mind-body modalities. Greater consultation skills were reported for fatigue, stomatitis, nausea, appetite, constipation/diarrhoea, insomnia, peripheral neuropathy and hot flashes. Trainees reported improved skills for pain (p=0.003), emotional (p<0.001) and informal caregiver-related concerns (p<0.001), with no change in palliative care-related skills. Qualitative analysis found both personal and professional attitude changes, with enhanced mindfulness and an expressed intent to implement the learnt skills in daily practice. CONCLUSIONS: The IO-palliative care nurse training programme increased IO-related and palliative care-related consultation skills for a wide range of quality of life-related concerns. Further research is needed to explore both short-term and long-term effects and the implementation of the learnt skills in clinical practice. TRIAL REGISTRATION NUMBER: NCT03676153.

Attitudes Among Nurses Toward the Integration of Complementary Medicine Into Supportive Cancer Care.

PURPOSE/OBJECTIVES: To explore the attitudes of nurses treating patients with cancer regarding the use of complementary and integrative medicine (CIM) therapies to reduce symptoms and improve quality of life (QOL). 
. DESIGN: Prospective and descriptive.
 
. SETTING: 12 hospital and community care settings in Israel. 
. SAMPLE: 973 nurses working in oncology and non-oncology departments.
. METHODS: A 26-item questionnaire was administered to a convenience sample of nurses treating patients with cancer. 
. MAIN RESEARCH VARIABLES: Interest in CIM integration and training in supportive cancer care.
. FINDINGS: Of the 973 nurses who completed the questionnaire, 934 expressed interest in integrating CIM into supportive cancer care. A logistic regression model indicated that nurses with a greater interest in integration tended to be older, believed that CIM improved patients' QOL, and had no structured postgraduate oncology training. Nurses who believed CIM to be beneficial for QOL-related outcomes were more likely to express interest in related training. The goals of such training include improving QOL-related outcomes, such as anxiety, insomnia, gastrointestinal symptoms, and pain. 
. CONCLUSIONS: Most nurses working with patients with cancer are interested in the integration of CIM into supportive cancer care. 
. IMPLICATIONS FOR NURSING: Most nurses would like to undergo training in CIM to supplement conventional care. CIM-trained integrative nurses can help promote the integration of patient-centered CIM therapies in supportive cancer care settings.