Embedding Mindfulness-Based Resiliency Curricula Into Surgical Training to Combat Resident Burnout and Improve Wellbeing.

Surgery residents are at a higher-than-average risk of burnout syndrome, which is characterized by emotional exhaustion, depersonalization, and a sense of ineffectiveness. This risk of burnout can translate to increased stress and distress in trainees, poor performance, as well as worse patient outcomes. Therefore, developing and implementing burnout reduction strategies that are feasible, acceptable, and effective among surgical residents is paramount. Studies demonstrate that inherent mindfulness is associated with improved resiliency, reduced stress and burnout, as well as improved cognitive and motor skill performance. Fortunately, mindfulness is a skill that can be developed and maintained through targeted mindfulness-based interventions embedded within surgical education curriculum. Here, we present the data supporting the use of mindfulness as an integral part of burnout reduction efforts in surgical trainees as well as highlight evidence-based strategies for implementation in diverse surgical training environments.

Barriers and facilitators to physical activity prehabilitation in patients with kidney cancer.

PURPOSE: Timely and effective physical activity (PA) prehabilitation is an evidence-based approach for improving a patient's health status preoperatively. Identifying barriers and facilitators to PA prehabilitation can help inform best practices for exercise prehabilitation program implementation. We explore the barriers and facilitators to PA prehabilitation in patients undergoing nephrectomy. METHODS: A qualitative exploratory study was conducted by interviewing 20 patients scheduled for nephrectomy. Interviewees were selected via convenience sampling strategy. The interviews were semi-structured and discussed experienced and perceived barriers/facilitators to PA prehabilitation. Interview transcripts were imported to Nvivo 12 for coding and semantic content analysis. A codebook was independently created and collectively validated. Themes of barriers and facilitators were identified and summarized in descriptive findings based on frequency of themes. RESULTS: Five relevant themes of barriers to PA prehabilitation emerged: 1) mental factors, 2) personal responsibilities, 3) physical capacity, 4) health conditions, and 5) lack of exercise facilities. Contrarily, facilitators potentially contributing to PA prehabilitation adherence in kidney cancer included 1) holistic health, 2) social and professional support, 3) acknowledgment of health benefits, 4) exercise type and guidance, and 5) Communication channels. CONCLUSION AND KEY FINDINGS: Kidney cancer patient's adherence to physical activity prehabilitation is influenced by multiple biopsychosocial barriers and facilitators. Hence, adherence to physical activity prehabilitation requires timely adaptation of health beliefs and behavior embedded in the reported barriers and facilitators. For this reason, prehabilitation strategies should strive to be patient-centered and include health behavioral change theories as underlying frameworks for sustaining patient engagement and self-efficacy.

Integrative Surgery: Embedding Complementary and Nonpharmacologic Therapies into Surgical Pain Management Strategies.

There has been a growing interest in the use of complementary and alternative medicine in modern pain management strategies on behalf of both patients and clinicians. Nonpharmacologic modalities such as cryotherapy, acupuncture, music, and mind-body therapies have been shown to aid in symptom control and improve quality of life in patients suffering from acute and chronic pain, and there is a growing body of literature demonstrating their feasibility, acceptability, and efficacy in the perioperative period. Here, we provide a brief review of the current evidence supporting the use of complementary therapies within existing perioperative pain management strategies and highlight evidence-based protocols to facilitate implementation into modern surgical practice.

Examination of Provider and Patient Knowledge, Beliefs, and Preferences in Integrative Oncology at a National Cancer Institute-Designated Comprehensive Cancer Center.

Purpose: The use of integrative approaches for symptom management is highly prevalent among patients undergoing cancer treatment and among cancer survivors and is increasingly endorsed by clinical practice guidelines. However, access to and implementation of integrative oncology (IO) approaches are hindered by barriers at multiple levels, including logistic, geographic, financial, organizational, and cultural barriers. The goal of this mixed-method study was to examine oncology provider and patient knowledge, beliefs, and preferences in IO to identify facilitators, barriers, and recommendations for implementation of IO modalities. Materials and Methods: Data sources included patient surveys and provider semistructured interviews. Patients were in active treatment (n = 100) and survivors (n = 100) of heterogeneous cancer types. Patient and survivor surveys interrogated: (1) interest in types of IO approaches; and (2) preferences for delivery modality, frequency, and location. Providers (n = 18) were oncologists and nurse navigators working with diverse cancer types. Interviews queried their knowledge of and attitudes about IO, about their patients' needs for symptom management, and for recommendations for implementation of IO approaches in their clinic. We used the Consolidated Framework for Implementation Research framework to systematically analyze provider interviews. Results: The primary interests reported among actively treated patients and survivors were massage therapy, acupuncture, and wellness/exercise. Most patients expressed interest in both group and individual sessions and in telehealth or virtual reality options. Emergent themes from provider interviews identified barriers and facilitators to implementing IO approaches in both the internal and external settings, as well as for the implementation process. Conclusion: The emphasis on mind-body interventions as integrative rather than alternative highlights the importance of interventions as evidence-based, comprehensive, and integrated into health care. Gaining simultaneous perspectives from both patients and physicians generated insights for the implementation of IO care into complex clinical systems within a comprehensive cancer center.

Mindfulness in Surgical Care, Training, and Practice.

There exists a robust amount of evidence supporting the broad application of mindfulness in a clinical environment. The evolution of mindfulness research is germane to modern surgical practice and education given its impact on patient outcomes, cognitive function, surgical skill, and mental health and wellbeing. "Mindfulness in surgical care, training, and practice" includes a series of articles that highlight the theoretical rationale behind mindfulness-based interventions (MBIs) for optimization of patient care and define its role in surgical education and practice. Furthermore, each article offers implementation strategies and best practices such that mindfulness-based interventions and curricula can be adapted to meet the unique needs of patients and providers existing within a diverse surgical environment. This series brings attention to the evolving archetype of surgical culture - one in which the wellbeing of individuals and communities is emphasized as fundamental to optimum patient care and outcomes.

Adherence Patterns and Acceptability of a Perioperative, App-Based Mindfulness Meditation Among Surgical Patients With Chronic Pain.

Identifying barriers to compliance with mindfulness-based interventions (MBIs) during the perioperative period is paramount to the design and implementation of non-pharmacologic, opiate-sparing pain regimens. We prospectively investigated the acceptability and adherence patterns of an app-based MBI amongst surgical patients with chronic pain. Patients were provided a subscription code to a meditation app and encouraged to use the app an average of 10 minutes/day over a 6-week study period. Patients reported a high level of interest in using the app prior to enrollment. 71% used the app at least once, 30% for half the recommended time, and 8% for the recommended amount of time. 88% of respondents enjoyed using the app and agreed it improved mental health and stress levels. Surgical patients with pre-existing pain report a high level of interest in utilizing MBIs perioperatively. Identifying barriers to compliance represents an important area of future investigation.

Integrative surgical oncology: A model of acute integrative oncology.

Integrative oncology has emerged as a recognized medical subspecialty because of growing interest in the use of integrative medicine in modern cancer care on behalf of both patients and providers. Acutherapy and mind-body techniques, such as meditation and yoga, have been shown to aid in symptom control and improve quality of life in oncologic patient populations, and the Society of Integrative Oncology and American Society of Clinical Oncology have recently endorsed a set of guidelines for the implementation of these techniques specifically in patients with breast cancer. Although the current guidelines focus largely on the management of chronic symptoms, there exists evidence to support the use of these techniques in acute symptom management as well. With surgical resection representing the backbone of many cancer treatment regimens, symptoms that arise during the perioperative period are prime examples of the acute symptomatology common among patients with cancer. Here, the authors provide a detailed literature review of the current evidence supporting the use of integrative techniques during the perioperative period and demonstrate their applicability for acute symptom management within oncologic and surgical populations. In doing so, the authors introduce a new paradigm of surgical practice they call integrative surgical oncology and integrative surgery.

Patient-Reported Outcomes of Pain and Related Symptoms in Integrative Oncology Practice and Clinical Research: Evidence and Recommendations.

Pain is a primary concern among patients with cancer and cancer survivors. Integrative interventions such as acupuncture, massage, and music therapy are effective nonpharmacologic approaches for cancer pain with low cost and minimal adverse events. Patient-reported outcomes (PROs) that have been validated in many clinical and research settings can be used to evaluate pain intensity, associated symptom burden, and quality of life. Clearly defined, reliable PROs can improve patient satisfaction and symptom control. As integrative oncology continues to evolve and expand, cancer-related pain PROs must be standardized to accurately guide clinicians and researchers. Well-validated pain PROs, such as the Brief Pain Inventory, are among the most commonly used for pain intensity assessment. Multiple symptom assessment tools such as the MD Anderson Symptom Inventory, the Memorial Symptom Assessment Scale, the Edmonton Symptom Assessment System, and the Patient-Reported Outcomes-Common Terminology Criteria for Adverse Events measurement system can also capture pain-associated symptom burden. Electronic PROs provide flexibility in collecting and analyzing PRO data. Clinical trials using carefully selected PROs and rigorous statistical analysis plans are fundamental to conducting high-quality integrative oncology research and promoting utilization of effective integrative interventions to improve patient outcomes. In this review, we aim to summarize current, validated PROs specific to cancer-related pain to aid integrative oncology clinicians and researchers in patient care and in study design and implementation.