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

The Spiritual Supporter Scale as a New Tool for Assessing Spiritual Care Competencies in Professionals: Design, Validation, and Psychometric Evaluation

This study aimed to design, validate and standardize the Spiritual Supporter (SpSup) Scale, a tool designed to assess competency to provide spiritual care including knowledge, sensitivity to spiritual needs and spiritual support skills. This instrument can be used by all those engaged in or training for caregiving roles. The study was conducted in Poland in the Polish language. The SpSup Scale demonstrates high overall reliability (Cronbach's α = 0.88), a satisfactory diagnostic accuracy (0.79), and a satisfactory discriminatory power of the items. Given the psychometric properties of SpSup Scale demonstrated here, the scale is recommended for the assessment of the competency to provide spiritual care in both clinical and research settings in Poland.

Spirituality and religion in residents and inter-relationships with clinical practice and residency training: a scoping review

OBJECTIVES

With the increased emphasis on personalised, patient-centred care, there is now greater acceptance and expectation for the physician to address issues related to spirituality and religion (SR) during clinical consultations with patients. In light of the clinical need to improve SR-related training in residency, this review sought to examine the extant literature on the attitudes of residents regarding SR during residency training, impact on clinical care and psychological well-being of residents and SR-related curriculum implemented within various residency programmes.

DESIGN

A scoping review was conducted on studies examining the topic of SR within residency training up until July 2020 on PubMed/Medline and Web of Science databases. Keywords for the literature search included: (Spirituality OR Religion) AND (Residen* OR "Postgraduate Medicine" OR "Post-graduate Medicine" OR "Graduate Medical Education").

RESULTS

Overall, 44 studies were included. The majority were conducted in North America (95.5%) predominantly within family medicine (29.5%), psychiatry (29.5%) and internal medicine (25%) residency programmes. While residents held positive attitudes about the role of SR and impact on patient care (such as better therapeutic relationship, treatment adherence and coping with illness), they often lacked the knowledge and skills to address these issues. Better spiritual well-being of residents was associated with greater sense of work accomplishment, overall self-rated health, decreased burnout and depressive symptoms. SR-related curricula varied from standalone workshops to continuous modules across the training years.

CONCLUSIONS

These findings suggest a need to better integrate appropriate SR-related education within residency training. Better engagement of the residents through different pedagogical strategies with supervision, feedback, reflective practice and ongoing faculty and peer support can enhance learning about SR in clinical care. Future studies should identify barriers to SR-related training and evaluate the outcomes of these SR-related curriculum including how they impact the well-being of patients and residents over time.

Patient desire for spiritual assessment is unmet in urban and rural primary care settings

Background

Incorporation of patient religious and spiritual beliefs in medical care has been shown to improve the efficacy of medical interventions and health outcomes. While previous study has highlighted differences in patient desire for spiritual assessment based on patient religiosity, little is known about patient desire for spiritual assessment based on community type, particularly in urban compared to rural communities. We hypothesized that, given demographic trends which show a higher degree of religiosity in rural areas, patients in rural communities will be more likely to desire spiritual assessment.

Methods

In this cross-sectional study of 141 adult primary care patients in rural and urban Colorado at non-religiously affiliated clinics, we surveyed patient demographic information, measures of religiosity, patient desire for spiritual assessment, and frequency of spiritual assessment in practice. Univariate logistic regression analyses were used to compare the two populations.

Results

In both Denver County (urban) and Lincoln County (rural) over 90% of patients identified as religious, spiritual, or a combination of the two. Thirty eight percent (38.3%) of patients in Denver County and 49.1% of patients in Lincoln desired spiritual assessment. Over 97% of patients in both areas reported rarely or never being asked about their R/S within the past year. For patients who have had five or more clinic visits in the past year, more than 91% in both areas stated they have never or rarely been asked about their beliefs.

Conclusions

While the majority of patients in this study identify as religious or spiritual and many patients desire spiritual assessment, the majority of patients have never or rarely been asked about their spirituality within the past year. This demonstrates a significant gap between patient preference and provider practice of spiritual assessment in the primary care setting, which was similar in both rural and urban settings. This highlights the need for interdisciplinary focus on spiritual assessment and incorporation of patient R/S beliefs in medical care to provide holistic patient care and improve health outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06300-y.

What symptoms tell us: A multiple case study of oncology consultations

OBJECTIVES

While patients' symptom experiences have been widely investigated, there is a lack of contextualized studies investigating how symptoms circulate in the medical consultation, how patients present them, what they convey, how physicians respond, and how patients and physicians negotiate with each other to find ways to address them. The aim of this study is to explore patients and physicians handling of symptoms throughout oncological consultations with a multiple case study approach.

METHODS

Five consultations, purposively selected from an existing dataset of audiotaped consultations with patients with advanced cancer, were analyzed by means of an inductive analytical approach based on a sensitive framework from the literature.

RESULTS

Patients' symptoms showed multiple dimensions such as medical, cognitive, emotional, psychological, interactional, symbolic, experiential, and existential.

SIGNIFICANCE OF RESULTS

Different symptom dimensions remained unnoticed and unaddressed in the consultations. The physician-centered symptom approach that was observed leads to consumed time and missed opportunities for relationship building with the patient. Physicians showed a lack of sensitivity regarding the multiple dimensions of symptoms. Based on the findings, strategies for a more comprehensive symptom approach can be conceived.

A comparative account of the traditional healing practices of healers and non-healers in the Kiudang area of Brunei Darussalam

ETHNOPHARMACOLOGICAL RELEVANCE

In this study, we compare the traditional medicinal knowledge and associated spiritual practices of healers with that of non-healers, to understand the relevance of healers in contemporary times. Given that Brunei Darussalam is well-known for its forest cover, the study also aims to understand the number of species collected from the forests, compared to those from human influenced habitats.

MATERIALS AND METHODS

A total of six specialist healers from Belait, Tutong, Dusun and Iban communities, and seven non-healers who had personal experience in self-medication using medicinal plants participated in the study. We identified the specialist healers through purposive sampling, on the basis of their reputation in the locality, while the non-healers were those experienced in self-medication, recommended by the healers. Informants were interviewed at their residences, followed by collection trips to the plant habitats. We classified the total recorded ailments into 15 disease categories. We then compared the medicinal uses cited by healers to those mentioned by non-healers, as well as with prior published records from Brunei Darussalam. We also compare the habitats of species cited by both healers and non-healers to understand the dependency of the local pharmacopoeia on forests and human-influenced habitats.

RESULTS

Our study records 175 medicinal plants belonging to 85 families, the majority of which (92) were exotic to Borneo. There were 110 species collected from disturbed, human influenced habitats such as roadsides, agricultural fields, secondary and degraded forests, and homestead lands, while 58 species were collected from the forests surrounding Kiudang. Majority of the plants used by both healers and non-healers were collected from human-influenced habitats, indicating that the local pharmacopoeia could be a disturbance one. Most of the medicinal plants recorded in this study were used to treat chronic, but non-life threatening conditions. Ailments affecting the digestive system were the most targeted group with 67 species used. All medicinal uses with more than one citation were recorded from healers. Medicinal uses cited by healers also had greater correspondence with prior published reports from Brunei Darussalam. Healers believe that combining medicinal plants can produce a synergistic effect. Our study found that traditional knowledge related to healing practices is mostly transmitted vertically from parents to children. We also show that a ritual gift (pikaras) and invocations characteristic of the beliefs of the healers play an important role in facilitating healing.

CONCLUSION

Our study adds further evidence to prior studies that the medicinal plants and healing practices in the Kiudang region could be considered as disturbance pharmacopoeia. Healers with their knowledge on both therapeutic and spiritual aspects of healing continue to play an important role in local healthcare.

Training for awareness of one's own spirituality: A key factor in overcoming barriers to the provision of spiritual care to advanced cancer patients by doctors and nurses

OBJECTIVE

When patients feel spiritually supported by staff, we find increased use of hospice and reduced use of aggressive treatments at end of life, yet substantial barriers to staff spiritual care provision still exist. We aimed to study these barriers in a new cultural context and analyzed a new subgroup with "unrealized potential" for improved spiritual care provision: those who are positively inclined toward spiritual care yet do not themselves provide it.

METHOD

We distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items included how often spiritual care should be provided, how often respondents themselves provide it, and perceived barriers to spiritual care provision.ResultWe had 770 respondents (40% physicians, 60% nurses) from 14 Middle Eastern countries. The results showed that 82% of respondents think staff should provide spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. In multivariable analysis of respondents who valued spiritual care yet did not themselves provide it to their most recent patients, predictors included low personal sense of being spiritual (p < 0.001) and not having received training (p = 0.02; only 22% received training). How "developed" a country is negatively predicted spiritual care provision (p < 0.001). Self-perceived barriers were quite similar across cultures.Significance of resultsDespite relatively high levels of spiritual care provision, we see a gap between desirability and actual provision. Seeing oneself as not spiritual or only slightly spiritual is a key factor demonstrably associated with not providing spiritual care. Efforts to increase spiritual care provision should target those in favor of spiritual care provision, promoting training that helps participants consider their own spirituality and the role that it plays in their personal and professional lives.

Effectiveness of CancerGuides®: A Study of an Integrative Cancer Care Training Program for Health Professionals

Purpose: To determine how CancerGuidesâ®, an integrative cancer care training program, would affect participants' perception of their professional skills, their mood, use of self care and mind-body modalities, and the acceptance of integrative cancer care at their institutions. Study Design: Qualitative and quantitative measures were used during the training program and at 6-month follow-up. A focus group met before and after the training, and individual interviews of focus group participants were done at follow-up. Methods: The week-long program consisted of lectures that provided information on integrating conventional and complementary therapies into individualized programs of cancer care. Small group sessions used mind-body techniques to allow participants to understand the dilemmas faced by cancer patients. A self-report survey was administered at the training program and at 6-month follow-up. The survey included questions on the personal and professional use of modalities and on participants' sense of how well they met the course objectives. Qualitative questions addressed self-care, changes in clinical practice, and the acceptance of integrative therapies by their institutions. The Profile of Mood States was administered before and after the training. Results: Six months after the training, there was a significant increase in the use and/or recommendation of complementary and alternative medicine modalities in clinical practice and a significant increase in the personal practice of these modalities. Participants' perceived level of skill for all of the course objectives was significantly increased following the training and was maintained at 6-month follow-up. There were significant reductions in the Anger-Hostility and Tension-Anxiety subscale scores of the Profile of Mood States questionnaire. In response to qualitative questions, participants reported positive changes in patient care and in their clinical practices at 6-month follow-up. The subset of participants in the focus group interviews reported similar improvements. Thirty-five percent of those responding at follow-up reported an increase in acceptance of integrative cancer therapies at their institutions, and 77% reported making positive changes in self-care. Conclusions: Cancer-Guides provided training that allowed participants to enhance personal self-care, to interact more effectively with their patients, and to develop programs of integrative cancer care.

Effectiveness of Physical, Psychological, Social, and Spiritual Intervention in Breast Cancer Survivors: An Integrative Review

Factors affecting the health outcomes of cancer patients have gained extensive research attention considering the increasing number and prolonged longevity of cancer survivors. Breast cancer survivors experience physical, psychological, social, and spiritual challenges. This systematic literature review aims to present and discuss an overview of main issues concerning breast cancer survivors after treatment. Treatment-related symptoms as well as psychosocial and spiritual aspects of breast cancer survivors are evaluated. Moreover, the benefits of intervention for emotional, physical, social, and spiritual needs of the patient during the survivorship are investigated. This review also proposes avenues for future studies in this field and develops a new, integrated, and complete interpretation of findings on the holistic well-being of women with breast cancer. Thus, this study provides clinicians with a more comprehensive source of information compared with individual studies on symptom experiences.

Do patients want doctors to talk about spirituality? A systematic literature review

OBJECTIVE

The aim of this systematic literature review was to ascertain the patient perspective regarding the role of the doctor in the discussion of spirituality.

METHODS

We conducted a systematic search in ten databases from inception to January 2015. Eligible papers reported on original research including patient reports of discussion of spirituality in a medical consultation. Papers were separated into qualitative and quantitative for the purposes of analysis and quality appraisal with QualSyst. Papers were merged for the final synthesis.

RESULTS

54 studies comprising 12,327 patients were included. In the majority of studies over half the sample thought it was appropriate for the doctor to enquire about spiritual needs in at least some circumstances (range 2.1-100%, median 70.5%), but patient preferences were not straightforward.

CONCLUSION

While a majority of patients express interest in discussion of religion and spirituality in medical consultations, there is a mismatch in perception between patients and doctors regarding what constitutes this discussion and therefore whether it has taken place.

PRACTICE IMPLICATIONS

This review demonstrated that many patients have a strong interest in discussing spirituality in the medical consultation. Doctors should endeavor to identify which patients would welcome such conversations.

Operationalizing Pain Treatment in the Biopsychosocial Model: Take a Daily "SWEM"--Socialize, Work, Exercise, Meditate

In the United States, chronic pain is often poorly treated at an exceedingly high cost. The use of the biomedical model to manage pain is frequently ineffective, and evidence suggests that the biopsychosocial (BPS) model is a better choice. A problem with the BPS model is that it has not been operationalized in terms of patient behavior. This commentary addresses that issue by suggesting that people with chronic pain and illness participate daily in four self-management health behaviors: socialize, work, exercise, and meditation, and discusses evidence that supports these recommendations. These self-management behaviors may decrease pain and thus reduce the need for pain medications and other medical interventions. Additional topics include patient adherence and health coaching.

Compared perspectives of Arab patients in Palestine and Israel on the role of complementary medicine in cancer care

CONTEXT

Complementary medicine (CM) is extensively used by patients with cancer across the Middle East.

OBJECTIVES

We aimed to compare the perspectives of two Arab populations residing in diverse socioeconomic-cultural settings in Palestine and Israel regarding the role of CM in supportive cancer care.

METHODS

A 27-item questionnaire was constructed and administered to a convenience sample of Arab patients receiving cancer care in four oncology centers in northern Israel and Palestine.

RESULTS

Each of the two groups had 324 respondents and was equally distributed by age and marital status. Compared with the Israeli-Arab group, Palestinian participants reported significantly higher CM use for cancer-related outcomes (63.5% vs. 39.6%, P < 0.001), which included more herbal use (97.6% vs. 87.9%, P = 0.001) and significantly lower use of dietary supplements, acupuncture, mind-body and manual therapies, and homeopathy. Most respondents in both groups stated that they would consult CM providers if CM was integrated in oncology departments. Related to this theoretical integrative scenario, Palestinian respondents expressed fewer expectations from their oncologists to actively participate in building their CM treatment plan. Treatment expectations in both groups focused on improving quality of life (QOL), whereas Palestinian respondents had fewer expectations for CM to improve fatigue, emotional concerns, sleep, and daily functioning.

CONCLUSION

Arab patients with cancer from Palestine and Israel highly support CM integration within their oncology institutions aiming to improve QOL. Nevertheless, respondents differed in their perceived model of CM integration, its treatment objectives, and their oncologists' role in CM integration.

Cancer survivors' perspectives and experience on western medicine and traditional Chinese medicine treatment and rehabilitation: a qualitative study

BACKGROUND

In the People's Republic of China, both western medicine (WM) and traditional Chinese medicine (TCM) are the main treatment and rehabilitation options for cancer patients. This study aimed to explore cancer survivors' perspectives and experience of treatment and rehabilitation, in order to promote patient-centered activities of treatment and rehabilitation.

METHODS

Using a qualitative research approach, 68 cancer survivors were recruited from eight community cancer rehabilitation organizations in Shanghai, People's Republic of China. Eight focus group interviews were conducted. All these interviews were transcribed verbatim, and the data were analyzed by theme analysis.

RESULTS

WM was the main choice in treatment phase though study participants noted more side effects. TCM was primarily used in the recovery phase. The lack of communication between doctors and cancer patients appears to affect treatment adherence and impair the doctor-patient relationship. WM was expensive for diagnostic procedures and treatment, while the cumulative costs of frequent use of TCM in the long rehabilitation period were also high. Both treatment options created significant perceived economic burden on patients. Conflicting information about dietary supplements tended to make cancer survivors confused.

CONCLUSION

Improving the communication between doctors and cancer patients helps to ameliorate cancer patient adherence and the effect of treatments. It is essential to educate cancer patients about the effect and cost of both WM and traditional TCM. Meanwhile, marketing management and guidance to consumers regarding use of dietary supplements in the cancer rehabilitation field are also necessary.

[Psychosocial status of Hungarian cancer patients. A descriptive study]

INTRODUCTION

Psychosocial status of cancer patients is still understudied in Hungary.

AIM

The aim of the authors was to obtain current information on the mental and social status of this patient group.

METHOD

Altogether, 1070 cancer patients with a wide range of cancer types were included in the study (30.0% male; age: 55.9 ± 11.0 years).

RESULTS

A large part of the patients had serious financial difficulties and 41.3% of them were struggling with at least one more comorbid chronic disease. Further, 52.2% of the patients reported at least moderate anxiety or depression, while the occurrence of suicidal thoughts was almost three times higher among them than in the Hungarian normal population (13.0% vs. 4.6%). Level of perceived social support was also lower than the population standards and 61.6% of the patients reported willingness to benefit from professional psychological support. Quality of social life of the patients deteriorated with time after cancer diagnosis. A positive phenomenon, however, was that the primary coping style reported was active problem solving.

CONCLUSIONS

The authors conclude that it is necessary to screen cancer patients for psychosocial difficulties and to establish conditions for their adequate mental and social care in Hungary.

Integrative health care in Israel and traditional arab herbal medicine: when health care interfaces with culture and politics

This article contributes to contemporary critical debate in medical anthropology concerning medical pluralism and integrative medicine by highlighting the issue of exclusion of traditional medicine (TM) and presenting attempts at border crossing. Although complementary medicine (CM) modalities are integrated into most Israeli mainstream health care organizations, local indigenous TM modalities are not. Ethnographic fieldwork focused on a group of Israeli dual-trained integrative physicians that has recently begun to integrate traditional herbal medicine preferred by the Arab minority, using it as a boundary object to bridge professional gaps between biomedicine, CM, and TM. This article highlights the relevance of political tensions, ethnicity, and medical inequality to the field of integrative health care. It shows that using herbal medicine as a boundary object can overcome barriers and provide opportunities for dialog and reciprocal learning.

Barriers and challenges in integration of anthroposophic medicine in supportive breast cancer care

In the last decade, more and more oncology centers are challenged with complementary medicine (CM) integration within supportive breast cancer care. Quality of life (QOL) improvement and attenuation of oncology treatment side effects are the core objectives of integrative CM programs in cancer care. Yet, limited research is available on the use of specific CM modalities in an integrative setting and on cancer patients’ compliance with CM consultation. Studies are especially warranted to view the clinical application of researched CM modalities, such as anthroposophic medicine (AM), a unique CM modality oriented to cancer supportive care. Our objective was to characterize consultation patterns provided by physicians trained in CM following oncology health-care practitioners’ referral of patients receiving chemotherapy. We aimed to identify characteristics of patients who consulted with AM and to explore patients’ compliance to AM treatment. Of the 341 patients consulted with integrative physicians, 138 were diagnosed with breast cancer. Following integrative physician consultation, 56 patients were advised about AM treatment and 285 about other CM modalities. Logistic multivariate regression model found that, compared with patients receiving non-anthroposophic CM, the AM group had significantly greater rates of previous CM use [EXP(B) = 3.25, 95% C.I. 1.64-6.29, p = 0.001] and higher rates of cancer recurrence at baseline (p = 0.038). Most AM users (71.4%) used a single AM modality, such as mistletoe (viscum album) injections, oral AM supplements, or music therapy. Compliance with AM modalities following physician recommendation ranged from 44% to 71% of patients. We conclude that AM treatment provided within the integrative oncology setting is feasible based on compliance assessment. Other studies are warranted to explore the effectiveness of AM in improving patients’ QOL during chemotherapy.

I will always be with you: traditional and complementary therapists' perspectives on patient-therapist-doctor communication regarding treatment of Arab patients with cancer in Israel

OBJECTIVE

In 2008, an Integrative Oncology Program was implemented at the Clalit Oncology Service in Haifa, Israel, to promote patients' well-being during chemotherapy and advanced stages of disease. We hypothesized that studying the perceptions of Arab complementary and alternative medicine (CAM) therapists would facilitate development of a cross-culturally integrative oncology approach.

METHODS

Semi-structured interviews were held with 27 Arab therapists who use medicinal herbs, the Quran and various CAM modalities, with the aim of characterizing their treatment practices and learning about their perspectives regarding conventional cancer care.

RESULTS

Thematic analysis revealed that therapists act as go-betweens, mediating between patients and conventional physicians. Therapists translate diagnoses into Arabic and elucidate key concepts. They tend to perceive their role as gatekeepers accompanying patients through the conventional health system, referring them for further examinations, and providing CAM-based supportive care consultation.

CONCLUSIONS

CAM therapists have an essential role in supportive care of Arab patients with cancer. Triangular patient-therapist-oncologist communication may have an impact on patients' experience and treatment quality.

PRACTICE IMPLICATIONS

Recognition of CAM therapists as mediators between patients' health beliefs and conventional perceptions of care may improve doctor-patient dialogue and facilitate supportive care provision in a cross-cultural context.

Can holism be practiced in a biomedical setting? A qualitative study of the integration of complementary medicine to a surgical department

In recent decades, complementary medicine (CM) has been increasingly integrated to conventional healthcare organizations, in which the biomedical profession clearly maintains dominance. Our objective was to investigate empirically what integration and 'holism' mean to the diverse professional groups involved and whether treatment becomes more holistic when CM is integrated. A qualitative study was conducted in a general surgery department at a public hospital in Israel. Data were collected by means of observations of medical encounters and daily work, and 30 in-depth interviews with medical directors, surgeons, senior nurses, CM practitioners and hospitalized patients. We found that most of the interviewed nurses, surgeons and directors and some patients believed that CM treatments were of value in addressing the psychological needs of patients within this predominantly somatic-oriented department. To CM practitioners and some of the patients, integration means introducing and practicing a holistic outlook in this biomedical context, which involves elements such as Qi, energy, soul and spirit. Such practices were directed to a suitable audience, namely, patients as well as conventional medical staff who were willing to explore a holistic approach. We concluded that patient care tends to become more comprehensive when CM is integrated. Despite the overall dominance of biomedicine, holistic CM practices were introduced to the biomedical setting of the hospital. Yet, the question whether holistic CM practices and perceptions will eventually lead nurses and physicians toward paradigmatic integration, has still to be examined.

Cancer patients' experience of combined treatment with conventional and traditional Chinese medicine: a biopsychosocial phenomenon

BACKGROUND

Traditional Chinese medicine (TCM) is used worldwide as a complementary and alternative medicine, but little is known about cancer patients' experience when using combination therapy of TCM and conventional medicine.

OBJECTIVES

The goal of this study was to understand the experiences of Taiwanese cancer patients undergoing conventional chemotherapy and using TCM at the same time.

METHODS

For this qualitative descriptive study, 9 cancer patients (42-63 years old) were interviewed individually and in depth using a semistructured guide. All interviews were audiotaped and transcribed verbatim. Data were concurrently collected and analyzed using a constant comparative method to develop major themes and categories.

RESULTS

Data analysis revealed 3 themes: (1) biomedical aspect: TCM as a supplementary force to conventional medicine, (2) psychological aspect: different beliefs about TCM create different TCM uses, and (3) social aspect: interactions among patients, physicians, and economic issues.

CONCLUSIONS

Our study reveals that the phenomenon of using TCM is captured in a biopsychosocial model.

IMPLICATIONS FOR PRACTICE

When assessing the issue of TCM use among cancer patients, healthcare providers must take into consideration its biological, psychological, and social aspects.

Integrative oncology in the Middle East: from traditional herbal knowledge to contemporary cancer care

BACKGROUND

Based on traditional, historical, ethnobotanical, laboratory, and clinical findings, we present research framework aiming to identify Middle Eastern herbs that are worthy of further research for their anticancer potential.

METHODS

A comprehensive research project was developed by a multinational team comprising family physicians, medicine specialists, oncologists, an Islamic medicine history specialist, a traditional medicine ethnobotanist, and a basic research scientist. The project followed two consecutive phases: (i) historical and ethnobotanical search for cancer-related keywords and (ii) Medline search for in vitro and in vivo studies.

RESULTS

This search yielded 44 herbs associated with cancer care. The Medline search yielded 34 herbs of which 9 herbs were reported in various clinical studies.

CONCLUSIONS

This multidisciplinary survey was found to be a valuable way to identify herbs with potential clinical significance in cancer care. Based on this pilot study, it is suggested that the Middle East can serve as a valuable region for future multicultural-oriented cancer research.

Barriers to integration of traditional and complementary medicine in supportive cancer care of arab patients in northern Israel

In 2008, an Integrative Oncology Program (IOP), aiming to improve patients' quality of life during chemotherapy and advanced cancer, was launched within the Clalit Health Organization's oncology service at the Lin Medical Center, Haifa, Israel. The IOP clinical activity is documented using a research-based registry protocol. In this study, we present an analysis of the registry protocol of 15 Arab patients with cancer who were referred to the IOP. Analysis of patients' reported outcomes using the Edmonton Symptom Assessment Scale suggests that integrative medicine care improves fatigue (P = 0.024), nausea (P = 0.043), depression (P = 0.012), anxiety (P = 0.044), appetite (P = 0.012), and general well-being (P = 0.031). Barriers to integration of traditional and complementary medicine in supportive care of Arab patients are discussed followed by six practical recommendations aimed at improving accessibility of patients to integrative supportive care, as well as compliance with treatments.

Greco-arab and islamic herbal-derived anticancer modalities: from tradition to molecular mechanisms

The incidence of cancer is increasing in the developed countries and even more so in developing countries parallel to the increase in life expectancy. In recent years, clinicians and researchers advocate the need to include supportive and palliative care since the establishment of the diagnosis and throughout the duration of treatment, with the goal of improving patients' quality of life. This patient-centered approach in supportive care is also shared by various traditional and complementary medicine approaches. Traditional Arab-Islamic medicine offers a variety of therapeutic modalities that include herbal, nutritional, and spiritual approaches. Physicians and scholars, such as Avicenna (980–1037), Rhazes (965–915), Al Zahrawi (936–1013), and Ibn al Nafis (1218–1288) referred to cancer etiology in various medicinal texts and suggested both preventive and therapeutic remedies to alleviate suffering. This review presents research data related to the anticancer activities of herbs used in Arab-Islamic medicine and allude to their potential role in improving the quality of life of cancer patients.

Psycho-spiritual integrative therapy for women with primary breast cancer

Breast cancer presents physical and psychological challenges, but can also result in posttraumatic growth (PTG). Twenty-four women completed Psycho-Spiritual Integrative Therapy (PSIT) treatment and completed assessments for PTG and QOL before, immediately following, and 1 month after treatment. Women showed improvement (p < .01) on the FACT-B (Functional Assessment of Cancer Therapy-Breast) Physical Well-being, Emotional Well-being, and Functional Well-being subscales, on the Profile of Mood States (POMS) Depression, Anger, and Fatigue subscales (p < .05), and on their POMS Tension, Vigor and Total Mood Disturbance (TMD) scores (p < .01). Also, women showed improvement on the FACIT-Sp-Ex (Functional Assessment of Chronic Illness Therapy-Spiritual) Meaning/Peace subscale, the Spiritual Well-being total scale (p < .01), and on the New Possibilities (p < .01) and Personal Strength (p < .05) subscales of the Posttraumatic Growth Inventory (PTGI). This preliminary study suggests that PSIT may improve well being and stimulate PTG in breast cancer patients.

Integration of herbal medicine in primary care in Israel: a jewish-arab cross-cultural perspective

Herbal medicine is a prominent complementary and alternative medicine (CAM) modality in Israel based on the country's natural diversity and impressive cultural mosaic. In this study, we compared cross-cultural perspectives of patients attending primary care clinics in northern Israel on herbal medicine specifically and CAM generally, and the possibility of integrating them within primary care. Research assistants administered a questionnaire to consecutive patients attending seven primary care clinics. About 2184 of 3713 respondents (59%) defined themselves as Muslims, Christians or Druze (henceforth Arabs) and 1529 (41%) as Jews. Arab respondents reported more use of herbs during the previous year (35 versus 27.8% P = .004) and of more consultations with herbal practitioners (P < .0001). Druze reported the highest rate of herbal consultations (67.9%) and Ashkenazi Jews the lowest rate (45.2%). About 27.5% of respondents supported adding a herbal practitioner to their clinic's medical team if CAM were to be integrated within primary care. Both Arabs and Jews report considerable usage of herbal medicine, with Arabs using it significantly more. Cross-cultural perspectives are warranted in the study of herbal medicine use in the Arab and Jewish societies.

Exploring association of spiritual perspectives with complementary medicine use among patients with Type 2 diabetes in Israel

BACKGROUND

Spirituality, as distinct from religiosity, has become a most common term in complementary and alternative medicine (CAM) discourse. The association between religiosity and spirituality in the context of CAM use is a complex one and is worthy of being researched in specific local cultural contexts.

OBJECTIVE

Exploring the association between CAM use and religiosity, in patients with and without diabetes Type 2 attending primary care clinics in Northern Israel.

RESEARCH DESIGN AND METHODS

Research assistants administered a questionnaire developed to assess CAM use in primary care to a convenience sample of patients attending seven primary care clinics.

RESULTS

Of the 3742 respondents, 485 (12.9%) reported having Type 2 diabetes. Respondents with diabetes reported more overall CAM use during the previous year (46.9% vs. 42%, P=0.049). A logistic regression model of patients with diabetes Type 2 indicated that CAM use was associated with higher self-assessed religiosity [Exp(B)=1.898, 95% CI for Exp(B) 1.02-3.529, P=0.043]. CAM use among patients with diabetes was also associated more with female gender, higher education, and age under 60. The positive association between CAM use and degree of self-assessed religiosity was further studied in sub-populations of Jewish and Arab patients with diabetes Type 2. A logistic regression model of the Jewish population indicated significant association between CAM use and higher religiosity [Exp(B)=3.668, 95% CI for Exp(B) 1.232-10.922, P=0.02].

CONCLUSION

Primary care physicians need to be aware of a possible association between religiosity and CAM use in patients with diabetes. Physicians may consider adding questions on CAM and religiosity to routine clinical interviews in order to enrich their dialog with diabetes patients.

Factors associated with self-reported physical and mental health after hematopoietic cell transplantation

Hematopoietic cell transplantation (HCT) is an intensive treatment for hematologic malignancies that has the potential to cure disease or prolong life, but also to impair quality of life for survivors. Earlier studies have suggested that various factors are associated with physical and mental health after HCT. In this study, we evaluated demographic and clinical factors before and after HCT and selected psychosocial factors after HCT, exploring their association with self-reported physical and mental health. We studied a cohort of 662 survivors at a median of 6.6 years after HCT. Pre-HCT demographic and clinical factors accounted for only a small amount of the variance in physical and mental health post-HCT (3% and 1%, respectively). Adding post-HCT clinical variables to the pre-HCT factors accounted for 32% and 7% of physical and mental outcomes, respectively. When both clinical and psychosocial factors were considered, better physical health post-HCT was associated with younger age, race other than white, higher current family income, currently working or being a student, less severe transplantation experience (ie, not experiencing graft-versus-host disease), fewer current comorbidities, higher Karnofsky status, less social constraint, less social support, and less trait anxiety. This multivariate model accounted for 36% of the variance in physical health, with the psychosocial variables contributing very little. When both clinical and psychosocial factors were considered, better mental health after HCT was associated with more severe transplantation experience, less social constraint, greater spiritual well being, and less trait anxiety. This multivariate model accounted for 56% of the variance in mental health, with the psychosocial factors accounting for most of the variance. These data suggest that clinical factors are explanatory for much of the post-HCT physical health reported by HCT survivors, but very little of self-perceived mental health. These observations provide insight into the identification of factors that can allow recognition of at-risk patients, as well as factors amenable to intervention.

The 3 H and BMSEST models for spirituality in multicultural whole-person medicine

PURPOSE

The explosion of evidence in the last decade supporting the role of spirituality in whole-person patient care has prompted proposals for a move to a biopsychosocial-spiritual model for health. Making this paradigm shift in today's multicultural societies poses many challenges, however. This article presents 2 theoretical models that provide common ground for further exploration of the role of spirituality in medicine.

METHODS

The 3 H model (head, heart, hands) and the BMSEST models (body, mind, spirit, environment, social, transcendent) evolved from the author's 12-year experience with curricula development regarding spirituality and medicine, 16-year experience as an attending family physician and educator, lived experience with both Hinduism and Christianity since childhood, and a lifetime study of the world's great spiritual traditions. The models were developed, tested with learners, and refined.

RESULTS

The 3 H model offers a multidimensional definition of spirituality, applicable across cultures and belief systems, that provides opportunities for a common vocabulary for spirituality. Therapeutic options, from general spiritual care (compassion, presence, and the healing relationship), to specialized spiritual care (eg, by clinical chaplains), to spiritual self-care are discussed. The BMSEST model provides a conceptual framework for the role of spirituality in the larger health care context, useful for patient care, education, and research. Interactions among the 6 BMSEST components, with references to ongoing research, are proposed.

CONCLUSIONS

Including spirituality in whole-person care is a way of furthering our understanding of the complexities of human health and well-being. The 3 H and BMSEST models suggest a multidimensional and multidisciplinary approach based on universal concepts and a foundation in both the art and science of medicine.

Complementary/alternative medicine for supportive cancer care: development of the evidence-base

AIM

The aim of this article is to compare the evidence relating to the effectiveness of complementary/alternative medicine (CAM) in palliative cancer care as it existed in 2000 and 2005.

METHODS

Our comparison is based on systematic reviews using the same methodology at these two points in time.

RESULTS

The results reveal a buoyant research activity in this sector. Consequently, new evidence for 19 CAM modalities has emerged between 2000 and 2005. For some treatments, the evidence is encouraging but for very few, it is as yet fully convincing.

CONCLUSION

It follows that further research is warranted, particularly in areas where the data already looks encouraging.