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Kwong MH, Ho L, Li ASC, Nilsen P, Ho FF, Zhong CCW, Chung VCH. Integrative oncology in cancer care - implementation factors: mixed-methods systematic review. BMJ Support Palliat Care 2023:spcare-2022-004150. [PMID: 37173126 DOI: 10.1136/spcare-2022-004150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Integrative oncology (IO) appears to be beneficial to patients with cancer, but its implementation remains a challenge. Guided by the Theoretical Domains Framework (TDF) and the Capability-Opportunity-Motivation-Behaviour (COM-B) model, this systematic review identified the barriers to and facilitators of IO implementation in conventional cancer care settings. METHODS We searched eight electronic databases from their inception until February 2022 for qualitative, quantitative or mixed-methods empirical studies reporting the implementation outcomes for IO services. Critical appraisal approach was tailored according to study types. The identified implementation barriers and facilitators were mapped onto TDF domains and the COM-B model, and subsequently onto the behavioural change wheel (BCW) for formulating behavioural change interventions. RESULTS We included 28 studies (11 qualitative, 6 quantitative, 9 mixed-methods and 2 Delphi studies) of satisfied methodological quality. The main implementation barriers were the lack of IO knowledge, the absence of funding and healthcare professionals' low level of IO receptiveness. The key implementation facilitators were the dissemination of evidence on IO clinical benefits, the equipping of professionals with IO service delivery skills and the provision of a supportive organisational climate. CONCLUSION Multifaceted implementation strategies are needed to address the determinants influencing IO service delivery. Based on our BCW-based analysis of the included studies, the key behavioural change techniques are: (1) educating healthcare professionals about the value and application of traditional and complementary medicine; (2) ensuring access to actionable clinical evidence on IO effectiveness and safety and (3) designing guidelines on communicating traditional and complementary medicine interventions with patients and caregivers for biomedically trained doctors and nurses.
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Affiliation(s)
- Ming Hong Kwong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Leonard Ho
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Angus S C Li
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Per Nilsen
- Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Östergötland, Sweden
| | - Fai Fai Ho
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Claire C W Zhong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Vincent C H Chung
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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Grimm D, Voiss P, Paepke D, Dietmaier J, Cramer H, Kümmel S, Beckmann MW, Woelber L, Schmalfeldt B, Freitag U, Kalder M, Wallwiener M, Theuser AK, Hack CC. Gynecologists' attitudes toward and use of complementary and integrative medicine approaches: results of a national survey in Germany. Arch Gynecol Obstet 2021; 303:967-980. [PMID: 33201377 PMCID: PMC7985114 DOI: 10.1007/s00404-020-05869-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/31/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Despite patients' widespread use and acceptance of complementary and integrative medicine (IM), few data are available regarding health-care professionals' current implementation of it in clinical routine. A national survey was conducted to assess gynecologists' attitudes to and implementation of complementary and integrative treatment approaches. METHODS The Working Group on Integrative Medicine of the German Society of Gynecological Oncology conducted an online survey in collaboration with the German Society of Gynecology and Obstetrics (DGGG) in July 2019. A 29-item survey was sent to all DGGG members by email. RESULTS Questionnaires from 180 gynecologists were analyzed, of whom 61 were working office-based in private practice and 95 were employed in hospitals. Seventy percent stated that IM concepts are implemented in their routine clinical work. Most physicians reported using IM methods in gynecological oncology. The main indications for IM therapies were fatigue (n = 98), nausea and vomiting (n = 89), climacteric symptoms (n = 87), and sleep disturbances (n = 86). The most commonly recommended methods were exercise therapy (n = 86), mistletoe therapy (n = 78), and phytotherapy (n = 74). Gynecologists offering IM were more often female (P = 0.001), more often had qualifications in anthroposophic medicine (P = 0.005) or naturopathy (P = 0.019), and were more often based in large cities (P = 0.016). CONCLUSIONS There is strong interest in IM among gynecologists. The availability of evidence-based training in IM is increasing. Integrative therapy approaches are being implemented in clinical routine more and more, and integrative counseling services are present all over Germany. Efforts should focus on extending evidence-based knowledge of IM in both gynecology and gynecological oncology.
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Affiliation(s)
- Donata Grimm
- Department of Gynecology and Gynecologic Oncology, Hamburg-Eppendorf University Medical Center, Martinistrasse 52, 20246 Hamburg, Germany
- Department of Gynecology and Obstetrics, Schleswig-Holstein University Medical Center, Campus Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Petra Voiss
- Department of Internal and Integrative Medicine, Faculty of Medicine, Evangelische Kliniken Essen-Mitte, University of Duisburg-Essen, Am Deimelsberg 34a, 45276 Essen, Germany
| | - Daniela Paepke
- Department of Gynecology and Obstetrics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, Munich, Germany
| | - Johanna Dietmaier
- Department of Gynecology and Gynecologic Oncology, Hamburg-Eppendorf University Medical Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - Holger Cramer
- Department of Internal and Integrative Medicine, Faculty of Medicine, Evangelische Kliniken Essen-Mitte, University of Duisburg-Essen, Am Deimelsberg 34a, 45276 Essen, Germany
| | - Sherko Kümmel
- Breast Care Unit, Evangelische Huyssens-Stiftung, Kliniken Essen Mitte, Henricistrasse 92, 45136 MastologyEssen, Germany
| | - Matthias W. Beckmann
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitätsstrasse 21–23, 91054 Erlangen, Germany
| | - Linn Woelber
- Department of Gynecology and Gynecologic Oncology, Hamburg-Eppendorf University Medical Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology and Gynecologic Oncology, Hamburg-Eppendorf University Medical Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ulrich Freitag
- Dipl. Med. Ulrich Freitag, State Association Chairman of the BVF, Private Practice, Turnerweg 11a, 23970 Wismar, Germany
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, Phillips University of Marburg, Baldingerstrasse, 35033 Marburg, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Anna-Katharin Theuser
- Institute for Women’s Health (IFG) GmbH, Universitätsstrasse 21–23, 91054 Erlangen, Germany
| | - Carolin C. Hack
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitätsstrasse 21–23, 91054 Erlangen, Germany
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