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Schiff E, Levy I, Arnon Z, Ben-Arye E, Attias S. First, keep it safe: Integration of a complementary medicine service within a hospital. Int J Clin Pract 2018; 72:e13082. [PMID: 29665222 DOI: 10.1111/ijcp.13082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/08/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES This paper sought to explore risk/safety considerations associated with the integration of a complementary medicine (CM) service within a public academic medical centre in Israel. METHODS We reviewed various sources pertaining to the CM service (interviews with CM staff, patients' electronic charts, service guidelines, correspondence with hospital administration) and conducted a thematic analysis to evaluate safety-related incidents during the 7 years of operation. In addition, we systematically assessed the charts for reports of treatment-associated adverse effects, which were documented in an obligatory field on treatment reports. RESULTS After reviewing transcripts of interviews with 12 CM practitioners and with the director and vice-director of the CM service as well as transcripts of 8560 consultations that included 7383 treatments, we categorised 3 major domains of CM safety management: (i) prevention of safety-related incidents by appropriate selection of CM practitioners and modalities, (ii) actual adverse incidents and (iii) prevention of their recurrence using both hospital and CM service safety protocols. CM staff reported 5 categories of adverse incidents, most of which were minor. Twenty-nine adverse incidents were documented in the 7383 treatment sessions (0.4%). CONCLUSIONS Safety management needs to be addressed both before introducing CM services in hospitals and throughout their integration. Important considerations for the safe integration of CM practices in the hospital include communication between CM and conventional practitioners, adherence to hospital safety rules, implementing a systematic approach for detecting and reporting safety-related incidents and continuous adaptation of the CM service safety protocols.
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Affiliation(s)
- Elad Schiff
- Internal Medicine B Department, Bnai Zion Medical Center, Haifa, Israel
- Complementary Medicine Service, Bnai Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ilana Levy
- Internal Medicine B Department, Bnai Zion Medical Center, Haifa, Israel
| | - Zahi Arnon
- Complementary Medicine Service, Bnai Zion Medical Center, Haifa, Israel
| | - Eran Ben-Arye
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Integrative Oncology Program, Oncology Service, Lin Medical Center, Clalit Health Services, Haifa, Israel
| | - Samuel Attias
- Complementary Medicine Service, Bnai Zion Medical Center, Haifa, Israel
- School of Public Health, University of Haifa, Haifa, Israel
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Affiliation(s)
| | - Jae Yeon Jung
- Division of Dermatology, City of Hope Comprehensive Cancer Center, Duarte, California; Cancer Immunotherapeutics and Tumor Immunology, City of Hope Comprehensive Cancer Center, Duarte, California
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Kalder M, Müller T, Fischer D, Müller A, Bader W, Beckmann MW, Brucker C, Hack CC, Hanf V, Hasenburg A, Hein A, Jud S, Kiechle M, Klein E, Paepke D, Rotmann A, Schütz F, Dobos G, Voiß P, Kümmel S. A Review of Integrative Medicine in Gynaecological Oncology. Geburtshilfe Frauenheilkd 2016; 76:150-155. [PMID: 26941447 DOI: 10.1055/s-0042-100208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
In recent years complementary and alternative medicine (CAM) has increasingly been the focus of international research. Numerous subsidised trials (7903) and systematic reviews (651) have been published, and the evidence is starting to be integrated into treatment guidelines. However, due to insufficient evidence and/or insufficient good quality evidence, this has mostly not translated to practice recommendations in reviews by the Cochrane collaboration gynaecology group. There is nevertheless a not insignificant number of CAM providers and users. The percentage of oncology patients who use CAM varies between 5 and 90 %. Doctors have been identified as the main providers of CAM. Half of gynaecologists offer CAM because of personal conviction or on suggestion from colleagues. This must be viewed in a critical light, since CAM is mostly practiced without appropriate training, often without sufficient evidence for a given method - and where evidence exists, practice guidelines are lacking - and lack of safety or efficacy testing. The combination of patient demand and lucrativeness for doctors/alternative medicine practitioners, both based on supposed effectiveness CAM, often leads to its indiscriminate use with uncertain outcomes and significant cost for patients. On the other hand there is published, positive level I evidence for a number of CAM treatment forms. The aim of this article is therefore to review the available evidence for CAM in gynaecological oncology practice. The continued need for research is highlighted, as is the need to integrate practices supported by good evidence into conventional gynaecological oncology.
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Affiliation(s)
- M Kalder
- Klinik für Frauenheilkunde und Geburtshilfe, Philipps-Universität Marburg, Marburg
| | - T Müller
- AGAPLESION Markus Krankenhaus, Abteilung für Gynäkologie und Geburtshilfe, Frankfurt am Main
| | - D Fischer
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Ernst von Bergmann, Potsdam
| | - A Müller
- Frauenklinik, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe
| | - W Bader
- Zentrum für Frauenheilkunde, Klinikum Bielefeld Mitte, Bielefeld
| | - M W Beckmann
- Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Nürnberg
| | - C Brucker
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Paracelsus Medizinische Privatuniversität, Nürnberg
| | - C C Hack
- Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Nürnberg
| | - V Hanf
- Frauenklinik und Brustzentrum Nathanstift, Klinikum Fürth, Fürth
| | - A Hasenburg
- Klinik und Poliklinik für Geburtshilfe und Frauenkrankheiten, Universitätsmedizin Mainz, Mainz
| | - A Hein
- Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Nürnberg
| | - S Jud
- Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Nürnberg
| | - M Kiechle
- Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München
| | - E Klein
- Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München
| | - D Paepke
- Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München
| | - A Rotmann
- Praxis für Frauenheilkunde, Geburtshilfe und Naturheilkunde, Rodgau
| | - F Schütz
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg, Heidelberg
| | - G Dobos
- Brustzentrum und Klinik für Senologie der Kliniken Essen-Mitte, Essen
| | - P Voiß
- Brustzentrum und Klinik für Senologie der Kliniken Essen-Mitte, Essen
| | - S Kümmel
- Brustzentrum und Klinik für Senologie der Kliniken Essen-Mitte, Essen
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Utilization of and Attitudes towards Traditional Chinese Medicine Therapies in a Chinese Cancer Hospital: A Survey of Patients and Physicians. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:504507. [PMID: 23093982 PMCID: PMC3475319 DOI: 10.1155/2012/504507] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 09/10/2012] [Indexed: 02/07/2023]
Abstract
Background. In China, the use of traditional Chinese medicine (TCM) is very popular, but little is known about how it is integrated with conventional cancer care. We conducted parallel surveys of patients and physicians on TCM utilization. Methods. Two hundred forty-five patients and 72 allopathic physicians at the Fudan University Shanghai Cancer Center completed questions on their use of and attitude towards TCM. Results. Patient mean age was 51, with 60% female. Eighty-three percent of patients had used TCM. Use was greatest for Chinese herbal medicine (CHM; 55.8%). Only 1.3% of patients used acupuncture and 6.8% Qi Gong or Tai Qi. Sixty-three percent of patients notified their oncologist about TCM use. The most common reason for use was to improve immune function. CHM was often used with a goal of treating cancer (66.4%), a use that 57% of physicians agreed with. Physicians were most concerned with interference with treatment, lack of evidence, and safety. Ninety percent of physicians have prescribed herbs and 87.5% have used TCM themselves. Conclusion. The use of TCM by Chinese cancer patients is exceptionally high, and physicians are generally well informed and supportive of patients' use. Botanical agents are much more commonly used than acupuncture or movement-based therapies.
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