Abstract
To address the needs of cancer patients, two things are important: (1) oncology physicians and other health professionals in cancer care should receive training so that they can guide their patients through the maze of available offers in complementary and integrative medicine (CIM), and (2) more CIM providers should possess competencies to provide evidence-informed CIM treatments to cancer patients.
The increasing interest of cancer patients in complementary and integrative medicine (CIM) and growing evidence about the effectiveness of some CIM interventions make it a topic of interest during oncology consultations. When asking patients, the patients indicate that they would like to obtain advice about CIM options from their oncology physician.1 When asking oncology physicians about this, the physicians feel uneasy when this topic is mentioned in a consultation because they fear that they have inadequate knowledge.2
To close this gap, two things are required: (1) oncology physicians and other health professionals in cancer care who can guide their patients through the confusion of available offers, and (2) more providers with competencies to provide evidence-informed CIM treatments to cancer patients.
The first necessity is addressed within a research network funded by the German Cancer Aid (Competence Network Complementary Medicine in Oncology). One project within this network develops and evaluates a training program for oncology physicians to advise their patients about CIM. This type of training should consider that while physicians would prefer to have more knowledge about CIM treatments and their evidence, they do not have much time to learn those facts. In addition, training that provides skills to emphasize advising a patient in a reasonable time frame and in a confident manner is required. In particular, younger physicians benefit from skills training as shown in our cluster-randomized pilot study.3 Patients' multi-layered interest in CIM treatments reflect other aspects they could be considering such as coping with the disease and fear of death, which can be hidden behind this interest. Physicians should be able to distinguish between addressing the patients' needs to provide advice on CIM and when other hidden topics have priority. Based on experience and evidence from education research, a blended learning (e-learning+onsite workshop) approach seems most suitable. However, we also learned from our pilot trial that for learning and teaching purposes, it is important that the CIM consultation follows a clear structure. Therefore, considering the needs of patients and physicians and taking the results from previous projects into account, a systematic guideline for a 20-min consultation has been developed in a consensus process. The different steps of the consultation as well as knowledge about CIM treatments and their evidence are taught in a blended learning format. This training program for oncology physicians is now being evaluated in a cluster-randomized study with 48 physicians (trial registration DRKS00012704). However, this is only one contribution to close the gap, and more programs that also address other health professions are required.
On the other hand, if patients decided, based on the advice of their physician, to pursue a CIM treatment such as acupuncture or yoga, it would be of limited help if they did not have access to a good provider. The Society of Integrative Oncology will contribute to this necessity by providing a set of core competencies that have been defined in an international, interprofessional consensus process and can be applied to a broad range of providers. This strategy will hopefully enable more well-trained providers to address the needs of cancer patients in the future.
Witt, Claudia M