A Qualitative Analysis of Cancer Patients' Perceptions of an Interprofessional Counseling Service on Complementary and Integrative Healthcare

Medical guidelines recommend actively addressing patients' information needs regarding complementary and integrative healthcare (CIH). Within the CCC-Integrativ study, an interprofessional counseling program on CIH was developed and implemented at four comprehensive cancer centers (CCCs) in Germany. As part of the process evaluation, this study examines cancer patients' experiences with interprofessional CIH counseling sessions conducted by a physician and a nurse. Forty problem-centered interviews were conducted using a semi-structured interview guide. All interviews were audio-recorded, transcribed verbatim, and analyzed using deductive-inductive content analysis based on Kuckartz and Rädiker's approach. Findings revealed that most participants had prior experience with CIH approaches and were burdened by physiological and psychological symptoms. Counseling sessions focused on cancer- and treatment-related symptoms and appropriate CIH recommendations (e.g., herbal poultice against anxieties and acupressure against nausea). Participants appreciated the mutual exchange and integration of perspectives from different healthcare professions within the interprofessional approach. They noted that the counseling team comprehensively addressed their healthcare and CIH information needs. Suggestions for improvement included the specificity of the CIH recommendations. As the participants only received counseling and no CIH treatments, information about reputable CIH providers was particularly important to many seeking advice. Patients with cancer receiving tailored CIH counseling from two healthcare professionals experienced benefits in CIH counseling for symptom management. The interprofessional teams offered a comprehensive perspective on patients' needs, proposing personalized recommendations for symptom control. These insights may foster collaboration between healthcare professionals interested in CIH counseling, enabling them to expand and consolidate their counseling services.

Protocol for the process evaluation of a counselling intervention designed to educate cancer patients on complementary and integrative health care and promote interprofessional collaboration in this area (the CCC-Integrativ study)

Background

Conducting a process evaluation is essential to understand how health interventions work in different healthcare settings. Particularly in the case of complex interventions, it is important to find out whether the intervention could be carried out as planned and which factors had a beneficial or hindering effect on its implementation. The aim of this study is to present the detailed protocol of the process evaluation embedded in the controlled implementation study CCC-Integrativ aiming to implement an interprofessional counselling program for cancer patients on complementary and integrative health care (CIH).

Methods

This mixed methods study will draw upon the “Consolidated Framework for Implementation Research” (CFIR) combined with the concept of “intervention fidelity” to evaluate the quality of the interprofessional counselling sessions, to explore the perspective of the directly and indirectly involved healthcare staff, as well as to analyze the perceptions and experiences of the patients. The qualitative evaluation phase consists of analyzing audio-recorded counselling sessions, as well as individual and group interviews with the involved persons. The quantitative evaluation phase applies questionnaires which are distributed before (T0), at the beginning (T1), in the middle (T2) and at the end (T3) of the intervention delivery.

Discussion

This protocol provides an example of how a process evaluation can be conducted parallel to a main study investigating and implementing a complex intervention. The results of this mixed methods research will make it possible to identify strengths and weaknesses of the team-based intervention, and to target more specifically the key factors and structures required to implement healthcare structures to meet patients’ unmet needs in the context of CIH. To our knowledge, this study is the first applying the CFIR framework in the context of interprofessional CIH counselling, and its results are expected to provide comprehensive and multidisciplinary management of cancer patients with complex supportive healthcare needs.

[Creating evidence for naturopathic nursing interventions in oncology - a systematic approach]

BACKGROUND

Nurses working in oncology use a wide range of naturopathic interventions in their daily practice to alleviate symptoms and improve the quality of life of oncological patients. However, there is no external evidence for many of these interventions. Due to a lack of scientific studies in the field, the aim of the project described here is to develop a standardized procedure to generate evidence on naturopathic interventions, on the basis of which recommendations may be derived for nursing practice.

METHOD

The systematic procedure presented here was developed by the working group (WG) Integrative Nursing in Oncology over a period of four years in an iterative process. This process is based on the expert panel members' experience with the development of guidelines and/or quality instruments such as practice standards.

RESULT

The systematic methodological approach presented here consists of three successive steps where internal and external evidence have been combined: a scoping review, a structured consensus process with oncology nurses to collect and evaluate naturopathic interventions, and finally a further supplementary literature review based on additional findings of the consensus conference. The procedure was successfully carried out for mucositis, insomnia, fatigue, hand-foot syndrome and chemotherapy-induced polyneuropathy.

CONCLUSION

Through the step-by-step synthesis of internal evidence and the best available external evidence, the evidence base for naturopathic nursing interventions in oncology can be generated and practice recommendations derived. The procedure represents a successful theory-practice transfer through structured cooperation between (nursing) scientists and nursing practitioners. In terms of the AWMF classification, the practice recommendations developed in the process described fall somewhere in between an S1 guideline (informal consensus of an expert group) and an S2e guideline (evidence-based).