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Zusammenfassung Hintergrund Pflegefachpersonen, die in der onkologischen Versorgung tatig sind, wenden in ihrem Alltag verschiedenste naturheilkundliche Pflegemasnahmen zur Symptomlinderung und Steigerung der Lebensqualitat bei onkologischen Patient*innen an. Fur viele dieser Pflegemasnahmen liegen allerdings weder externe Evidenz oder leitlinienbasierte Handlungsempfehlungen vor. Um diese Evidenzlucke zu fullen, war es das Ziel des hier beschriebenen Projekts, ein systematisches Verfahren zur Generierung von Evidenz fur eine indikationsbasierte naturheilkundliche Behandlung zu entwickeln. Methode Das hier vorgestellte systematische Verfahren wurde von der Arbeitsgruppe (AG) Integrative Pflege in der Onkologie uber vier Jahre in einem iterativen Prozess erarbeitet. Grundlage waren die Erfahrungen des Expert*innengremiums in der Entwicklung von Leitlinien und/oder Qualitatsinstrumenten wie Praxisstandards. Ergebnis Das hier vorgestellte systematische Verfahren besteht aus drei aufeinanderfolgenden Schritten, wobei interne und externe Evidenz kombiniert wurden: einem Scoping Review, einem strukturierten Konsensusverfahren mit Fachpflegepersonen aus der Onkologie zur Sammlung und Bewertung naturheilkundlicher Pflegeinterventionen in der Onkologie und abschliesend einer weiteren erganzenden Literaturrecherche auf Grundlage der Erkenntnisse der Konsensuskonferenz. Das Verfahren stellt eine Erweiterung des fur Mukositis, Insomnie, Fatigue, Hand-Fus-Syndrom und chemotherapieinduzierter Polyneuropathie erfolgreich durchlaufenen Verfahrens dar. Schlussfolgerung Durch die schrittweise Synthese der internen Evidenz mit der besten verfugbaren externen Evidenz konnen Aussagen zur Praxis und Evidenzbasierung von naturheilkundlichen Pflegeinterventionen in der Onkologie generiert und Handlungsempfehlungen abgeleitet werden. Das Vorgehen stellt einen gelungenen Theorie-Praxis-Transfer durch strukturierte Zusammenarbeit von (Pflege-)Wissenschaftler*innen und Pflegepraktiker*innen dar. Die dabei entwickelten Handlungsempfehlungen konnen in der AWMF-Klassifikation zwischen einer S1-Leitlinie (informeller Konsens einer Expert*innengruppe) und einer S2e-Leitlinie (evidenzbasiert) eingeordnet werden.

According to international literature, patients with cancer wish to have information on complementary and integrative healthcare (CIH). Medical guidelines recommend actively approaching patients with cancer discussing potential benefits and risks of individual CIH methods. While some CIH methods, for example, acupuncture and yoga, have been proven effective in high-quality studies, other CIH methods lack studies or bear the risk of interactions with chemotherapeutics, for example, herbal drugs. Therefore, an evidence-based interprofessional counselling programme on CIH will be implemented at four Comprehensive Cancer Centres in the federal state of Baden-Wuerttemberg, Germany.A complex intervention consisting of elements on patient, provider and system levels will be developed and evaluated within a multilayer evaluation design with confirmatory evaluation on patient level. Patients with a cancer diagnosis within the last 6 months will receive three individual counselling sessions on CIH within 3 months (=intervention on patient level). The counselling will be provided by an interprofessional team of medical and nursing staff. For this purpose, an intensive online training programme, a CIH knowledge database and an interprofessional team-building process were developed and implemented (=intervention on provider level). Moreover, training events on the basics of CIH are offered in the outpatient setting (=intervention on system level). Primary outcome of the evaluation at the patient level is patient activation measured (PAM) with the PAM-13 after 3 months. Secondary outcomes, for example, quality of life, self-efficacy and clinical parameters, will be assessed at baseline, after 3 months and at 6 months follow-up. The intervention group (n=1000) will be compared with a control group (n=500, treatment as usual, no CIH counselling. The outcomes and follow-up times in the control group are the same as in the intervention group. Moreover, the use of health services will be analysed in both groups using routine data. A qualitative-quantitative process evaluation as well as a health economic evaluation will identify relevant barriers and enabling factors for later roll-out.The study has been approved by the appropriate Institutional Ethical Committee of the University of Tuebingen, No. 658/2019BO1. The results of these studies will be disseminated to academic audiences and in the community.DRKS00021779; Pre-results.

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.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.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.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).

Background: Patients with cancer receiving tumor therapy often suffer from oral mucositis. Objectives: The aim of this project was to summarize experiences with nursing procedures by experts in integrative oncology and to establish recommendations for nursing interventions that can prevent or cure mucositis. Methods: The study design was an interdisciplinary consensus process based on a systematic literature search. Results: The panel discussed and agreed on 19 nursing procedures, which included mouthwashes, such as teas, supplements, oil applications, and different kinds of ice cubes to suck, as well as flaxseed solution, propolis, and mare milk. Twelve interventions were classified as effective, with effectiveness for OraLife, propolis, sea buckthorn pulp oil, marshmallow root tea also for xerostomia, Helago chamomile oil, mare milk, and Saliva Natura rated as highly effective in clinical experience. In the systematic literature search, a total of 12 out of 329 randomized controlled trials and meta-analyses on chamomile (n = 3), Calendula (n = 1) and sage (n = 1), propolis (n = 2), and sucking ice cubes (cryotherapy; n = 5) met all inclusion criteria. Trial evidence for effectiveness in oral mucositis was revealed for propolis and cryotherapy. Conclusions: The current evidence supports the use of some nursing procedures (f.e. propolis for 2 and 3 grade mucositis) for improving oral mucositis during cancer therapies. There is still a need to define general clinical practice guidelines for the supportive treatment of mucositis, as well as for more interdisciplinary research in this area.

Objective A collaborative team is necessary to help patients achieve their healthcare goals using complementary medicine. At present, healthcare professionals do not feel sufficiently qualified to provide this service. This study sought to identify competencies and teaching methods for interprofessional training on complementary and integrative medicine at medical schools. Methods Sixty-five German-speaking experts with various professional backgrounds were invited to take part in a three-round Delphi study. In the first round, predefined competencies were assessed on a seven-point Likert scale, and participants were invited to propose additional competencies that would be evaluated in the subsequent rounds. The competencies were ranked based on the participant assessments and were assigned to four relevance groups. In the second and third rounds, suitable teaching methods were identified using free-text fields and multiple-choice questions. In a final workshop, participants synthesized the outcomes of the previous sessions and derived key competencies that would be a benefit to undergraduate interprofessional training in complementary and integrative medicine at medical schools. Results The three rounds plus final worksop were attended by 50, 40, 36 and 11 experts. The competencies that these experts determined to be highly relevant to teaching complementary and integrative medicine emphasized, in particular, the respectful treatment of patients and the importance of taking a medical history. From these highly relevant competencies, three key targets were agreed upon in the final workshop: students are able to 1) classify and assess complementary medical terms and methods; 2) work collaboratively and integrate patients into the interprofessional team; 3) involve patients and their relatives respectfully and empathetically in all healthcare processes. To achieve these competency goals, the following teaching methods were highlighted: students discuss therapy options based on authentic patient cases with each other and practice empathic patient communication incorporating complementary medicine. Further, the theoretical background of complementary medicines could be provided as online-training, to use the class sessions for hands-on exercises and interprofessional exchange and discussion. Conclusion Despite the heterogeneous panel of experts, a consensus was reached on the competency orientation and teaching approaches. The results can promote the implementation of interprofessional training for complementary medicine in undergraduate education.

Die Inanspruchnahme von Verfahren aus der Komplementaren und Integrativen Medizin (KIM) ist in der deutschen Allgemeinbevolkerung stark verbreitet, insbesondere bei chronisch Kranken, darunter viele Patienten mit onkologischen Erkrankungen. Viele KIM-Verfahren (z. B. Misteltherapie oder andere Phytotherapeutika, Akupunktur, Mikronahrstoffe, Yoga, Aromatherapie, etc.) haben das Potenzial, die Lebensqualitat sowie spezifische somatische und psychische Symptome der Patienten zu verbessern. Allerdings bergen gerade pflanzliche Stoffe auch das Risiko von Interaktionen mit anderen Arzneimitteln, weshalb eine kompetente arztliche Beratung in diesem Bereich unabdingbar ist. Umfragen zeigen, dass onkologisch erkrankte Patienten ein hohes Informationsbedurfnis gerade wahrend der Supportivtherapie und in der Nachsorge haben und sich eine entsprechende kompetente Begleitung u. a. durch ihren Hausarzt wunschen. Vor diesem Hintergrund werden derzeit Schulungen und Kommunikationstrainings fur Hausarzte entwickelt und evaluiert. Eine weitere positive Entwicklung der letzten Jahre sind stationare und tagesklinische Versorgungskonzepte der sog. integrativen Onkologie, die zunehmend von evidenzbasierten KIM-Verfahren gekoppelt mit kompetenter Beratung zur Starkung der Patientenkompetenz Gebrauch machen.

Item does not contain fulltext PURPOSE/OBJECTIVES: To answer how the planned intervention was performed in routine care, which factors supported or distracted from its implementation, and how key organizational structures have been built and sustained.. RESEARCH APPROACH: Mixed-methods process evaluation.. SETTING: Two German outpatient cancer clinics.. PARTICIPANTS: Purposive sampling of 297 recruited patients with gynecologic cancer, their treating oncology nurses, and their interprofessional healthcare team, and the clinical stakeholders of two different outpatient cancer clinics.. METHODOLOGIC APPROACH: Guided by the Consolidated Framework for Implementation Research (CFIR), five distinct interrelated substudies were designed to evaluate intervention characteristics, inner and outer settings, characteristics of the individuals involved, and the process of implementation. Quantitative and qualitative data will be analyzed separately and then integrated into a framework analysis.. FINDINGS: Oncology nurses found the regular process analytic sessions to be beneficial, not only for sharing their experience, but also for experiencing social support and social connectedness.. INTERPRETATION: Key implementation facets of the nurse-led intervention will be examined systematically. The results can guide future implementation processes, which need to be tailored to interested facilities.. IMPLICATIONS FOR NURSING: The CFIR framework is well established but not yet widely applied in supportive treatment research. The current study aims to apply and combine this framework with the concept of intervention fidelity.

Background Patients, and especially oncology patients, increasingly demand information and application of complementary therapies to supplement their conventional medical treatment and follow-up care. Due to the widespread interest in holistic treatment opportunities in oncology populations, healthcare professionals need to be prepared in differentiating evidence-based methods of the complementary and alternative medicine (CAM) spectrum and how to consult with patients about it. Objective This paper reports on the implementation and evaluation of a newly designed module “Complementary and Alternative Medicine in oncological healthcare” in the bachelor degree program Interprofessional Health Care (B.Sc.). Design The study applied a developed evaluation questionnaire to capture students’ perspectives on the CAM contents. This assessment instrument was administered pre and post the CAM teaching unit. Setting Interprofessional medical education, University Hospital Heidelberg, Germany. Results The integration of the CAM elective module was possible and was met by positive response. Students’ interest was reflected in an increase of their self-reported knowledge gain and positive CAM attitude. Comparison of pre and post evaluation data demonstrate that, particularly, students’ expectations on developing their own opinion about CAM, and getting an overview of the evidence-base of different CAM methods have been met. Conclusions Evaluation results indicate that the module content was in line with the students’ expectations and may have positively impacted on their general CAM attitude. The results support us in continuing to offer this CAM course within the elective module to prepare today’s healthcare professionals for patient-oriented healthcare delivery.

Objectives Physicians and other health professionals like nurses, physiotherapists and midwives should be prepared to work in a patient-centred and team-based manner through appropriate interprofessional training. This includes consideration of patients’ preferences for complementary treatment methods, as well as reflection of one's own professional role and that of the others. The CanMEDS Physician Competency Framework is an established instrument that describes the competencies of health professionals in seven roles. We investigated which role competencies should be addressed in an undergraduate interprofessional curriculum on Complementary and Integrative Medicine. Design In a Delphi study, an interprofessional expert group evaluated the relevance of the CanMEDS role competencies (n = 49) and the respective individual competencies (n = 30) on a seven-point Likert scale. For analysis, we assigned the competencies according to the ratings, to four groups of relevance (consensus: >80 %) and compared the proportions of individual competencies classified as relevant within the seven role competencies. Results The role Medical Expert was rated as highly relevant for all individual competencies. For the roles Professional, Collaborator, Communicator and Scholar, all or most individual competencies were rated at least as relevant. For the roles Leader or Health Advocate all individual competencies were rated as not relevant. Conclusions In order to improve healthcare including complementary treatment options, it is initially of great importance to impart expert and communication skills in undergraduate interprofessional training in addition to improving teamwork. The acquisition of management and consulting skills could only be given priority in a later phase of training.

The purpose of this study was to develop a complex nursing intervention including complementary and alternative medicine (CAM) for breast and gynecologic cancer patients during chemotherapy to improve quality of life. Data sources Theoretical framework and concepts, practical nursing knowledge, and evidence-based studies were compiled in interprofessional meetings. Data synthesis The final complex intervention consists of three autonomous, but interacting components: (1) CAM nursing package, (2) resource-oriented counseling, and (3) evidence-based information material on CAM. CAM interventions include acupressure, aromatherapy, compress, and massage, targeting 14 clinically relevant symptoms during chemotherapy. Participants receive these interventions during chemotherapy with instructions for self care. During a counseling interview, the patient’s needs and preferences are assessed by trained nurses. Furthermore, participants are equipped with evidence-based information material (booklet and DVD). Prior to study start, nurses attended training modules for administering CAM therapies and for communicating and counseling within the salutogenic approach. It was possible to design a multimodal CAM nursing intervention based on a theoretical concept, evidence-based studies, and practical nursing experience targeting the prevention or relief of side-effects women suffer during chemotherapy. The systematic analysis of the CONGO study will contribute to evidence-based CAM nursing care within supportive cancer care. Oncology nurses play an important role in supportive CAM care of breast and gynecologic cancer patients in daily clinical practice. Within oncology outpatient services, the implementation of evidence-based CAM nursing interventions and counseling may contribute to understand the impact of nursing on patient quality of life and symptom relief. This can lead to a new understanding of the nurse’s professional role.

Objective The aim of this study was to explore how and why Australian men with cancer practice complementary therapies (CTs) and how their significant others (SOs) contribute to the regular uptake of CTs. Methods This qualitative study employed semi-structured interviews with 26 male cancer patients and 24 SOs. Participants were purposefully sampled from a preceding Australian survey investigating the use of CTs in men with cancer (94% response rate and 86% consent rate for follow-up interview). Interviews were conducted in a metropolitan location, and the 43 interview transcripts were analyzed thematically. Results Three core themes were identified: men used CTs as (a) problem-focused coping (e.g., diet modification), (b) emotion-focused coping (e.g., meditation), and (c) meaning-based coping (e.g., prayer). Practicing CTs helped men to cope with physical, emotional, and spiritual concerns, although some men spoke of difficulties with practicing meditation to regulate their emotions. SOs were supportive of men's coping strategies but were only rarely involved in men's emotion-focused coping. Conclusions Complementary therapies have the potential to facilitate coping with cancer, independent of any measurable physiological benefit. Our findings suggest that when clinicians engage in conversations about CTs use, they should consider the type of coping strategy employed by their patient. Such information may enhance the efficacy of some interventions (e.g., meditation) and also provide for an opportunity to discuss patients' expectations concerning CTs. Copyright © 2014 John Wiley & Sons, Ltd.

Background: Although studies have shown that complementary and alternative medicine (CAM) use is common in cancer patients, no survey has assessed CAM use in men with a variety of cancers. In Australia, no data exist about male cancer patients’ use of CAM. Patients and methods: A self-administered questionnaire was completed by 403 men attending four cancer outpatient services in Metropolitan Adelaide. Data were analyzed using Pearson’s v2 tests and multivariate logistic regression analysis. Results: CAMs were currently used by 52.9%, or used at some point by 61.5%, of respondents. The most popular CAM treatments were dietary supplements (36.1%), prayer (25.9%), herbs and botanicals (21.4%), and relaxation techniques/meditation (15.2%). CAM use was directed by a cancer specialist in 9.9% of respondents. Independentpredictors of CAM use were metastatic cancer (P = 0.022), actively practicing religion (P = 0.008), and tertiaryeducation (P = 0.007). Conclusions: CAM use in males is equally common across all cancer diagnoses, namely prostate, hematological malignancies, colorectal, lung, and other cancers. Oncologists should be aware that one-third of male patients modify their diet and/or search for spiritual guidance, particularly when diagnosed with metastatic cancer. Refereed/Peer-reviewed

Purpose: Complementary and alternative medicine (CAM) is frequently used in cancer patients, often with contribution of the significant others (SOs), but without consultation of healthcare professionals. This research explored how cancer patients integrate and maintain CAM use in their everyday life, and how SOs are involved in it. Conclusions: CAM routines and rituals constitute key elements in cancer patients' regular and satisfied CAM use, and they promote familial strengthening. Clinicians and physicians can convey these benefits to patient consultations, further promoting the safe and effective use of CAM. Methods: In this qualitative study, male participants were selected from a preceding Australian survey on CAM use in men with cancer (94%response rate and 86%consent rate for follow-up interview). Semistructured interviews were conducted with 26 men and 24 SOs until data saturation was reached. Interview transcripts were coded and analyzed thematically, thereby paying close attention to participants' language in use. Results: A major theme associated with high CAM use was "CAMroutines and rituals," as it was identified that men with cancer practiced CAM as (1) functional routines, (2) meaningful rituals, and (3) mental/spiritual routines or/and rituals. Regular CAM use was associated with intrapersonal and interpersonal benefits: CAM routines provided men with certainty and control, and CAM rituals functioned for cancer patients and their SOs as a means to create meaning, thereby working to counter fear and uncertainty consequent upon a diagnosis of cancer. SOs contributed most to men's uptake and maintenance of dietary-based CAM in ritualistic form resulting in interpersonal bonding and enhanced closeness. Refereed/Peer-reviewed

The aim of this study was to explore how and why Australian men with cancer practice complementary therapies (CTs) and how their significant others (SOs) contribute to the regular uptake of CTs.This qualitative study employed semi-structured interviews with 26 male cancer patients and 24 SOs. Participants were purposefully sampled from a preceding Australian survey investigating the use of CTs in men with cancer (94% response rate and 86% consent rate for follow-up interview). Interviews were conducted in a metropolitan location, and the 43 interview transcripts were analyzed thematically.Three core themes were identified: men used CTs as (a) problem-focused coping (e.g., diet modification), (b) emotion-focused coping (e.g., meditation), and (c) meaning-based coping (e.g., prayer). Practicing CTs helped men to cope with physical, emotional, and spiritual concerns, although some men spoke of difficulties with practicing meditation to regulate their emotions. SOs were supportive of men's coping strategies but were only rarely involved in men's emotion-focused coping.Complementary therapies have the potential to facilitate coping with cancer, independent of any measurable physiological benefit. Our findings suggest that when clinicians engage in conversations about CTs use, they should consider the type of coping strategy employed by their patient. Such information may enhance the efficacy of some interventions (e.g., meditation) and also provide for an opportunity to discuss patients' expectations concerning CTs.

Purpose: To explore how men’s Significant Others (SOs), including family members and close friends, contribute to the uptake and maintenance of specific CAM therapies. Methods: This study was the second, qualitative phase of a mixed-methods project investigating the use of CAM in an Australian male cancer population. Male participants were purposefully selected from a pool of 403 patients who answered a survey in the first quantitative phase (94% response rate and 86% consent rate for follow-up interview). Then semi-structured interviews among 26 men with a variety of cancers and 24 SOs were conducted. All 43 interviews were recorded, transcribed, and analysed thematically. Results: Men used CAM/Natural products to cope with physical concerns, and this was actively supported by men’s SOs who contributed to the uptake and maintenance of these CAMs. The shared CAM preparation and consumption functioned to strengthen the bond between men and their SOs, and also helped men’s SOs to cope with uncertainty and regain control. In contrast, men practiced CAM/Mind-body medicine to receive emotional benefits, and only rarely shared this practice with their SOs, indicating a need for coping with emotions in a private way. Conclusions: Men's CAM use is a multifaceted process that can be better understood by considering CAM categories separately. CAM/Natural products help men to cope with physical concerns, while CAM/Mind-body medicine assist men to cope with their emotions in a private way. Oncology professionals can use this information to better promote and implement integrative cancer care services. Refereed/Peer-reviewed