Global advances in integrative medicine and health最新文献

Background: Integrative therapies are increasingly in demand for both symptom management and quality of life in palliative care (PC) populations. Multidisciplinary PC professionals need continuing education/continuing medical education (CE/CME) to keep current on the evidence-informed use of integrative therapies in PC planning.

Objectives: (1) Elicit input from multidisciplinary PC providers on needs for CE/CME content on integrative care, and indicators of implementation for use in impact assessment. (2) Produce an online CE/CME program responsive to provider input. (3) Assess program impact on PC providers in a randomized controlled trial.

Methods: Focus groups with 47 multidisciplinary PC personnel assessed needs for CE/CME content and identified practice-related behaviors indicating implementation of integrative care. Qualitative analysis then informed development a 9-hour CE/CME program, and identified candidate items for an outcome measure (Integrative Practice Assessment) to assess impact. Validation testing followed with 63 new subjects. A randomized, waitlist-controlled trial then assessed program impact on (1) confidence understanding evidence-informed use of integrative therapies in PC, and (2) implementation of practice behaviors that promote integrative care.

Results: 213 subjects were randomized and 170 provided follow-up data on program impact. Subjects' confidence (10-point scale) understanding safety considerations increased from 5.4 to 8.7; recommending modalities, from 4.2 to 8.3; and explaining modalities, from 4.8 to 8.5. Direct actions promoting integrative care in the last 10 patient encounters increased (12.2 to 17.9). Indirect actions taken in the work setting increased in the past month to advocate integrative therapies (from 5.7 to 9.1), and to promote organizational change (from 10.9 to 18.2). (All outcomes P < .001).

Conclusion: This provider-driven CE/CME program led to significant positive changes in practitioners' self-efficacy and implementation of integrative care practices in PC settings. The results indicate that CE/CME can have measurable impacts that benefit providers and may potentially impact patients, families and the culture of care.

Introduction: Many cancer patients experience high levels of anxiety during chemotherapy, which can negatively impact their mental health and their physiological, emotional, and spiritual well-being. Different complementary therapies aim to attenuate these effects, including music therapy. Although there is preliminary evidence on the positive effects of music therapy and music-based interventions in chemotherapy wards, few studies report live group interventions delivered by accredited music therapists.

Objective: To determine the effect of a single live group music therapy intervention on state anxiety and well-being levels of adult cancer patients during chemotherapy.

Methodology: This study protocol follows the SPIRT guidelines and reports a two-arm multicenter randomized clinical trial (RCT). The intervention group will receive standard care + a live group music therapy session and the control group will receive standard care only. The primary outcome is state anxiety, measured with the six-item State-Trait Anxiety Inventory (STAI-6). The secondary outcome is well-being, measured with the Well-being Numerical Rating Scales (WB-NRSs). The scales will be applied before and after each intervention. Sample size calculation resulted in a total of 102 participants.

Conclusions: This study seeks to contribute to the improvement of psycho-emotional health and well-being of cancer patients during chemotherapy. It is the first multi-center RCT on music therapy with cancer patients in [country, de-identified for peer review] and aims to gather knowledge about music's role to improve patients' mental health during acute treatment.

Trial registration: clinicaltrials.gov (NCT06577324, submission date August 21^st, 2024).

Background: Cancer among young adults (18-39 years) is relatively rare, but remains a leading cause of disability, morbidity, and mortality. Identifying strategies to support young adults' health following a diagnosis of cancer is important. Yoga may enhance health and could be delivered by videoconference. However, little research exploring yoga, and no research exploring videoconference delivery of yoga has been conducted with this cohort. We worked with young adults affected by cancer and developed, piloted, and refined a yoga intervention delivered by videoconference.

Objective: To evaluate our yoga intervention in a full-scale, mixed methods, single-arm, hybrid effectiveness-implementation trial.

Methods: Young adults 18 years or older, diagnosed with cancer between the ages of 18-39 years of age, and at any stage along the cancer trajectory are eligible. Participants receive 2 yoga classes/week over 12-weeks by videoconference and complete assessments at baseline, post-intervention, and 6- and 12-month follow-ups. Assessments include self-reported questionnaires (ie, stress, yoga barriers, physical activity behaviour, fatigue, cognition, cancer-related symptoms, general health, health-related quality of life, self-compassion, mindfulness, group identification), physical assessments (ie, aerobic endurance, flexibility, range of motion, balance, functional mobility), and a semi-structured interview (post-intervention only; exploring perceptions of acceptability, feasibility, and experiences). Quality improvement cycles occur every 6 months. Repeated measures analysis of variance will be conducted to explore effectiveness, descriptive statistics and responder/non-responder analyses will be used to explore implementation, and qualitative interview data, analyzed using content analysis and reflexive thematic analysis, will bolster effectiveness and implementation findings.

Discussion: As the first full-scale trial to evaluate yoga delivered by videoconference for this cohort, findings will make substantial contributions to young adults' supportive cancer care.

Conclusion: This protocol, reporting on yoga delivered by videoconference for young adults diagnosed with cancer, will enhance transparency and reproducibility and provide a reference for forthcoming trial results.

Trial registration: NCT05314803 at clinicaltrials.gov.

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Background: The well-being of healthcare teams is an important consideration when seeking to improve patient experience and quality of care. Prior studies have found that changes to working conditions are most effective in improving clinician well-being. Integrative Group Medical Visits (IGMVs) modify working conditions in ways that have potential to improve clinician experience.

Objective: The objective of this study was to understand healthcare teams' experiences with IGMVs.

Methods: In this qualitative study, interviews were conducted via Zoom and telephone with 21 clinicians, administrators, and staff from safety-net healthcare settings throughout the United States (U.S.) who have implemented IGMVs for patients with chronic pain. Interviews included questions about clinician experience, well-being, and satisfaction with the IGMV model. Interviews were recorded, transcribed, and coded using thematic content analysis by a team of trained qualitative researchers.

Results: The authors identified five themes describing how IGMV positively affected clinician well-being: organizational supports, human-centered engagement, collaboration with an interprofessional team, provision of guideline-concordant care, and enhanced meaning and purpose for the clinicians.

Conclusion: The current study was the first to use interviews from healthcare teams who have implemented IGMV to assess their experience. The themes identified warrant further investigation into IGMVs as a strategy to promote clinician well-being and mitigate aspects of burnout.

Background: While the Liaison Committee on Medical Education emphasizes the teaching of cultural competence in medical education, the concept of cultural humility, focusing on self-reflection and lifelong learning, has been proposed as a more effective approach. Although there have been numerous discussions on both topics, understanding how faculty in clinical settings help students develop cultural humility skills remains limited.

Objective: Our multimethod study utilized a survey and semi-structured interviews to identify strategies that faculty at one institution use to help students develop cultural humility skills.

Methods: We administered a 10-question survey to assess faculty demographics, teaching characteristics, and familiarity with cultural humility. Participants most familiar with cultural humility were invited for semi-structured interviews. Survey data were analyzed with descriptive statistics, and interview data were thematically analyzed to identify key teaching strategies.

Results: In our study of 49 medical faculty members, the majority of participants were female (61%) and predominantly White (67%), covering a wide range of specialties and years of teaching. Of the participants, 74% expressed being at least somewhat familiar with cultural humility, and 10 consented to interviews. Strategies for cultural humility education included one-on-one instruction, feedback, and reflections. Thematic analysis underscored fostering learner curiosity about cultures, early patient exposure, and incorporating diverse learning perspectives as essential in developing students' cultural humility skills.

Conclusion: Cultural humility is an important attribute for healthcare professionals that can enhance patient-centered care. Through focused interviews with faculty in our study and subsequent thematic analysis, our results suggest the need for longitudinal and multimodal educational strategies to cultivate cultural humility among medical students. By understanding current teaching methods, educators can design and assess more effective curricula to prepare future doctors for a culturally diverse patient population.

Background: Socioeconomically disadvantaged populations have a high prevalence of chronic pain, exacerbated by social isolation, intersectional stigma, and disparities in pain assessment and treatment. Effective interventions using a multilevel, biopsychosocial approach are needed to decrease the unequal burden of pain. Group-based integrative pain management in primary care safety net clinics is a promising model to improve pain care for racially and ethnically diverse low-income people.

Objective: To describe a study protocol to test the impacts of 2 group-based models - group acupuncture and integrative group medical visits - on multilevel pain-related outcomes.

Methods: The study uses a 2x2 factorial randomized clinical trial to test two 12 week group-based models: group acupuncture and integrative group medical visits (IGMV, with psychoeducation, mind-body approaches, and social support). English or Spanish-speaking adults with chronic pain for ≥3 months receiving care in San Francisco Department of Public Health primary care clinics are eligible for the trial. All participants will receive usual care and be randomized to group acupuncture, IGMV, both, or waitlist control. The primary outcomes are changes from baseline to 3 month follow-up in pain impact and in social support for chronic pain. Secondary outcomes include pain interference, pain intensity, depression, anxiety, quality of life, and social isolation. Data will include patient-reported outcomes, electronic health record data, and qualitative interviews, focus groups and observations to assess multilevel individual, interpersonal and organizational outcomes.

Discussion: Multilevel approaches are needed to advance health equity in pain management. Our study contributes to knowledge of group-based integrative pain management in primary care safety net clinics to address multilevel barriers and disparities in pain care.

Objective: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic and debilitating illness with symptoms such as post-exertional malaise and cognitive dysfunction that can be challenging for patients to manage independently. Randomized controlled trials (RCTs) have examined mind-body and psychological approaches that teach patients coping skills for mitigating ME/CFS symptoms, including emerging literature on Qigong or Tai Chi instruction programs. This systematic review aims to summarize the characteristics of these trials and highlight potential areas for future optimization and refinement.

Methods: Ovid MEDLINE, Embase.com, Web of Science Core Collection, Cochrane CENTRAL, PsycINFO via Ovid, and ClinicalTrials.gov were searched in April 2023 using controlled vocabulary and keywords for the following eligibility criteria: Sample (ME/CFS), Design (RCT), Behavioral Intervention (mind-body or psychological interventions). Data extraction and reporting followed Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: "Qigong" and "Tai Chi" yielded 142 and 80 abstracts, respectively. Of the 222 abstracts, full texts were available for 5 RCTs of Qigong (k = 5; N = 481). Notably, no trials of Tai Chi utilized a randomized control design. Among the 5 Qigong RCTs, the publication range was from 2012 to 2023. Details regarding intervention components and effects were summarized. Qigong intervention sessions (median = 12, mode = 10, 12) tended to last between 1-2 hours and occur across 5-12 weeks (median = 7, mode = 5). The Qigong interventions were all delivered in groups and incorporated at-home practice. Daily practice was a requirement (k = 4) or an advisement (k = 1). Patient-reported outcomes suggest an emerging evidence base for diffuse benefits on physical and emotional health outcomes.

Conclusions: Qigong interventions are promising, yet relatively understudied, in improving ME/CFS symptom severity and frequency. Future trials must implement standardized eligibility criteria for ME/CFS history, integrate Qigong or Tai Chi with other empirically supported mind-body and psychological practices, and assess long-term resiliency outcomes relevant to ME/CFS survivorship.

Background: Heart-Smile Training (HST) is an interoceptive compassion-based behavioral intervention that in case reports has been beneficial for depression. Interoception refers to the awareness and regulation of physiological signals from inside the body. Depressed patients often have diminished interoceptive awareness and often experience disconnection from bodily needs and sensations. In addition to interoceptive dysfunction, depression often involves negative self-evaluation and self-critical rumination. HST is a compassion-based meditation training program that explicitly cultivates interoceptive awareness of the heart area. This study aims to investigate the possible neurocardiac mechanisms engaged through HST for depression patients.

Methods: We plan to enroll 50 subjects to be randomized into a 4-week HST intervention group and a waitlist group. A battery of psychological questionnaires will be administered at baseline and post-intervention timepoints, and electroencephalography (EEG) will be collected during compassion meditation guided by pre-recorded audio. The primary clinical outcome measures are on the feasibility of the intervention and research procedures, the primary mechanistic outcome measure is the post-intervention change in Heartbeat Evoked Potential (HEP) amplitude. Secondary outcome measures include changes in depression severity and EEG gamma spectral activity. Exploratory outcome measures include effects of HST on skin conductance response, heart rate variability, EEG spectral properties in other frequency bands, as well as a list of psychological questionnaires that measure depression and anxiety symptoms, emotion regulation, mindfulness, interoceptive awareness, self-compassion, gratitude, sleep quality, quality of life and social connectedness.

Results: Results not yet available.

Conclusion: This is the first study on the feasibility and interoceptive neurocardiac mechanism of HST. Our findings will provide frontier knowledge on the physiological working mechanism of behavioral interventions with an interoception-based meditative approach. https://clinicaltrials.gov/study/NCT05564533.