Integrative Oncology Program, Lin and Carmel Medical Centers, Clalit Health Services; Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
The Oncology Service, Lin Medical Center, 35 Rothschild St, Haifa, Israel.
Support Care Cancer. 2018 Jul;26(7):2251-2257. doi: 10.1007/s00520-018-4068-6. Epub 2018 Feb 1.
Complementary and integrative medicine (CIM) is acknowledged in more and more oncology-care centers as part of supportive and palliative cancer care. However, only limited research is available on medical training of CIM practitioners regarding end-of-life (EOL) care. In this study, we assess the impact of multi-disciplinary EOL training on cultural-diverse groups of CIM-trained healthcare practitioners (HCPs) working in integrative oncology care settings in Germany and Israel.
The authors co-designed an evidence-based patient-centered EOL-training curriculum incorporating palliative and CIM concepts of care. Afterwards, a 3-day course was designed for 25 HCPs working in three anthroposophic-medicine-oriented medical centers in Germany and 14 CIM-trained HCPs from one oncology center in Israel. Qualitative assessment of the EOL-training impact on trainees was assessed 4-month post-intervention. Narratives were analyzed using ATLAS.ti software for systematic coding.
Post-training narrative assessment was reported by 18 German and 14 Israeli HCPs comprising 10 physicians, 12 nurses and paramedical practitioners, and 10 CIM therapists and spiritual care-providers. Content analysis of post-training outcomes suggested participants' attitude-change regarding their professional role in EOL care as individuals and as members of a team. Participants acquired practical clinical tools to enhance EOL care and to better communicate with patients about death, implementing a patient-centered, cultural-sensitive approach.
EOL training of CIM-trained HCPs enhances communication and palliative clinical skills. Multidisciplinary and international training settings emphasize a cross-cultural perspective and enrich the bio-psycho-social-spiritual model of palliative care.
补充和整合医学（CIM）在越来越多的肿瘤治疗中心被认可，作为支持性和姑息性癌症护理的一部分。然而，关于 CIM 从业者临终关怀培训的医学研究非常有限。在这项研究中，我们评估了多学科临终关怀培训对在德国和以色列的综合肿瘤学治疗环境中工作的 CIM 培训医疗保健从业者（HCPs）的多元文化群体的影响。
作者共同设计了一个基于证据的以患者为中心的临终关怀培训课程，纳入了姑息治疗和 CIM 的关怀理念。之后，为在德国的三个人智医学为导向的医疗中心工作的 25 名 HCP 和以色列的一个肿瘤中心的 14 名 CIM 培训 HCP 设计了为期 3 天的课程。干预后 4 个月，对受训者的临终关怀培训影响进行了定性评估。使用 ATLAS.ti 软件对叙事进行系统编码，分析叙事内容。
18 名德国和 14 名以色列 HCP 报告了培训后的叙事评估，包括 10 名医生、12 名护士和辅助医疗从业者以及 10 名 CIM 治疗师和精神关怀提供者。培训后结果的内容分析表明，参与者对其在临终关怀中的个人和团队专业角色的态度发生了变化。参与者获得了实用的临床工具，以增强临终关怀，并更好地与患者沟通死亡，实施以患者为中心、文化敏感的方法。
对 CIM 培训的 HCP 进行临终关怀培训可以提高沟通和姑息治疗技能。多学科和国际培训环境强调跨文化视角，并丰富了姑息治疗的生物心理社会精神模式。
