Cornell University, New York, NY, USA.
Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA.
Integr Cancer Ther. 2024 Jan-Dec;23:15347354231223969. doi: 10.1177/15347354231223969.
Integrative oncology [IO] is sought-after by patients, endorsed by clinical guidelines, and valued within National Cancer Institute Centers. Shared Medical Appointments [SMA] leverage health education and social connection to deliver enhanced patient experience, population health, cost-reduction, and clinician well-being. Integrative Oncology Shared Medical Appointments increase access to integrative medicine but delivering these services via telehealth have not been evaluated.
We created, and pilot tested a Virtual Integrative Oncology Shared Medical Appointment Series (VIOSMAS) to assess its feasibility, acceptability, and efficacy at an urban academic teaching hospital.
The 7-session hour-long Living Well with and after Cancer series included didactics, multi-disciplinary experiential sessions, and group discussion. Topics included (1) Introduction, (2) Herbs/Botanicals/Fungi, (3) Mindful Movement, (4) Acupuncture, (5) Narratives and Nature, (6) Diet and Culinary Medicine, and (7) Vitamins/Supplements. Virtual visits via telehealth were offered to enhance patient participation during the pandemic. Outcome measures included recruitment, retention, pre/post-series patient survey and qualitative clinician feedback.
Between 9/2021 and 4/2023, 72 unique patients were recruited to 5 cohorts and had a total of 332 VIOSMAS visits. A total of 50 patients (69%) attended 4 or more of the 7-session series; 60 (83% were women); patients ranged in age from 28 to 93 years (median 66); 36 (50%) lived outside the city center; the most common cancer diagnoses were breast, lymphoma, and lung cancer. Patients were from diverse demographics. Pre-program, patients reported desiring assistance in addressing diverse symptoms including fatigue, insomnia, pain, gastrointestinal (GI) symptoms, anxiety, and depression. Post-series, patients reported that the VIOSMAS addressed their goals and symptoms; they also reported incorporating recommended lifestyle changes in diet, exercise, sleep, and stress management; they were satisfied with the number of sessions and telehealth format. The participating clinicians reported high levels of satisfaction with VIOSMAS. Revenue to the institution from VIOSMAS exceeded the revenue potential of equivalent time spent for individual visits while supporting extended physician-patient contact.
VIOSMAS is feasible for patients and clinicians, addresses patients' symptoms and questions about lifestyle and complementary therapies, and generates more revenue than individual visits. Larger implementation trials with appropriate comparison groups are recommended.
综合肿瘤学（IO）深受患者欢迎，符合临床指南，并得到美国国立癌症研究所中心的重视。共病共诊（SMA）利用健康教育和社会联系来提供更好的患者体验、改善人口健康、降低成本和提高临床医生的幸福感。整合肿瘤学共病共诊增加了对整合医学的获取，但通过远程医疗提供这些服务尚未得到评估。
我们创建并试点了一个虚拟整合肿瘤学共病共诊系列（VIOSMAS），以评估其在城市学术教学医院的可行性、可接受性和疗效。
为期 7 节、每节 1 小时的“与癌症共存和康复”系列课程包括讲座、多学科体验式课程和小组讨论。课程内容包括（1）介绍，（2）草药/植物/真菌，（3）正念运动，（4）针灸，（5）叙事与自然，（6）饮食与烹饪医学，和（7）维生素/补充剂。通过远程医疗提供虚拟就诊，以增强患者在大流行期间的参与度。评估指标包括招募、保留、系列前后患者调查和定性临床医生反馈。
在 2021 年 9 月至 2023 年 4 月期间，共招募了 72 名患者参加 5 个队列，共进行了 332 次 VIOSMAS 就诊。共有 50 名患者（69%）参加了 7 节系列课程中的 4 节或更多节；60 名患者（83%为女性）；患者年龄从 28 岁到 93 岁不等（中位数为 66 岁）；36 名患者（50%）居住在市中心以外；最常见的癌症诊断是乳腺癌、淋巴瘤和肺癌。患者具有不同的人口统计学特征。在计划前，患者报告说希望在解决各种症状方面得到帮助，包括疲劳、失眠、疼痛、胃肠道（GI）症状、焦虑和抑郁。在系列课程结束后，患者报告说 VIOSMAS 满足了他们的目标和症状；他们还报告说在饮食、锻炼、睡眠和压力管理方面实施了推荐的生活方式改变；他们对课程的次数和远程医疗格式感到满意。参与的临床医生对 VIOSMAS 表示高度满意。VIOSMAS 为机构带来的收入超过了个别就诊的潜在收入，同时支持了延长医患接触时间。
VIOSMAS 对患者和临床医生来说是可行的，能够解决患者关于生活方式和补充疗法的症状和问题，并产生比个别就诊更多的收入。建议进行更大规模的实施试验，并设置适当的对照组。
