Elad Schiff

Complementary medicine in the primary care setting: Results of a survey of gender and cultural patterns in Israel.

OBJECTIVE The purpose of this study was to examine the use of complementary and alternative medicine (CAM) in a primary care practice in Israel to determine prevalence and patterns of use. METHODS Trained research assistants invited all patients attending the administrative, medical, pharmaceutical, or nursing services of 7 clinics in urban and rural areas of northern Israel over a 16-month period, from April 1, 2005, through August 1, 2006, to complete a 13-item written questionnaire about CAM use and beliefs about CAM safety and efficacy. CAM was defined as therapies often referred to as alternative, complementary, natural, or folk/traditional medicine, and which are not usually offered as part of the medical treatment in the clinic, including herbal medicine, Chinese medicine (including acupuncture), homeopathy, folk and traditional remedies, dietary/nutritional therapy (including nutritional supplements), chiropractic, movement/manual healing therapies (including massage, reflexology, yoga, and Alexander and Feldenkrais techniques), mind-body techniques (including meditation, guided imagery, and relaxation), energy and healing therapies, and other naturopathic therapies. The Pearson chi(2) test and multivariate logistic regression were used to assess univariate associations with the odds ratios of CAM use among Arab and Jewish women. A t test was performed to determine whether there were any differences in the continuous variables between the 2 groups. RESULTS Of 3972 consecutive patients who received the questionnaire, 3447 responded; 2139 respondents (62%) were women. Of the female respondents, 2121 reported their religion (1238 respondents [58%] self-identified as being Arab, and 883 [41.6%] as being Jewish). Compared with men, more women used CAM during the previous year (46.4% vs 39.4%; P < 0.001). Women were more likely to use CAM and to be interested in receiving CAM at primary care clinics. Arab women reported less CAM use than Jewish women but were more interested in experiencing CAM, had a higher degree of confidence in CAM efficacy and safety, and more frequently supported the integration of CAM practitioners in primary care clinics. CONCLUSIONS In this study, women visiting primary care clinics in northern Israel used CAM more often than men did. Arab women reported less use of CAM than did Jewish women but also reported greater confidence in CAM efficacy and safety.

Integrative oncology research in the Middle East: weaving traditional and complementary medicine in supportive care

IntroductionComplementary and alternative medicine (CAM) has an important role in supportive cancer care in the Middle East and is often used in association with traditional medicine. This article provides a comprehensive review of published data on CAM research in supportive cancer care in the Middle East.Methods and resultsA multi-disciplinary Middle-Eastern Research Group in Integrative Oncology (MERGIO) was established in six countries. Authors independently searched Medline database for articles in Arabic, Hebrew, French, and Turkish using oncology and CAM-related keywords. Articles were recorded according to the first author’s affiliation with an academic or clinical institution in the Middle East.ResultsWe identified 143 articles on CAM and cancer care that had been published in12 Middle-Eastern countries. Eighty-five articles were directly related to cancer supportive care. The latter included studies on the prevalence of CAM use by patients with cancer, aspects related to of doctor–patient communication, ethics and regulation, psychosocial aspects of CAM, CAM safety and quality assurance, studies of CAM education for health care providers, and ethno-botanical studies and reviews. Twenty-eight articles referred to clinical research on supportive care, and the use of specific CAM modalities that included acupuncture, anthroposophic medicine, dietary and nutritional therapies herbal medicine, homeopathy, mind–body medicine, shiatsu, therapeutic touch, and yoga.ConclusionsCAM-related supportive care research is prevalent in the Middle East, a fact that may serve as a basis for future multinational-multidisciplinary research work in supportive care in oncology.

Integrating complementary medicine in supportive cancer care models across four continents.

The need to integrate complementary medicine (CM) consultation in supportive care of patients with cancer is acknowledged by oncologists owing to the ongoing research on CM efficacy and awareness of its potential risks. In this article, we aim to provide oncologists with models for CM integration within supportive care. Descriptive analysis of key elements which facilitate CM integration is presented by physicians leading six integrative cancer care programs across four continents. Perspectives of integration are supplemented by a literature review, quantitative data on the clinical activity in each center, and qualitative narrative-based citations of seven oncology patients and healthcare providers. It is recommended that CM consultation be provided by physicians with extensive CM training. The following key elements were identified as essential for integrative program design within oncological supportive care: (1) Location of the integrative physician (IP) room within the oncology department area, (2) Required oncologist referral to CM consultation, (3) Allocated time to IP-oncologist communication, (4) Research-based integrative practice, (5) Inclusion of paid professional CM practitioners, (6) Institutional cost covered service. Integration of CM consultation within oncological supportive care needs to take in account six key elements that ensure high-quality evidence-based concomitant integrative practice.

Integrative oncology in the Middle East: from traditional herbal knowledge to contemporary cancer care

BACKGROUND Based on traditional, historical, ethnobotanical, laboratory, and clinical findings, we present research framework aiming to identify Middle Eastern herbs that are worthy of further research for their anticancer potential. METHODS A comprehensive research project was developed by a multinational team comprising family physicians, medicine specialists, oncologists, an Islamic medicine history specialist, a traditional medicine ethnobotanist, and a basic research scientist. The project followed two consecutive phases: (i) historical and ethnobotanical search for cancer-related keywords and (ii) Medline search for in vitro and in vivo studies. RESULTS This search yielded 44 herbs associated with cancer care. The Medline search yielded 34 herbs of which 9 herbs were reported in various clinical studies. CONCLUSIONS This multidisciplinary survey was found to be a valuable way to identify herbs with potential clinical significance in cancer care. Based on this pilot study, it is suggested that the Middle East can serve as a valuable region for future multicultural-oriented cancer research.BACKGROUND Based on traditional, historical, ethnobotanical, laboratory, and clinical findings, we present research framework aiming to identify Middle Eastern herbs that are worthy of further research for their anticancer potential. METHODS A comprehensive research project was developed by a multinational team comprising family physicians, medicine specialists, oncologists, an Islamic medicine history specialist, a traditional medicine ethnobotanist, and a basic research scientist. The project followed two consecutive phases: (i) historical and ethnobotanical search for cancer-related keywords and (ii) Medline search for in vitro and in vivo studies. RESULTS This search yielded 44 herbs associated with cancer care. The Medline search yielded 34 herbs of which 9 herbs were reported in various clinical studies. CONCLUSIONS This multidisciplinary survey was found to be a valuable way to identify herbs with potential clinical significance in cancer care. Based on this pilot study, it is suggested that the Middle East can serve as a valuable region for future multicultural-oriented cancer research.

Bridging the physician and CAM practitioner communication gap: suggested framework for communication between physicians and CAM practitioners based on a cross professional survey from Israel.

OBJECTIVE Our study aimed to develop a framework to improve communication between physicians and CAM practitioners regarding mutual patients. METHODS Following a modified Delphi process, we developed preliminary recommendations regarding communication between physicians and CAM practitioners. We then surveyed 473 physicians and 781 CAM practitioners regarding their opinions on these recommendations. RESULTS High reliability and validity of the survey were found among the physicians and CAM practitioners (Cronbachs alpha score of .94 and .83, respectively). Physicians and CAM practitioners considered communication regarding mutual patients important (80% and 97%, respectively; P<.001). A medical/referral letter was the preferred communication mode. Physicians and CAM practitioners concurred on four elements that should be included in such a referral letter: conventional-CAM diagnosis with coherent terminology, possible conventional-CAM treatment interactions, description of the treatment plan and its goals, and quality issues regarding CAM supplements. CONCLUSIONS A practical framework for advancing physician-CAM practitioner communication is feasible, and may be applied in daily medical care with the goal of bridging the patient-physician-CAM practitioner communication gap. PRACTICE IMPLICATIONS Communication between physicians and CAM practitioners regarding mutual patients is important. Establishing a framework for the mode and content of such communication is feasible.

The use of boundary objects to enhance interprofessional collaboration: integrating complementary medicine in a hospital setting

Because of the inherent complexity of human health, the provision of good quality patient care requires collaboration in multidisciplinary teams. Integrative healthcare provides a unique setting for the study of interprofessional collaboration in the context of power disparities. The research objective was to examine which means and mechanisms were used to facilitate interprofessional collaboration when integrating complementary medicine (CM) into a hospitals surgical department. Throughout 2010 we conducted a qualitative study in an Israeli public hospitals surgical department, using observations and 30 in-depth interviews with managers, surgeons, physicians, nurses, patients and CM practitioners. The sociological concepts of boundary actor and boundary object and the context of power relations served as a framework for this research. This article contributes to the field of interprofessional collaborative care research by: analysing types of collaboration inhibitors--epistemological and social-structural gaps; pointing to boundary actors who establish interprofessional collaboration in an integrative hospital setting and noting the boundary objects they use; and comparing collaboration levels. The collaboration between CM practitioners and the departments staff is a loosely coupled system. When coordination was achieved, reaching profound agreements seemed of lesser importance to the parties. Closer collaboration and cross-fertilisation were found among CM practitioners.

Ethical Issues in Integrative Oncology

Integrative oncology relates to an emerging dialog between complementary and alternative medicine (CAM) scholars, oncologists, family practitioners, and other health care providers who envision an extended and holistic patient-centered approach to oncology care. The multiple commitments of integrative oncology to a medical humanistic approach and to a strong evidence-based foundation may impose considerable ethical concerns and dilemmas. The authors use narrative ethics to present a case study that exemplifies the ethical challenges confronting physicians and health care providers who wish to provide an integrative approach for their patients. An ethical analysis of the narrative is provided to help clarify the ethical issues and conflicts within it. Finally, a framework that may transform ethical constraints to a communication tool is proposed.

Attitudes of patients with gynecological and breast cancer toward integration of complementary medicine in cancer care.

Objective The purpose of this study was to explore prospectively the perspectives of patients with breast and gynecological cancers regarding integration of complementary and alternative medicine (CAM) in conventional oncology settings. Methods We developed a 27-item questionnaire that was administered to convenient sample of patients with breast cancer and another with gynecological cancer who were attending a community-based oncology service in northern Israel. Results Of the 275 respondents, 109 (39.6%) had gynecological cancers and 166 (60.4%) had breast cancer. Current and/or previous year CAM use for oncology treatment was significantly higher among the patients with gynecological cancer (73/166 [44%] vs 67/106 [63%], P = 0.03). A logistic regression model indicated that CAM use was associated with gynecological cancer (EXP [B], 2.51; 95% confidence interval for EXP [B], 1.29–4.88; P = 0.007], younger age, Jewish religion, and lesser degree of religiosity. The patients highly expected their gynecologist-oncologist and family doctor to refer them to CAM counseling. Moreover, they expected their gynecologist-oncologist to participate in building a CAM treatment plan if CAM were to be integrated into the oncology service. The patients expected the CAM consultant to inform them of the safety and efficacy of CAM treatments, emphasizing expectations to strengthen their general ability to cope with the disease, reduce chemotherapy side effects, and provide emotional and spiritual support. Conclusion Although patients with gynecological malignancies use CAM significantly more than patients with breast cancer, both groups share similar conceptions regarding the active role of their gynecologist oncologists in the process of CAM integration within supportive care and expect CAM consultation to focus on improving their well-being.

Herbs in hemato-oncological care: an evidence-based review of data on efficacy, safety, and drug interactions.

Herbal remedies are clearly a complementary and alternative modality used frequently by patients with hemato-oncological neoplasias during the course of their specific treatment. This review focuses on the potential safety and efficacy of herbs which are either used often or even on a daily basis by patients with hematological malignancies or indicated in the herbal pharmacopeias utilized by various traditional systems of medicine, in order to improve the well-being of patients with these cancers. Traditional medicine worldwide is a source for ongoing laboratory research related to the activity of herbs on cultured cell lines derived from patients with leukemia, lymphoma, and myeloma. Although the number of clinical studies in the field of hemato-oncology is limited, there appears to be potential efficacy in studies of mistletoe (Viscum album), green tea, Indian and Middle-Eastern spices, and some traditional Chinese, American, and European herbs. In addition to the potential efficacy of herbs, safety issues are also reviewed here, particularly, the documented and potential side effects, herb–drug interactions, and matters of quality control. Based on the above issues, the authors suggest enhancing doctor–patient communication regarding herbal use by adopting a patient-centered attitude based on scientific perspective.

Hypnosis for Postradiation Xerostomia in Head and Neck Cancer Patients: A Pilot Study

Xerostomia, the sensation of dry mouth, affects almost all patients who undergo radiotherapy for cancer in the head and neck area. Current therapies for xerostomia are inadequate, and the condition negatively impacts the quality of life. This prospective observational pilot study aimed to evaluate whether hypnosis could improve salivation and decrease xerostomia. Twelve patients with xerostomia after radiotherapy for head and neck cancer were assessed for severity of xerostomia symptoms and sialometry. They then received a single hypnosis session with specific suggestions to increase salivation. The session was recorded on a compact disk (CD), and the participants were instructed to listen to it twice a day for one month. Sialometry was repeated immediately after hypnosis. Validated xerostomia questionnaires were completed at one, four, and 12 weeks after hypnosis. A substantial overall improvement was reported by eight patients at 12 weeks (66%). The saliva flow rate increased on sialometry in nine patients following hypnosis (75%). There was no correlation between the magnitude of changes in the measured saliva flow rate and changes in subjective measures (Spearmans correlation coefficient r=0.134). Symptomatic improvement significantly correlated with the number of times the patients listened to the hypnosis CD (r=0.714, P=0.009). No adverse events were reported. The data from this small observational trial suggest that hypnosis may be an effective treatment for xerostomia. Confirmation in a larger randomized and controlled investigation is warranted.