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Developing and Evaluating Integrative Oncology Models
At the OICC we are committed to ensuring our model of care is informed by the latest research evidence, and also evaluating the care we offer to people living with cancer. We have several ongoing studies to explore the development and evaluation of unique integrative oncology models, including the OICC model and other in operation internationally.
- A Systematic Review of Integrative Oncology Programs.
- Integrative Cancer Care in the Ottawa Region: Perspectives of Health Care Providers, Patients and their Families.
- Towards Integrative Cancer Care: A Participatory, Formative Evaluation of Practitioner Integration at the Ottawa Integrative Cancer Centre.
Funded by the Lotte & John Hecht Memorial Foundation
Please note: This abstract was presented as a poster presentation at the 1st Annual Canadian Cancer Research Conference; Toronto, 2011.
Background: The discipline of integrative oncology has emerged in response to cancer patients’ increasing tendency to use complementary approaches, such as naturopathic medicine, acupuncture and meditation to manage their cancer experience. It is an evidence-based approach that combines the best of both conventional and complementary medicine in a shift towards whole person care. There are numerous examples of integrative oncology practice in the literature.
Objective: Our objective was to systematically review and summarize the academic literature describing integrative oncology programs. Methods: We followed the methods of systematic review. We searched nine electronic databases, handsearched journals and conference abstracts and contacted experts for articles describing integrative oncology programs. A standardized data extraction form and guidelines were pilot tested before data were extracted according to six concepts: description of article, description of program, components of care, organizational structure, patient flow and measurable outcomes. All data were extracted by one, and verified by a second, investigator. Data were summarized descriptively.
Results: A broad screen of 1,621 records resulted in 53 articles describing 29 integrative oncology programs being included. 12 programs (41%) operate in the United States, ten (34%) in England, two (7%) in Germany and two (7 %) in Canada. Over half (n=16; 55%) operate within a hospital setting, while seven (24%) are community-based. Referrals most commonly come from patients self-referring (n=15; 52%), conventional healthcare providers (n=9; 31%), and cancer agencies (n=7; 24%). 41% (n=12) provide conventional care onsite, whereas seven (24%) collaborate with conventional centres to provide integrative care. A wide variety of complementary therapies are offered: mind-body medicine, massage, nutrition counseling and acupuncture are most common. Programs are supported financially in a variety of ways, including through charitable donations (n=10; 34%), cancer agencies or hospitals (n=7; 24%), private foundations (n=6; 21%) and public funding (n=3; 10%). Nearly two-thirds (n=18; 62%) maintain an active research program and/or an evaluation strategy (n=15; 52%). The focus is on clinical trials of therapies offered within the programs and evaluation of the integrative model.
Conclusion: Documented integrative oncology programs share a common vision to provide whole-person, patient-centred and integrative care, but each program is unique in terms of components of care, organizational structure, and patient flow. Programs seem to develop in direct relation to their local environment and the people leading the process. There is a lack of information regarding facilitators and barriers to the development and sustainability of such programs.
STUDY STATUS: This study is now complete. A scientific manuscript is currently under consideration at Current Oncology.
INVESTIGATORS: Dugald Seely, ND, MSc, FABNO (Principal Investigator); Laura Weeks, PhD; Sarah Young, MA, DipST.
Integrative Cancer Care in the Ottawa Region: Perspectives of Health Care Providers, Patients and their Families
Funded by the Lotte & John Hecht Memorial Foundation
Please note: This abstract was presented as an oral research presentation at the 8th International Conference of the Society for Integrative Oncology.
Purpose: Many models of integrative oncology care have emerged in the past two decades, each varying in terms of therapies offered, professional leadership, means of professional collaboration and their funding and operational structure. To be successful, a model must develop in relation to the specific social, cultural and political environments in which it will operate. With the goal to develop an integrative oncology centre in the Ottawa region, we set out to explore the needs and perspectives of healthcare providers and cancer patients and their families regarding a feasible model of integrative cancer care including potential facilitators and barriers to successful operation. Methods: We conducted a descriptive qualitative study that included 39 in-depth interviews with cancer patients (n=12) and their family members (n=1) and complementary (n=11) and conventional (n=15) healthcare providers. Interviews were semi-structured and covered a range of issues regarding complementary and integrative care and treatment decision-making. Of relevance to this presentation were questions to elicit perspectives on an operational model of integrative cancer care in the Ottawa region. Qualitative content analysis was used to analyze interview transcripts.
Results: Participants offered a range of insight into a feasible model of care. Suggestions were made for a structured (versus unstructured) program, which would include assignment of a primary caregiver, either a medical or naturopathic doctor, to each patient. A Coordinator of Integrative Care was thought to help provide continuous and whole person care by serving as the main contact person for each patient. Regular clinical rounds, shared patient charts and informal opportunities for practitioners to meet were suggested as ways to help ensure decision-making is collaborative and care is patient-centred. Specific roles suggested for complementary therapists within integrative care include: managing side effects of conventional treatment; supportive care; psychological care; care of exceptional cases; and, helping to identifying treatment interactions. Several practitioners argued that research should be a central part of the mandate: to help develop the evidence base for complementary and integrative care; assess cost effectiveness; add credibility; and, improve patient care. Most participants agreed a salary-based model would be most appropriate as a means to equalize contributions of, and reduce competition amongst, team members. Further, participants agreed that patients should bear some responsibility for payment; however, a program to provide access to patients and families in need would be appropriate. Finally, numerous facilitators and barriers to successful operation were articulated that are both general to integrative oncology and specific to the Ottawa context.
Conclusions: The Ottawa Integrative Cancer Centre (OICC) will open in the Fall of 2011 based in part on this model developed through consultation with relevant stakeholders for the specific context of the Ottawa region. The OICC’s operational model will incorporate a comprehensive evaluation strategy that will include soliciting feedback from stakeholders on an ongoing basis. We anticipate an evolution of care and integration between the OICC and other healthcare institutions and practitioners. Thus, the model will be flexible to allow for change to address the needs of the community served and the relationships developed.
STUDY STATUS: This study is now complete and a manuscript is in progress to be submitted for publication in a scientific journal later in 2012.
INVESTIGATORS: Dugald Seely, ND, MSc, FABNO (Principal Investigator); Laura Weeks, PhD; Sarah Young, MA, DipST; Dawn Stacey, RN, PhD, CON(C); Heather Boon, BScPharm, PhD; Marja Verhoef, PhD; Lynda Balneaves, RN, PhD; Cathy DeGrasse, RN, MSc; Shailendra Verma, MD, FRCP.
Towards Integrative Cancer Care: A Participatory, Formative Evaluation of Practitioner Integration at the Ottawa Integrative Cancer Centre
Funded by the Canadian Complementary and Alternative Medicine Research Fund
To ensure progress towards the OICC mission of providing evidence-informed integrative oncology care, research and education there is a need to evaluate integrative practice at the OICC in relation to a collective vision. The objectives of this study are therefore to describe elements of integrative practice in place at the OICC, define a collective vision for integrative practice, and develop strategies to facilitate the provision of patient-centred, integrative care. The study builds on previous research exploring interprofessional team relationships in Canadian integrative healthcare settings. We are conducting a multi-phase, participatory formative evaluation that includes: 1) A descriptive analysis of scheduling data; 2) Interviews with OICC practitioners to explore actual and ideal elements of integrative practice; 3) Focus groups with OICC practitioners to define a collective vision for integrative practice; 4) A comparison of actual practice to the defined collective vision; and 5) Developing strategies to change practice. This study will help clarify a collective vision for integrative oncology within the OICC, provide valuable information on actual practice and elicit strategies to ensure continual progress towards the vision. Beyond the OICC, however, there is an increasingly recognized need for access to safe and effective IO care, but no clear model to follow and a lack of evidence to support policy development. We expect the lessons learned through this study can be generalized to other developing programs and inform policies in the broader Canadian context.
STUDY STATUS: The study has received ethical approval through the Canadian College of Naturopathic Medicine. Interviews with OICC practitioners will occur throughout the Fall of 2012.
INVESTIGATORS: Laura Weeks, PhD (Principal Investigator); Dugald Seely, ND, MSc, FABNO; Daniel Hollenberg, PhD; Isabelle Gaboury, PhD.
Voices of Support
“I applaud the OICC’s commitment to being a leader in integrative oncology research. From interactions with mutual patients, I realize that the clinical care provided by the OICC has real value to the people under our care, and that this care can and should be expanded to others. With the research that we’ve done together already and the approach you take in science and clinical care, I believe the OICC will achieve great prominence as a valuable resource for patients.”
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