Evaluating CIH counseling for cancer patients

Complementary and integrative healthcare (CIH) is a significant aspect of cancer care, with many patients seeking these approaches to manage symptoms and side effects of treatment. A controlled implementation study, titled 'CCC-Integrativ', was conducted to evaluate the effects of an interprofessional evidence-based counseling program for CIH in enhancing patient activation among cancer patients.

The study was a prospective controlled non-randomized implementation study with a focus on the micro-, meso-, and macro-level outcomes, accompanied by a mixed-methods process evaluation and health economic analysis. The primary objective was to assess the impact of the program on patient activation, measured by the Patient Activation Measure questionnaire (PAM-13) at baseline, post-intervention, and at a 6-month follow-up.

The CCC-Integrativ intervention was an evidence-based counseling service designed for oncology patients, incorporating a patient-oriented approach with evidence-based treatment options. The intervention included a 10-month training program for interprofessional counseling teams, covering various CIH approaches and lifestyle topics.

Patients in the intervention group received three individual counseling sessions within three months, with the first session being face-to-face and subsequent sessions flexible in format. The control group received conventional standard healthcare and was offered the CIH counseling service after the 6-month observation period. The study was registered and approved by the ethics committees, ensuring ethical standards were maintained.

The study involved 1128 participants recruited from four University Hospital Comprehensive Cancer Centers in Germany, with 443 in the control group and 685 in the intervention group. The majority of participants were female, with a mean age of 57.1 years.

The intervention group showed a significant improvement in PAM-13 scores compared to the control group, with an adjusted mean difference of 2.22 points, indicating a positive effect on patient activation. The study also found that patients in the intervention group experienced less deterioration in activation levels compared to the control group, suggesting a preventive effect of the intervention.

The CCC-Integrativ study demonstrated that individually tailored counseling on CIH by interprofessional teams can significantly enhance patient activation, which is crucial for self-management in chronic diseases like cancer. The study's findings align with international literature, showing that higher patient activation is associated with improved health outcomes, better adherence to treatment plans, and lower healthcare costs.

The study's strengths include its multicenter approach, large cohort, and interprofessional counseling model. However, the non-randomized design and potential selection bias are limitations. The study concludes that implementing such a program at cancer centers can advance patient-centered care, emphasizing self-management and addressing the substantial patient demand for CIH methods.