Enhancing patient activation: a controlled implementation study of an interprofessional evidence-based counseling program for complementary and integrative healthcare in cancer patients ('CCC-Integrativ')

Abstract

Complementary and integrative healthcare (CIH) is increasingly recognized as a valuable approach to empowering and activating cancer patients. Studies have shown that higher patient activation is positively associated with improved health outcomes and reduced healthcare costs. The CCC-Integrativ study aimed to assess the implementation of an evidence-based counseling service on CIH at four Comprehensive Cancer Centers (CCC) in Germany. In this controlled implementation study, the patient-level intervention included three CIH consultations within a 3-month period delivered by interprofessional teams of physicians and nurses. The primary endpoint was patient activation using the PAM-13 at baseline (T1) and post-intervention (T2), and compared between control (CO, receiving routine care) and the intervention group (IG) using an analysis of covariance. Missing data were handled with multiple imputations. Maintenance effects at 6-month follow-up (T3) were investigated using a linear mixed model. A total of n = 1128 oncology patients (CO = 443, IG = 685) with diverse tumor entities and cancer stages were included in the study. The overall mean baseline PAM-13 score was 69.74 (SD = 14.24) (n = 959 (85.0%)). A statistically significant between-group difference in post-intervention PAM-13 scores was observed (F_group(1, 1866.82) = 8.634, P = 0.003), with an adjusted mean difference of 2.22 PAM-points. Age, gender, tumor entity, disease stage, or CCC study site did not significantly predict post-treatment PAM-13 scores. The maintenance effect of the intervention was not statistically significant (F_timeXgroup(1, 3316.04) = 2.337, P = 0.096). Individually tailored counseling on CIH, offered by specifically trained, interprofessional teams, significantly improved patient activation. Given the established positive effects of higher patient activation, the implementation of such a program at cancer centers may yield beneficial outcomes for both patients and the healthcare system.

Keywords

adult oncology / complementary medicine / complementary and integrative healthcare / herbal medicine / nutritional support / oncology / preventive medicine / patient activation / interprofessional counseling

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Acknowledgements

This work was supported by the Innovationsfonds of the Federal Joint Committee 2019–2022 (No. 01NVF18004). The authors are gratefully for all patients who took part to the CCC-Integrativ study. We would also thank Holger Mauch for reviewing this manuscript. ChatGPT also assisted in linguistic revisions of the manuscript.

Compliance with ethics guidelines

Conflicts of Interest Jan Valentini, Daniela Froehlich, Inka Roesel, Regina Stolz, Cornelia Mahler, Peter Martus, Nadja Klafke, Markus Horneber, Claudia Witte, Klaus Kramer, Christine Greil, Barbara Gruen, Katrin Tomaschko-Ubelaender, and Stefanie Joos declare that they do not have any conflict of interests.

The study has been approved by the appropriate Institutional Ethical Committee of the University of Tuebingen (No. 658/2019BO1).

Trial Registration Number

DRKS00021779

Collaborators: CCC-Integrativ study group

A Schmitt, B Kröger, B Noack, B Wattenberg, E Kaschdailewitsch, H Mauch, K Gauß, K Harder, L Lohmüller, Institute for General Practice and Interprofessional Care, University Hospital and Faculty of Medicine Tuebingen, Germany; A Seckinger, D Zips, K Müller, Comprehensive Cancer Center Tübingen-Stuttgart, Germany; E Winkler, M Busacker-Scharpff, M Hoffmann, M Krug, M Reuter, S Eismann, Department of Medical Oncology, National Centre for Tumor Diseases, Heidelberg, Germany; A Kestler, B Leicht, C Nagat, C Raff, F Rapp, K Kraus, W Kmietschak, Department of Integrative Medicine, University Hospital and Faculty of Medicine Ulm, Germany; A Battran, A Frohn, B Held, C Perinchery, C Pfister-Jimenéz, Department of Medicine I, Medical Centre University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; H Dürsch, J Bossert, J Szecsenyi, M Wensing, Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany; A Kaltenbach, U Boltenhagen, Department of Nursing Science, Institute for Health Sciences, University Hospital and Faculty of Medicine Tuebingen, Germany; A Behzad, A Leppert. B Stein, Department of Internal Medicine, Division of Pneumology, Paracelsus Medical University, Klinikum Nuernberg, Germany; B Broge, C Witte, aQua Institute for Applied Quality Improvement and Research in Health Care, Goettingen, Germany; S Treffert, AOK Baden-Württemberg

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