We read with great interest the article by Valentini
et al., which presents a controlled implementation study evaluating an interprofessional evidence-based counseling program for complementary and integrative healthcare (CIH) in oncology patients [
1]. The study provides an important contribution to the field, particularly in recognizing the potential of patient activation as a means to improve self-management and engagement in cancer care. While the authors acknowledge certain limitations, several aspects merit further scrutiny to ensure a balanced interpretation of the findings and their implications for clinical practice.
One major concern relates to the magnitude of the observed effect [
2]. The reported adjusted mean difference in patient activation scores between the intervention and control groups, though statistically significant, raises questions regarding its clinical relevance. A difference of 2.22 points on the PAM-13 scale, while measurable, falls short of what might be considered a meaningful impact on patient behavior or health outcomes [
3]. Without established thresholds for minimally important differences in this context, it remains unclear whether such an effect translates into tangible benefits for oncology patients, particularly in the context of their complex medical needs.
Furthermore, the study employs a non-randomized design with a treatment-control comparison, which introduces potential biases despite the authors’ rationale for avoiding randomization [
4]. The use of a convenience sampling approach for the intervention group and a temporally distinct recruitment phase for controls raises concerns regarding baseline comparability. While statistical adjustments may account for known confounders, the possibility of unmeasured biases influencing the results cannot be dismissed. Additionally, the influence of external factors such as concurrent psychological support, social determinants of health, and patient expectations remains unexplored, potentially confounding the observed intervention effects [
5].
Another aspect warranting discussion is the absence of significant maintenance effects at six-month follow-up. The lack of sustained improvements in patient activation suggests that the intervention’s benefits may be transient. While the authors acknowledge this limitation, further inquiry into the mechanisms underlying this attenuation is necessary. Given that long-term patient engagement is a critical component of self-management in oncology [
6], future interventions may need to integrate reinforcement strategies or extended counseling sessions to ensure lasting impact.
The study also introduces a structured CIH counseling program facilitated by interprofessional teams of physicians and nurses, yet it does not adequately address potential heterogeneity in counseling delivery. The degree to which individual counselors adhered to standardized protocols, the extent of patient-provider rapport, and variations in counseling content may have influenced the outcomes [
7]. Without a detailed assessment of implementation fidelity, it is difficult to ascertain whether the intervention’s effects can be consistently replicated across diverse clinical settings.
Additionally, while the authors emphasize the potential benefits of CIH counseling for patient activation, the study does not provide insights into patient adherence to recommended CIH interventions post-counseling. Measuring behavioral uptake of CIH recommendations—such as adherence to exercise regimens, nutritional modifications, or stress management practices—would offer a more comprehensive understanding of the intervention’s real-world effectiveness [
8].
Lastly, broader systemic considerations warrant reflection. The integration of CIH counseling into routine oncology care is an ambitious goal, yet practical barriers such as provider training, time constraints, and resource allocation pose significant challenges [
9]. The generalizability of this study’s findings to other healthcare systems, particularly those with differing levels of CIH acceptance and infrastructure, remains uncertain. Addressing these implementation challenges is essential before advocating for widespread adoption of such interventions.
In conclusion, while Valentini
et al. present an innovative approach to enhancing patient activation through interprofessional CIH counseling [
1], several methodological and practical considerations merit further exploration. A clearer delineation of clinically meaningful effects, strategies to sustain activation, and assessments of real-world adherence and feasibility would strengthen the case for integrating such programs into oncology care. We encourage continued investigation into these areas to ensure that patient-centered interventions yield both statistically and clinically significant benefits.
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