Training oncology physicians to advise their patients on complementary and integrative medicine: An implementation study for a manual‐guided consultation

Abstract

Background The unmonitored use of complementary medicine in patients with cancer can be associated with an increased risk of safety‐related issues, such as lower adherence to conventional cancer therapies. Training oncology physicians to advise their patients about the effectiveness and safety of these therapies could improve this situation. Methods The objective of this study was to develop and pretest a consultation framework that has high potential to be widely implemented. The framework comprises: 1) a systematically developed and tested, manualized, guided consultation; and 2) blended learning training (e‐learning and communication skills training workshop) to upskill oncology physicians in advising their patients on complementary and integrative medicine (CIM). For this implementation study, mixed methods were used to develop the manual (literature review, consensus procedure, pilot testing) and the training (questionnaires and interviews with oncology physicians and patients with cancer and an examination of the skills in a setting with standardized patients). Results The training was tested with 47 oncology physicians from across Germany. The manual‐guided consultation (context: general information on the setting and communication techniques; inform: consultation duration and content; capture: previous CIM use; prioritize: focus on consultation; advise: evidence‐based CIM recommendations; discuss, advise, accept, or advise against other CIM; concretize advice: summary and implementation; and monitor: documentation) was considered suitable. The structure and time frame (maximum, 20 minutes) of the consultation as well as the training were feasible and well accepted. Conclusions The current study demonstrates that the KOKON‐KTO framework (a German acronym for Competence Network for Complementary Medicine ‐ Consultation Training for Oncology Physicians) is suitable for training oncology physicians. Its implementation can lead to better physician‐patient communication about CIM in cancer.

Development and Implementation of Situational Judgment Tests as an Evaluation Method for Training Oncology Physicians: Application in the KOKON-KTO Training

“…SJT Answers For each question, the best choice answer was derived from the KOKON-KTO consultation manual [18] taking into account the competencies for Integrative Oncology [20]. To add suitable and realistic distractors, two physicians (one oncology gynecologist and one medical oncologist; both regularly advising cancer patients on CIM), as well as two experienced CIM researchers (psychologist, public health researcher), each added one answer to the SJTs, resulting in five answers per SJT (four distractors, one best choice answer according to KOKON-KTO consultation manual).…”

“…Implementation Process The SJTs were incorporated into the e-learning intervention of the KOKON-KTO training [18]. The e-learning was developed according to learning objectives following constructive alignment rules [23] and the underlying consultation manual of the training [18], as well as international educational competencies for health professionals working in integrative oncology [20].…”

Komplementärmedizin in der gynäkologisch-onkologischen Sprechstunde: Wie mache ich mich fit dafür?

“…Ziel ist, dass die Teilnehmenden nach dem Kurs mit ihren Patientinnen konkrete Therapiepläne entwickeln können und auch einzelne Therapien selber ausführen können. Der Kurs beinhaltet auch die relevanten Aspekte des positiv evaluierten KOKON-KTO-Trainings [15]. Zudem wurden die dafür relevanten der o. g. SIO-Kompetenzen [14] berücksichtigt.…”

Don't ask, don't tell: It's time to talk about complementary, alternative, and integrative medicine with our patients

“…Engaging in a meaningful discussion with a patient about a topic for which there is limited formal education and is potentially controversial is a daunting task to add on top of the time and financial pressures oncologists are facing today in medicine. In their article in this issue of Cancer , Witt et al have substantially helped us move forward to address this issue of poor communication regarding CAIM in the oncology setting . The study investigators created a robust training program that addresses 2 important issues: what to discuss with patients and how to discuss it.…”

“…The topic of CAIM use by our oncology patients can no longer be swept under the rug as oncology clinicians play a critical role in advising patients to prevent harm and improve clinical outcomes. The education program developed by Witt et al moves us forward by providing practical methods to help oncologists learn about the field of integrative medicine and how to have succinct and effective discussions with patients. However, the program requires a significant time commitment and thus other educational strategies will need to be developed in parallel to incorporate brief self‐learning with online resources for clinicians who may not have the time to devote to a longer program.…”