Orit Gressel

Objectives: Integrative medicine programs are increasingly being implemented in clinical settings, including gynecology and obstetrics. This study explores an integrative obstetric and maternity care (IObM) model designed for real-life peri-labor settings, comparing perspectives among parturient women to obstetric healthcare professionals (HCPs) regarding operative components of the model. Methods: A 26-item questionnaire was prospectively administered to women hospitalized from the 22nd week of gestation (antenatal, early labor, or immediate postpartum) and to obstetric HCPs, primarily obstetricians and nurse-midwives, in three obstetric wards. Four core items addressed key aspects of the IObM model: the source of and indications for referral to IObM treatments, preferred IObM modalities, and willingness to receive care from uncertified IObM providers. Results: The two respondent groups (63 parturient women and 60 HCPs; response rate 95 and 100%, respectively) showed similar patterns regarding language, religiosity, spiritual relatedness, prior complementary medicine use (>66%), and perceived effectiveness and risks during pregnancy and labor. Internal consistency within each of the four core items was moderate and acceptable (parturients, α = 0.61–0.69; HCPs, α = 0.62–0.68). HCPs showed greater support than parturients for nurse-midwife referrals (p = 0.002) and mind-body trained therapies (p = 0.002). Both groups recommended labor-related indications for IObM referral, primarily labor pain, anxiety, and labor progression. Parturients were more supportive of nurse-provided IObM care (p = 0.012). Conclusions: Exploring expectations of parturient women and HCPs is essential when designing IObM models of care. Four core aspects should be prioritized: source of and indication for the referral to IObM treatments and mapping of preferred IObM modalities and providers. These findings reflect acceptability, expectations, and preferences in a single center with an established integrative service and should not be read as evidence of clinical effectiveness or of successful implementation. Further prospective research should explore implementation of these models in real-life practice, assessing effectiveness, risks, and birth experience.

Objectives Enhanced recovery after surgery is a concept increasingly addressed in prehabilitation research, addressing patients’ unmet needs and quality of life (QOL)-related concerns, while overcoming barriers to implementing effective models of care. The present narrative overview examined the gynaecological oncology prehabilitation literature, within the context of integrative oncology (IO) whose goals include enriching prehabilitation care. Methods A multidisciplinary and multinational team of 9 coauthors from Israel and Germany conducted a narrative review, searching PubMed/Medline databases for complementary medicine and IO-related keywords relevant to the gynaecological oncology-related prehabilitation setting. Results A total of 55 papers addressing IO-related prehabilitation models in gynaecological oncology were identified. The research addressed issues related to QoL-related concerns, including anxiety and uncertainty among patients during prehabilitation. IO modalities addressing these symptoms included mind-body medicine; manual-movement therapies; acupuncture and guidance on the use of herbal medicine. Five stages along the prehabilitation timeline for implementing IO therapies were identified, beginning at the initial diagnosis of cancer, until surgery or the initiation of chemotherapy and other oncological drug treatments. Conclusions The inclusion of IO programmes during prehabilitation for gynaecological cancer should be a routine part of patient care, from the initial diagnosis of cancer through surgery and anti-cancer drug treatments. The IO model of care can significantly enhance the patient-centred prehabilitation setting for those with gynaecological cancer, while exploring the patient’s health belief model, expectations and unmet needs, especially for QoL-related concerns for which currently available supportive care has limited effectiveness.

Objectives Supportive and palliative care include non-oncology settings where patients suffer from pain and quality of life-related concerns. Integrative medicine plays important roles in supportive care and symptom management, including Integrative Obstetric (IOb) programmes within peri-partum settings. Multidisciplinary approaches may help nurse-midwives and obstetricians improve patient care and associated outcomes. This study presents a national perspective on IOb programmes in Israel. Methods A qualitative research methodology was codesigned by the Society for Complementary Medicine and Society of Maternal-Fetal Medicine, Israel Medical Association. A questionnaire with 17 open-ended questions was distributed throughout obstetrics and gynaecology departments across Israel. Respondent narratives were qualitatively analysed using ATLAS.Ti software for systematic coding. Results 22 senior obstetricians and IOb directors across 11 centres with IOb programmes completed the questionnaire. Core themes considered essential for the design and operation of IOb programmes included (1) determining major goals and indications for referral, primarily pain and anxiety; (2) targeting patients most likely to benefit; (3) identifying barriers and enablers to implementation and communication with the obstetric team; (4) designing the referral process and (5) documenting outcomes and safety of the IOb intervention in electronic medical files. Conclusions Designing and implementing IOb models of care that effectively support holistic symptom management within obstetric settings requires identifying barriers and enablers and establishing effective communication between obstetric and integrative medical teams. Further research should explore other multidisciplinary models of IOb care and structured referral development and testing while assessing risks and effectiveness.

Background: Research on quality of life (QoL)-related concerns among patients with both diabetes mellitus (DM) and cancer is limited. This study compared the QoL-related concerns and characteristics among chemotherapy-treated patients with cancer and DM to those without DM. Methods: Chemotherapy-treated patients were evaluated during integrative oncology (IO) consultations, which included evidence-based complementary therapies recommended by their healthcare providers to address quality of life (QoL) concerns. During these consultations, the participants were assessed for comorbidities, including diabetes mellitus (DM). QoL-related concerns were measured using the Edmonton Symptom Assessment Scale (ESAS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Results: Of the 1171 patients referred for an IO consultation, 272 (23.2%) had an established diagnosis of DM. The DM patients were older, presented with more advanced stages of cancer, and had more chronic comorbidities (p < 0.001). While fatigue was the most frequently reported QoL-related concern in both groups, the patients with DM had more severe pain scores in the ESAS (4.9 vs. 4.4, p = 0.022) and lower ESAS well-being scores (5.9 vs. 5.5, p = 0.021). Conclusions: Chemotherapy-treated patients with cancer and DM are characterized by higher rates of comorbidities and report more severe scores for pain and for poorer general well-being. Oncologists and diabetologists should consider referring patients with both diagnoses for an IO consultation to address their QoL-related concerns. More research is needed to understand the impact of IO consultations and treatments on well-being among patients diagnosed with both DM and cancer.