Challenges in Implementing Guideline on Integrative Oncology and Pain: The Israeli Perspective

Eran Ben-Arye; Jun Mao; Eduardo Bruera; Noah Samuels; Yael Keshet; Richard T Lee; Dina Ben-Yehuda; Elon Eisenberg; Gil Bar-Sela; Pesach Shvartzman; Lynda G Balneaves; Michal Shani; Martin Ellis; Debu Tripathy; Shifra Ash; Avishay Elis; Zvi Vaknin; Ruth Ofir; Elad Schiff

doi:10.1016/j.jpainsymman.2023.09.022

Challenges in Implementing Guideline on Integrative Oncology and Pain: The Israeli Perspective

J Pain Symptom Manage. 2024 Jan;67(1):69-76. doi: 10.1016/j.jpainsymman.2023.09.022. Epub 2023 Sep 26.

Authors

Eran Ben-Arye¹, Jun Mao², Eduardo Bruera³, Noah Samuels⁴, Yael Keshet⁵, Richard T Lee⁶, Dina Ben-Yehuda⁷, Elon Eisenberg⁸, Gil Bar-Sela⁹, Pesach Shvartzman¹⁰, Lynda G Balneaves¹¹, Michal Shani¹², Martin Ellis¹³, Debu Tripathy¹⁴, Shifra Ash¹⁵, Avishay Elis¹⁶, Zvi Vaknin¹⁷, Ruth Ofir¹⁸, Elad Schiff¹⁹

Affiliations

¹ Integrative Oncology Program (E.B-A), The Oncology Service; Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel; Ruth and Bruch Rappaport Faculty of Medicine (E.B-A., E.E.), Technion-Israel Institute of Technology, Haifa, Israel. Electronic address: eranben@netvision.net.il.
² ASCO Guideline on Integrative Medicine for Pain Management (J.M.); Memorial Sloan Kettering Cancer Center, New York, NY, USA.
³ ASCO Guideline on Integrative Medicine for Pain Management (E.B.); MD Anderson Cancer Center, Houston, Texas, USA.
⁴ Center for Integrative Complementary Medicine (N.S.), Shaarei Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel.
⁵ Department of Sociology (Y.K.), The Western Galilee College, Acco, Israel.
⁶ City of Hope Comprehensive Cancer Center (R.T.L.), Duarte, California, USA.
⁷ Hadassah-Hebrew University Medical School (D.B-Y.), Faculty of Medicine, Hebrew University of Jerusalem, Israel.
⁸ Ruth and Bruch Rappaport Faculty of Medicine (E.B-A., E.E.), Technion-Israel Institute of Technology, Haifa, Israel; The Israel Pain Society (E.E.), Israel Medical Association, Israel.
⁹ Israeli Society of Clinical Oncology & Radiation Therapy (ISCORT) (G.B-S.), Israel Medical Association; Cancer Center, Emek Medical Center, Afula, Israel.
¹⁰ Israel Society for Palliative Medicine (P.S.), Israel Medical Association; Siaal Center for Community Research, Pain and Palliative Care Unit, Kappy and Eric Flanders National Palliative Care Resource Centre, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
¹¹ College of Nursing, Faculty of Health Sciences (L.G.B.), University of Manitoba, Winnipeg, Manitoba, Canada.
¹² Israel Association of Family Physicians (M.S.), Israel Medical Association; Department of Family Medicine, Central District, Clalit Health Service, Rehovot, Israel; Sackler Faculty of Medicine (M.S.), Tel Aviv University, Tel Aviv, Israel.
¹³ Israel Society of Hematology and Transfusion Medicine (M.E.), Israel Medical Association; Hematology Institute and Translational Hemato-Oncology Laboratory, Meir Medical Center, Israel.
¹⁴ Department of Breast Medical Oncology (D.T.), University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
¹⁵ Israeli Society of Pediatric Hematology/Oncology (S.A.), Israel Medical Association; Department of Pediatric Hematology-Oncology, Rambam Medical Center, Haifa, Israel.
¹⁶ Israel Society of Internal Medicine (A.E), Israel Medical Association; Department of Internal Medicine "C", Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.
¹⁷ Israeli Society of Gynecologic Oncology (Z.V.), Israel Medical Association; Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center, Zerifin, Israel; Affiliated to the Sackler Faculty of Medicine (Z.V.), Tel Aviv University, Tel Aviv, Israel.
¹⁸ Israeli Oncology Nursing Society (R.O.), Department of Pediatric Hematology-Oncology, Rambam Medical Center, Haifa, Israel.
¹⁹ The Society of Complementary Medicine (E.S.), Israel Medical Association; Department of Internal Medicine & Integrative Medicine Service, Bnai-Zion Medical Center, Haifa, Israel.

PMID: 37769821
DOI: 10.1016/j.jpainsymman.2023.09.022

Abstract

Context and objectives: To explore the feasibility of implementing the joint guideline on integrative medicine for pain management in oncology, published by the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO), for integrative oncology (IO) services in supportive and palliative care.

Methods: A qualitative research methodology was co-designed by the SIO-ASCO guideline committee, with the Society for Complementary Medicine, Israel Medical Association (IMA). A questionnaire with five open-ended questions exploring barriers and enablers to implementing the guideline was distributed to chairs and board members of nine IMA-affiliated medical societies; four deans of Israeli medical schools; and nurses from the Israeli Society for Oncology Nursing. Respondent narratives were qualitatively analyzed using ATLAS.Ti software for systematic coding.

Results: Questionnaires were completed by 52 physicians and nurses from medical oncology, hematology, gynecological oncology, pediatric oncology, palliative medicine, pain, family medicine, internal medicine, and integrative medicine. The SIO-ASCO guidelines were endorsed by nine IMA-affiliated societies. The domains identified included the importance of guideline implementation in clinical practice; barriers and facilitators to implementation; practical aspects required for this implementation (e.g., IO training); clinical indications for referral; budget-related issues; and clinical and administrative models enabling practical implementation of the guideline.

Conclusion: We found across-the-board consensus among the nine IMA-affiliated societies supporting the current guideline. This, while identifying potential facilitators and barriers in order to address the implementation of the SIO-ASCO guideline recommendations.

Keywords: Cancer; guideline; integrative medicine; integrative oncology; israel; pain; palliative care.

MeSH terms

Child
Humans
Integrative Oncology* / methods
Israel
Medical Oncology
Neoplasms* / therapy
Pain