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

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; Stefanie Joos; CCC-Integrativ Study Group

doi:10.1007/s11684-024-1097-z

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

Front Med. 2024 Nov 14. doi: 10.1007/s11684-024-1097-z. Online ahead of print.

Authors

Affiliations

¹ Institute for General Practice and Interprofessional Care, University Hospital and Faculty of Medicine Tuebingen, Tuebingen, Germany. jan.valentini@med.uni-tuebingen.de.
² Institute for General Practice and Interprofessional Care, University Hospital and Faculty of Medicine Tuebingen, Tuebingen, Germany.
³ Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital and Faculty of Medicine Tuebingen, Tuebingen, Germany.
⁴ Department of Nursing Science, Institute for Health Sciences, University Hospital and Faculty of Medicine Tuebingen, Tuebingen, Germany.
⁵ Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
⁶ Department of Internal Medicine, Division of Pneumology, Paracelsus Medical University, Klinikum Nuernberg, Nuernberg, Germany.
⁷ aQua Institute for Applied Quality Improvement and Research in Health Care, Goettingen, Germany.
⁸ Department of Integrative Medicine, University Hospital and Faculty of Medicine, Ulm, Germany.
⁹ Department of Medicine I, Medical Centre University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
¹⁰ Department of Medical Oncology, National Centre for Tumor Diseases, Heidelberg, Germany.
¹¹ Fachbereich Integriertes Leistungsmanagement, AOK Baden-Württemberg Hauptverwaltung, Stuttgart, Germany.

PMID: 39542987
DOI: 10.1007/s11684-024-1097-z

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 and integrative healthcare; complementary medicine; herbal medicine; interprofessional counseling; nutritional support; oncology; patient activation; preventive medicine.