title: Communication and integration: a qualitative analysis of perspectives among Middle Eastern oncology healthcare professionals on the integration of complementary medicine in supportive cancer care.
abstract: OBJECTIVE
  The use of complementary and traditional medicine (CTM ) in Middle Eastern countries is widespread, including among patients with cancer. Perspectives of oncology healthcare professionals (HCPs) in this region regarding the integration of CTM within conventional supportive cancer care were explored.
  
  
  METHODS
  An 11-item questionnaire with an open-ended question asking respondents to comment about the integration of CTM within supportive cancer care was sent to Middle Eastern oncology HCPs, using snowball sampling methodology. The narratives provided were examined using thematic analysis.
  
  
  RESULTS
  A total of 339 oncology HCPs completed and returned the study tool (80.3 % response rate ), of which 178 from 15 Middle Eastern countries responded to the open-ended question. The majority of respondents are in favor of the integration of CTM within supportive cancer care, though ideas on how this should be implemented varied. Thematic analysis identified multifactorial barriers to integration, which focused on HCPs' perspectives (e.g., a lack of knowledge and training; a skeptical approach to CTM), attitudes of patients and caregivers (e.g., unrealistic expectations regarding the outcomes of CTM treatments) and HCP-patient communication. In order to overcome these barriers, respondents suggested education and training programs for oncology HCPs which would focus on improving patients' quality-of-life-related outcomes.
  
  
  CONCLUSIONS
  Middle Eastern oncology HCPs support the integration of CTM within supportive cancer care, while recognizing the need for education and training in this field. A better understanding of CTM would provide the knowledge and skills which would promote a non-judgmental, evidence-based approach, fostering better communication with patients.
authors.affiliation: Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, 35 Rothschild St., 35152, Haifa and Western Galilee District, Israel. eranben@netvision.net.il.|Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. eranben@netvision.net.il.
authors.forename: Eran
authors.initials: E
authors.lastname: Ben-Arye
authors.affiliation: David Yellin Academic College, Jerusalem, Israel.
authors.forename: Ariela
authors.initials: A
authors.lastname: Popper-Giveon
authors.affiliation: Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, 35 Rothschild St., 35152, Haifa and Western Galilee District, Israel.|Tal Center for Integrative Oncology, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Noah
authors.initials: N
authors.lastname: Samuels
authors.affiliation: Center for Palliative Care Research and Education, Dokuz Eylul University, Inciralti, Izmir, Turkey.
authors.forename: Kamer
authors.initials: K
authors.lastname: Mutafoglu
authors.affiliation: Department of Internal Medicine, and Integrative Medicine Service, Bnai-Zion Hospital, Haifa, Israel.|The Department for Complementary Medicine, Law and Ethics, The International Center for Health, Law and Ethics, Haifa University, Haifa, Israel.
authors.forename: Elad
authors.initials: E
authors.lastname: Schiff
authors.affiliation: Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Suha
authors.initials: S
authors.lastname: Omran
authors.affiliation: Bank of Cyprus Oncology Center, Nicosia, Cyprus.
authors.forename: Haris
authors.initials: H
authors.lastname: Charalambous
authors.affiliation: Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
authors.forename: Tahani
authors.initials: T
authors.lastname: Dweikat
authors.affiliation: Makassed Charitable Hospital, East Jerusalem, Palestine.
authors.forename: Ibtisam
authors.initials: I
authors.lastname: Ghrayeb
authors.affiliation: Dr. A.Y Ankara Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Turker
authors.affiliation: National Center for Cancer Care and Research, Doha, Qatar.
authors.forename: Azza
authors.initials: A
authors.lastname: Hassan
authors.affiliation: Botany Department, National Research Centre, Dokki, Giza, Egypt.
authors.forename: Esmat
authors.initials: E
authors.lastname: Hassan
authors.affiliation: Department of Cancer Prevention, Ministry of Health, Amman, Jordan.
authors.forename: Omar
authors.initials: O
authors.lastname: Nimri
authors.affiliation: Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Rejin
authors.initials: R
authors.lastname: Kebudi
authors.affiliation: Middle East Cancer Consortium, Haifa, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Silbermann
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D003142:Communication; D000529:Complementary Therapies / Q000379:methods*; D019033:Delivery of Health Care, Integrated; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D008877:Middle East; D009367:Neoplasm Staging; D009369:Neoplasms / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D036301:Qualitative Research; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Complementary medicine; Doctor–patient communication; Integrative medicine; Palliative care; Supportive cancer care; Traditional medicine
references.citation: Patient Educ Couns. 2012 Dec;89(3):423-9
references.pmid: 22401792
references.citation: Qual Health Res. 2005 Nov;15(9):1277-88
references.pmid: 16204405
references.citation: J Altern Complement Med. 2012 Nov;18(11):1045-9
references.pmid: 22906212
references.citation: J Palliat Med. 2013 Apr;16(4):383-90
references.pmid: 23305189
references.citation: Soc Sci Med. 2009 Jan;68(1):177-82
references.pmid: 18992983
references.citation: Cancer. 2016 Feb 15;122(4):598-610
references.pmid: 26599199
references.citation: J Clin Oncol. 2001 May 1;19(9):2439-48
references.pmid: 11331323
references.citation: Ann Oncol. 2013 Oct;24(10):2641-2645
references.pmid: 23942776
references.citation: J Pain Symptom Manage. 2015 May;49(5):871-7
references.pmid: 25462209
references.citation: Evid Based Complement Alternat Med. 2012;2012:401867
references.pmid: 22203871
references.citation: Med Oncol. 2013 Jun;30(2):511
references.pmid: 23435989
references.citation: J Clin Oncol. 2014 Dec 20;32(36):4095-101
references.pmid: 25403205
references.citation: Ann Oncol. 2012 Jan;23(1):211-221
references.pmid: 21447617
references.citation: Pan Afr Med J. 2011;10:36
references.pmid: 22187618
references.citation: J Pain Symptom Manage. 2015 May;49(5):878-84
references.pmid: 25499828
references.citation: Ann Oncol. 2014 Feb;25(2):476-80
references.pmid: 24399080
references.citation: Integr Cancer Ther. 2013 Nov;12(6):488-95
references.pmid: 23625026
references.citation: Support Care Cancer. 2015 Sep;23(9):2605-12
references.pmid: 25617072
references.citation: Complement Ther Med. 2014 Apr;22(2):304-10
references.pmid: 24731902
references.citation: Complement Ther Clin Pract. 2012 May;18(2):121-6
references.pmid: 22500850
references.citation: Ann Oncol. 2012 Apr;23 Suppl 3:15-28
references.pmid: 22628412
references.citation: Oncologist. 2012;17(11):1475-81
references.pmid: 22933591