This study aimed to explore integrative oncology (IO) across the Middle East, examine how international IO leaders promote IO in the Middle East, and assess how the Middle East contributes to the development of IO globally. This narrative review employed a structured literature search and descriptive analytic approach, using multiple databases, predefined keywords, varied study designs, and multilingual sources. It was conducted by a multi-disciplinary team of clinicians, researchers, and medical educators from ten Middle Eastern countries (Cyprus, Egypt, Iran, Israel, Jordan, Morocco, Palestine, Sudan, Turkey, and United Arab Emirates) and global IO/palliative leaders from South America, India, China, Europe, and the USA, providing a real-life implementation perspective. The collaborative IO model of care ensures safe and effective traditional and herbal medicine practices, with a culturally-sensitive approach respecting health beliefs. Middle Eastern and international IO participants discuss how they can benefit from each other, drawing from Middle-East Research Group in Integrative Oncology (MERGIO) activities in clinical practice, research, and medical education. Important themes derived from the review include the potential for IO to advance patient-centered care, effectively improve quality of life-related concerns, ensure a safe therapeutic environment, and overcome accessibility- and disparity-related barriers. IO treatments should be provided by trained multi-disciplinary teams of integrative physicians and practitioners, within culturally-adapted multi-modal programs and a receptive national and regional healthcare policy. Research utilizing pragmatic methodologies reflects real-world IO practice, with IO prioritized in medical education providing students and healthcare professionals with high-quality clinical and research training across the Middle East.

Objective This paper explores the pivotal role of nurses in the design and implementation of integrative oncology (IO) programs in the Middle East. The collaborative work of the Middle East Research Group in Integrative Oncology (MERGIO) is highlighted, addressing nurse-led IO in both the region and globally. Methods In this narrative review, twelve IO professionals from the Middle East and North America reflected on IO-related nursing practices within the activities of MERGIO, including research; health professional education; and clinical practice. Barriers to and facilitators of IO nursing in the Middle East were identified. Results A large body of IO nursing research from the Middle East was identified, with an increasing number of studies examining IO education, primarily multi-disciplinary training, and clinical practice. The activities of MERGIO were facilitated through a collaboration with IO nurses from Europe, North America and other countries with academic affiliations; along with activities under the auspices of the Society for Integrative Oncology (SIO), including SIO Europe. Conclusions For the last 15 years IO nursing in the Middle East, supported by MERGIO, has made significant advances. Training programs for nurses using a competency-based IO syllabus, while providing clinical opportunities to implement these skills in real-life cancer care, should be regarded as primary and achievable goals. Implications for Nursing Practice Nurses should be seen as a driving force behind the promotion and implementation of IO in cancer care. While research and training are central to the design of competency-based IO nursing programs, the implementation gap between theory and IO practice must be bridged.

Background: Despite a plethora of evidence available on the benefits of palliative care (PC), it is estimated that only about 14% of those living in low- to middle-income countries (LMIC) or developing countries have access to PC. Objective: To globally examine PC expert perspectives regarding PC infrastructure and resources within each country, drug and opioid availability to provide PC, and workforce and educational issues. Design: Descriptive, open-ended survey seeking first-hand qualitative perspectives. Setting/Subjects: PC experts from 21 developing countries representing 5 continents around the world. Measurements: Qualitative narratives and discussions with PC experts. Results: The summaries inform four key recommendations for future progress of PC in developing countries: (1) PC infrastructure should increase accessibility to both urban and rural areas; (2) increasing medication and nonpharmacologic approaches for symptoms is essential; (3) interdisciplinary education should continue to expand and include scholarships, PC certifications, and advanced education; and 4) future research with developing countries is desperately needed to advance care and progress. Conclusions: Considerable PC progress has been accomplished; however, significant gaps remain. This report can be used to discuss PC capacity building within a country. It could serve as an important document while negotiating with authorities and Ministries of Health about expanding PC infrastructure, especially in rural areas. Finally, PC champions can use this report to advocate for increased opioid availability to promote comfort; in particular, increased availability of oral opioids is essential, so that patients can die comfortably at home.

Background: Cancer incidence in the world is predicted to increase in the next decade. While progress has been in diagnosis and treatment, much still remains to be done to improve cancer pain therapy, mainly in underserved communities in low-income countries. Objective: To determine knowledge, beliefs, and barriers regarding pain management in both high- and low-income countries (according to the WHO classification); and to learn about ways to improve the current state of affairs. Design: Descriptive survey. Setting/Subjects: Fifty-six countries worldwide; convenience sample of 1639 consisted of 36.8% physicians; 45.1% nurses, and 4.5% pharmacists employed in varied settings. Results: Improved pain management services are key elements. Top barriers include religion factors, lack of appropriate education and training at all levels, nonadherence to guidelines, patients' reluctance to report on pains, over regulation associated with prescribing and access to opioid analgesics, fear of addiction to opioids, and lack of discussions around prognosis and treatment planning. Conclusion: The majority of patients with cancer in low-income countries are undertreated for their pain. Promoting cancer pain accredited program of training and education on pain management for physicians and nurses is crucial, as well as advocating policymakers and the public at large.

Background: The World Health Assembly urges members to build palliative care (PC) capacity as an ethical imperative. Nurses provide PC services in a variety of settings, including the home and may be the only health care professional able to access some disparate populations. Identifying current nursing services, resources, and satisfaction and barriers to nursing practice are essential to build global PC capacity. Objective: To globally examine home health care nurses' practice, satisfaction, and barriers, regarding existing palliative home care provision. Design: Needs assessment survey. Setting/Subjects: Five hundred thirty-two home health care nurses in 29 countries. Measurements: A needs assessment, developed through literature review and cognitive interviewing. Results: Nurses from developing countries performed more duties compared with those from high-income countries, suggesting a lack of resources in developing countries. Significant barriers to providing home care exist: personnel shortages, lack of funding and policies, poor access to end-of-life or hospice services, and decreased community awareness of services provided. Respondents identified lack of time, funding, and coverages as primary educational barriers. In-person local meetings and online courses were suggested as strategies to promote learning. Conclusions: It is imperative that home health care nurses have adequate resources to build PC capacity globally, which is so desperately needed. Nurses must be up to date on current evidence and practice within an evidence-based PC framework. Health care policy to increase necessary resources and the development of a multifaceted intervention to facilitate education about PC is indicated to build global capacity.

I1 World Congress for Integrative Medicine & Health 2017 - A global forum for exploring the future of comprehensive patient care Benno Brinkhaus1, Torkel Falkenberg2,3, Aviad Haramati4,5, and Stefan N. Willich1 1Institute for Social Medicine, Epidemiology and Health Economics, Charite – Universitatsmedizin Berlin, Berlin, Germany; 2Department of Neurobiology Care Sciences and Society, Division of Nursing, Research Group Integrative Care, Karolinska Institutet, Stockholm, Sweden; 3I C – The Integrative Care Science Center, Jarna, Sweden; 4Department of Biochemistry, Molecular and Cellular Biology, Georgetown University, Medical Center, Washington, DC, USA; 5Department of Medicine, Georgetown University Medical Center, Washington, DC, USA We are excited to present the abstracts of the keynote speakers, parallel sessions and oral and poster presentations of the World Congress on Integrative Medicine & Health (WCIMH 2017; http://www.ecim-iccmr.org/2017/) to be held in Berlin on May 3-5, 2017, which will be jointly convened by the European Society of Integrative Medicine (ESIM) and the International Society for Complementary Medicine Research (ISCMR). The Congress will take place in association with a number of national and international organizations from North America and other continents. Consequently, the congress will provide the most comprehensive global forum and perspective in the field of Complementary and Integrative Medicine in 2017. The congress goal is reflected in its tag line: The Future of Comprehensive Patient Care - Strengthening the Alliance of Researchers, Educators and Providers. We believe that by bringing together researchers, educators and providers, who are addressing various aspects of Integrative Medicine and health, we can build on the evidence obtained through research to inform clinical education and practice and thereby create a better platform for comprehensive patient care. The main themes of the Congress are: Clinical care: The practice of Integrative Medicine should be based on distinct definitions, should be informed by evidence and evolve from guidelines that are developed by experts from conventional and complementary medicine. Education: Academic leaders and health officials have called for future clinicians to possess the knowledge and skills to understand how Integrative Medicine can be incorporated into conventional care to improve the health of the public. Therefore, it is essential to share best practices in how to create robust curricular opportunities for medical students to experience systematic teaching of the principles, strengths and limitations of Integrative Medicine. Research: Within this Congress scientists will showcase the highest quality research worldwide in this field and will provide the state-of-the-science evidence base through plenary lectures, symposia and abstract presentations. Traditional healing systems (THS): Traditional healing practices and practitioners are an important and often underestimated part of health care. THS is found in almost every country in the world and the demand for its services is increasing. Research contributing to evidence informed decision making is imperative to develop a cohesive and integrative approach to health care that allows governments, health care practitioners and, most importantly, those who use health care services, to access THS in a safe, respectful, cost-efficient and effective manner. Arts and medicine: For the first time at a research congress, this theme will explore the important contributions of the arts (music, visual arts, dancing, etc,) for integrative therapeutic interventions to achieve optimal health and healing. Given the ambitious scope of this worldwide international congress, the four authors of the present editorial serve as co-presidents and they are guided by the International Organizing Committee consisting of many experts from around the world including Myeong S. Lee, Jianping Liu, Kenji Watanabe (from Far East Asia), Renee Street (Africa), Amie. Steel (Australia), Paulo Arturo Caceres Guido, Chin An Lin (South America), Heather Boon, Josephine Briggs, John Weeks (North America) and Abdullah Al-Bedah, Mohamed Khalil, Elad Schiff (Middle East and Israel). The programming for each of the five themes is directed by WCIMH 2017 theme subcommittees involving some of the most highly regarded clinicians, educators and researchers in the world in this field (in alphabetic order): Linda Balneaves, Lesley Braun, Eva Bojner Horwitz, Gustav Dobos, Jeffery Dusik, David Eisenberg, Iva Fattorini, Eckhart G. Hahn, Suzanne B. Hanser, Frederick Hecht, George Lewith, Harald Matthes, Andreas Michalsen, Judy Rollins, Volker Scheid, Michael Teut, Robert Saper, Claudia M. Witt, Merlin Wilcox and Darong Wu. The Local Organizing Board is coordinated by M. Cree. We are very grateful to all organisations and individuals working diligently to making this first World Congress for Integrative Medicine & Health in 2017 a great success. We are also pleased to announce that the opening welcome will include the Director General for the World Health Organization, Dr Margaret Chan (on video). All plenary speakers are internationally recognized experts in the field of Complementary and Integrative Medicine such as Josephine B Briggs (US) and Merlin Willcox (UK) as keynote speakers for the theme traditional healing systems; Klaus Linde (Ger) and Michael Moore (UK) for the research theme; Lisa M Wong (US) and Tores Theorell (Sweden) will address the theme of arts and medicine; Darong Wu (China) and Jeffery A Dusek (US) are presenting on the theme of clinical care; and Aviad Haramati and David Eisenberg (both US) will close the Congress with presentations on education. In addition, more than 100 oral presentations in over 40 parallel sessions will be in the program to provide newly emerging data from recent research projects, experiences from new treatment aspects in clinical care, descriptions of new models of education in medicine, information about integration of traditional healing systems in health care systems and new aspects on the integration of arts in medicine. In addition, more than 400 posters will be presented in guided poster sessions during the three days of the Congress. To translate the congress goals and objectives into a tangible action for the field, a Berlin Agreement is being developed. With the title ‘Social and Self-responsibility in practicing and fostering Integrate Health and Medicine Globally,’ this document is meant to help shape the future of comprehensive patient care in Integrative Medicine, and addresses the responsibilities of all participants, including patients and citizens, physicians and all colleagues working in the healthcare system. The Berlin Agreement has been developed by the WCIMH 2017 congress presidents and the International Organizing Committee to create a document for further distribution to the scientific and clinical community and to health care stakeholders, decision makers, and politicians. We anticipate having the final version of the Berlin Agreement endorsed by a number of organizations prior to the Congress and also soliciting the support of congress at the WCIMH 2017 in Berlin. Our hope is that this document will provide an important impetus for further engagement world-wide after the Congress has concluded. Immediately before the start of WCIMH 2017 on Wednesday May 3rd 2017 there will be several high-quality pre-conference workshops covering all congress topics. Reflecting the political situation in recent years, especially in Europe, we have arranged for a unique half-day workshop on the topic: “Refugees with Chronic Diseases between the Middle-East and Europe: The Role of Traditional and Integrative Medicine in Bridging Gaps”, The speakers are all from the Middle East and Europe and will address how Integrative Medicine may serve as an important element to overcome the problematic health situation of refugees around the world. We are convinced that the field of Complementary and Integrative Medicine, including traditional healing systems and medicine and the arts, will benefit from The 2017 World Congress on Integrative Medicine & Health—a preeminent scientific international forum that is focused on highlighting advances in these thematic areas. We invite all practitioners, educators and researchers in the field of Integrative Medicine to come together, participate and engage together to make this Congress an exciting meeting for the successful advancement of Integrative Medicine across the globe.

The recent wave of migration from Middle Eastern countries to Europe presents significant challenges to the European health profession. These include the inevitable communication gap created by differences in health care beliefs between European oncologists, health care practitioners, and refugee patients. This article presents the conclusions of a workshop attended by a group of clinicians and researchers affiliated with the Middle East Cancer Consortium, as well as four European-based health-related organizations. Workshop participants included leading clinicians and medical educators from the field of integrative medicine and supportive cancer care from Italy, Germany, Turkey, Israel, Palestine, Iran, Lebanon, Jordan, Egypt, and Sudan. The workshop illustrated the need for creating a dialogue between European health care professionals and the refugee population in order to overcome the communication barriers to create healing process. The affinity for complementary and traditional medicine (CTM) among many refugee populations was also addressed, directing participants to the mediating role that integrative medicine serves between CTM and conventional medicine health belief models. This is especially relevant to the use of herbal medicine among oncology patients, for whom an open and nonjudgmental (yet evidence-based) dialogue is of utmost importance. The workshop concluded with a recommendation for the creation of a comprehensive health care model, to include bio-psycho-social and cultural-spiritual elements, addressing both acute and chronic medical conditions. These models need to be codesigned by European and Middle Eastern clinicians and researchers, internalizing a culturally sensitive approach and ethical commitment to the refugee population, as well as indigenous groups originating from Middle Eastern and north African countries.IMPLICATIONS FOR PRACTICE:European oncologists face a communication gap with refugee patients who have recently immigrated from Middle Eastern and northern African countries, with their different health belief models and affinity for traditional and herbal medicine. A culturally sensitive approach to care will foster doctor-refugee communication, through the integration of evidence-based medicine within a nonjudgmental, bio-psycho-social-cultural-spiritual agenda, addressing patients' expectation within a supportive and palliative care context. Integrative physicians, who are conventional doctors trained in traditional/complementary medicine, can mediate between conventional and traditional/herbal paradigms of care, facilitating doctor-patient communication through education and by providing clinical consultations within conventional oncology centers.