Cancer survivors and their informal caregivers (family members, close friends) often experience significant impairments in health-related quality of life (HRQOL), including disruptions in psychological, physical, social, and spiritual well-being both during and after primary cancer treatment. The purpose of this in-progress pilot trial is to determine acceptability and preliminary efficacy (as reflected by effect sizes) of CBCT® (Cognitively-Based Compassion Training) compared with a cancer health education (CHE) attention control to improve the primary outcome of depressive symptoms and secondary outcomes of other HRQOL domains (e.g., anxiety, fatigue), biomarkers of inflammation and diurnal cortisol rhythm, and healthcare utilization-related outcomes in both cancer survivors and informal caregivers. Forty dyads consisting of solid tumor survivors who have completed primary treatments (chemotherapy, radiation, surgery) and their informal caregivers, with at least one dyad member with ≥ mild depressive symptoms or anxiety, will be recruited from Tucson, Arizona, USA. Survivor-caregiver dyads will be randomized together to complete either CBCT or CHE. CBCT is a manualized, 8-week, group meditation-based intervention that starts with attention and mindfulness and builds to contemplative practices aimed at cultivating compassion to the self and others. The goal of CBCT is to challenge unexamined assumptions about feelings and behaviors, with a focus on generating spontaneous self-compassion and increased empathic responsiveness and compassion for others. CHE is an 8-week, manualized group intervention that provides cancer-specific education on various topics (e.g., cancer advocacy, survivorship wellness). Patient-reported HRQOL outcomes will be assessed before, immediately after (week 9), and 1 month after CBCT or CHE (week 13). At the same time points, stress-related biomarkers of inflammation (e.g., plasma interleukin-6) and saliva cortisol relevant for survivor and informal caregiver wellness and healthcare utilization will be measured. If CBCT shows acceptability, a larger trial will be warranted and appropriately powered to formally test the efficacy of this dyadic intervention. Interventions such as CBCT directed toward both survivors and caregivers may eventually fill a gap in supportive oncology care programs to improve HRQOL and healthcare utilization in both dyad members. Clinicaltrials.gov, NCT03459781 . Prospectively registered on 9 March 2018.

Objective: A healthy environment is integral to health, yet clinicians receive minimal environmental health training, missing repeated opportunities for preventive counseling. To address educational gaps and examine the usefulness of online education in environmental health, a 6-hour online course, Environmental Health: An Integrative Approach was developed for healthcare practitioners. The objective of this study was to evaluate the feasibility and effectiveness of the course. Methods: This was a within subjects longitudinal study examining change in medical knowledge, beliefs and attitudes toward environmental health topics, attitude toward the importance of conducting an environmental health history, barriers to conducting an environmental health history and confidence in environmental health history assessment skills.. Participants included physicians, nurses, nurse practitioners and other healthcare providers. Measures were completed prior to the course, upon completion, and at a 30-day follow-up. A course evaluation survey assessing educational quality, personal benefit/improved patient care, meeting course expectations, faculty expertise, and course completion time was completed. Data were collected 2012-2013 and analyzed in 2013-2014. Results: Evaluation results indicate the online format and content were well-received, easily implemented, met learners’ expectations, and completed in a manageable timeframe (N=436). Participants evidenced positive pre-post changes in attitudes toward environmental health issues, taking an environmental health history, and confidence in conducting an environmental health history (N=478; P < .007). Positive changes were maintained at follow-up for attitudes and confidence (N=344; P < .001); however reductions in some history taking barriers were not maintained. Conclusion: An online curriculum is a promising method for delivering a foundational environmental health education course to diverse healthcare professionals. Further study is needed to assess best methods for translation of the curriculum into effective clinical practice and improved patient outcomes.

Purpose This study assessed the feasibility of a meditation-based program called Cognitively-Based Compassion Training (CBCT) with breast cancer survivors. Enrollment and participant satisfaction with a novel intervention, adherence to program requirements, and differences between the intervention group and wait list controls on self-report measures were also assessed. Additionally, cortisol, a stress-related endocrine biomarker, was assessed. Methods Participants ( n = 33) were randomly assigned to CBCT or the wait list. CBCT provided eight weekly, 2-h classes and a “booster” CBCT session 4 weeks later. CBCT participants were expected to attend classes and meditate between classes at least three times per week. Pre-/post-intervention and follow-up questionnaires measured symptom change (depression, intrusive thoughts, perceived stress, fear of cancer recurrence, fatigue/vitality, loneliness, and quality of life). Saliva samples were collected at the same periods to assess the slope of diurnal cortisol activity. Results Enrollment, class attendance, home practice time, and patient satisfaction exceeded expectations . Compared to controls, post-intervention, the CBCT group showed suggestions of significant improvements in depression, avoidance of intrusive thoughts, functional impairment associated with fear of recurrence, mindfulness, and vitality/fatigue. At follow-up, less perceived stress and higher mindfulness were also significant in the CBCT group. No significant changes were observed on any other measure including diurnal cortisol activity. Conclusions Within the limits of a pilot feasibility study, results suggest that CBCT is a feasible and highly satisfactory intervention potentially beneficial for the psychological well-being of breast cancer survivors. However, more comprehensive trials are needed to provide systematic evidence. Relevance CBCT may be very beneficial for improving depression and enhancing well-being during breast cancer survivorship.

Use of integrative medicine (IM) is prevalent in children, yet availability of training opportunities is limited. The Pediatric Integrative Medicine in Residency (PIMR) program was designed to address this training gap. The PIMR program is a 100-hour online educational curriculum, modeled on the successful Integrative Medicine in Residency program in family medicine. Preliminary data on site characteristics, resident experience with and interest in IM, and residents’ self-assessments of perceived knowledge and skills in IM are presented. The embedded multimodal evaluation is described. Less than one-third of residents had IM coursework in medical school or personal experience with IM. Yet most (66%) were interested in learning IM, and 71% were interested in applying IM after graduation. Less than half of the residents endorsed pre-existing IM knowledge/skills. Average score on IM medical knowledge exam was 51%. Sites endorsed 1–8 of 11 site characteristics, with most (80%) indicating they had an IM practitioner onsite and IM trained faculty. Preliminary results indicate that the PIMR online curriculum targets identified knowledge gaps. Residents had minimal prior IM exposure, yet expressed strong interest in IM education. PIMR training site surveys identified both strengths and areas needing further development to support successful PIMR program implementation.

Background Integrative medicine (IM) is a patient-centered, healing-oriented clinical paradigm that explicitly includes all appropriate therapeutic approaches whether they originate in conventional or complementary medicine (CM). While there is some evidence for the clinical and cost-effectiveness of IM practice models, the existing evidence base for IM depends largely on studies of individual CM therapies. This may in part be due to the methodological challenges inherent in evaluating a complex intervention (i.e., many interacting components applied flexibly and with tailoring) such as IM. Methods/Design This study will use a combination of observational quantitative and qualitative methods to rigorously measure the health and healthcare utilization outcomes of the University of Arizona Integrative Health Center (UAIHC), an IM adult primary care clinic in Phoenix, Arizona. There are four groups of study participants. The primary group consists of clinic patients for whom clinical and cost outcomes will be tracked indicating the impact of the UAIHC clinic (n = 500). In addition to comparing outcomes pre/post clinic enrollment, where possible, these outcomes will be compared to those of two matched control groups, and for some self-report measures, to regional and national data. The second and third study groups consist of clinic patients (n = 180) and clinic personnel (n = 15-20) from whom fidelity data (i.e., data indicating the extent to which the IM practice model was implemented as planned) will be collected. These data will be analyzed to determine the exact nature of the intervention as implemented and to provide covariates to the outcomes analyses as the clinic evolves. The fourth group is made up of patients (n = 8) whose path through the clinic will be studied in detail using qualitative (periodic semi-structured interviews) methods. These data will be used to develop hypotheses regarding how the clinic works. Discussion The US health care system needs new models of care that are more patient-centered and empower patients to make positive lifestyle changes. These models have the potential to reduce the burden of chronic disease, lower the cost of healthcare, and offer a sustainable financial paradigm for our nation. This protocol has been designed to test whether the UAIHC can achieve this potential. Trial registration Clinical Trials.gov NCT01785485 .

Introduction: Healthcare reform is highlighting the need for more family practice and other primary care physicians. The Integrative Medicine in Residency (IMR) curriculum project helped family medicine residencies pilot a new, online curriculum promoting prevention, patient-centered care competencies, use of complementary and alternative medicine along with conventional medicine for management of chronic illness. A major potential benefit of the IMR program is enhanced recruitment into participating residencies, which is reported here.Methods: Using an online questionnaire, accepted applicants to the eight IMR pilot programs (n = 152) and four control programs (is = 50) were asked about their interests in learning integrative medicine (IM) and in the pilot sites how the presence of the IMR curriculum affected their ranking decisions.Results: Of residents at the IMR sites, 46.7% reported that the presence of the IMR was very important or important in their ranking decision. The IMR also ranked fourth overall in importance of ranking after geography, quality of faculty, and academic reputation of the residency. The majority of IMR residents (87.5%) had high to moderate interest in learning IM during their residency; control residents also had a high interest in learning IM (61.2%).Conclusions: The presence of the IMR curriculum was seen as a strong positive by applicants in ranking residencies. Increasing the adoption of innovative IM curricula, such as the IMR, by residency programs may be helpful in increasing applications of competitive medical students into primary care residencies as well as in responding to the expressed interest in learning the IM approach to patient care. (C) 2014 Published by Elsevier Inc.

The Journal of Alternative and Complementary MedicineVol. 20, No. 5 Research MethodologyPsychometric Analyses of the Arizona Lifestyle Inventory: A Multi-Dimensional Integrative Medicine Measure to Assess Wellness BehaviorsAudrey Brooks, Sally Dodds, Paula Cook, Victoria Maizes, and Patricia LebensohnAudrey Brooks, Sally Dodds, Paula Cook, Victoria Maizes, and Patricia LebensohnPublished Online:7 May 2014https://doi.org/10.1089/acm.2014.5357.abstractAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Psychometric Analyses of the Arizona Lifestyle Inventory: A Multi-Dimensional Integrative Medicine Measure to Assess Wellness Behaviors." The Journal of Alternative and Complementary Medicine, 20(5), p. A133FiguresReferencesRelatedDetails Volume 20Issue 5May 2014 InformationCopyright 2014, Mary Ann Liebert, Inc.To cite this article:Audrey Brooks, Sally Dodds, Paula Cook, Victoria Maizes, and Patricia Lebensohn.Psychometric Analyses of the Arizona Lifestyle Inventory: A Multi-Dimensional Integrative Medicine Measure to Assess Wellness Behaviors.The Journal of Alternative and Complementary Medicine.May 2014.A133-A133.http://doi.org/10.1089/acm.2014.5357.abstractPublished in Volume: 20 Issue 5: May 7, 2014PDF download

The Journal of Alternative and Complementary MedicineVol. 20, No. 5 Education ResearchComparison of Residents and Medical Students on Measures of Well-Being and LifestyleAudrey Brooks, Sally Dodds, Paula Cook, Victoria Maizes, and Patricia LebensohnAudrey BrooksSearch for more papers by this author, Sally DoddsSearch for more papers by this author, Paula CookSearch for more papers by this author, Victoria MaizesSearch for more papers by this author, and Patricia LebensohnSearch for more papers by this authorPublished Online:7 May 2014https://doi.org/10.1089/acm.2014.5269.abstractAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Comparison of Residents and Medical Students on Measures of Well-Being and Lifestyle." The Journal of Alternative and Complementary Medicine, 20(5), pp. A101–A102FiguresReferencesRelatedDetails Volume 20Issue 5May 2014 InformationCopyright 2014, Mary Ann Liebert, Inc.To cite this article:Audrey Brooks, Sally Dodds, Paula Cook, Victoria Maizes, and Patricia Lebensohn.Comparison of Residents and Medical Students on Measures of Well-Being and Lifestyle.The Journal of Alternative and Complementary Medicine.May 2014.A101-A102.http://doi.org/10.1089/acm.2014.5269.abstractPublished in Volume: 20 Issue 5: May 7, 2014PDF download

The Journal of Alternative and Complementary MedicineVol. 20, No. 5 Oral Abstract Session 04: Educational ResearchA Longitudinal Study of Well-Being, Burnout and Emotional Intelligence in Family Medicine ResidentsPatricia Lebensohn, Sally Dodds, Audrey Brooks, Paula Cook, Craig Schneider, John Woytowicz, and Victoria MaizesPatricia Lebensohn, Sally Dodds, Audrey Brooks, Paula Cook, Craig Schneider, John Woytowicz, and Victoria MaizesPublished Online:7 May 2014https://doi.org/10.1089/acm.2014.5017.abstractAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail View article"A Longitudinal Study of Well-Being, Burnout and Emotional Intelligence in Family Medicine Residents." The Journal of Alternative and Complementary Medicine, 20(5), p. A8FiguresReferencesRelatedDetailsCited byBecoming a coach: experiences of faculty educators learning to coach medical students1 July 2020 | BMC Medical Education, Vol. 20, No. 1Experiences with a universal mindfulness and well-being programme at a UK medical schoolHealth Education, Vol. 118, No. 4 Volume 20Issue 5May 2014 InformationCopyright 2014, Mary Ann Liebert, Inc.To cite this article:Patricia Lebensohn, Sally Dodds, Audrey Brooks, Paula Cook, Craig Schneider, John Woytowicz, and Victoria Maizes.A Longitudinal Study of Well-Being, Burnout and Emotional Intelligence in Family Medicine Residents.The Journal of Alternative and Complementary Medicine.May 2014.A8-A8.http://doi.org/10.1089/acm.2014.5017.abstractPublished in Volume: 20 Issue 5: May 7, 2014PDF download

BACKGROUND AND OBJECTIVES Stress in medical education has been well documented, often with the primary focus on negative factors such as depression and burnout. Few studies have attempted to assess well-being mediating behaviors. This study describes the relationship between wellness behaviors and measures of well-being at the start of family medicine residency. METHODS Using an online questionnaire, first-year family medicine residents (n=168) completed standardized measures exploring perceived stress, depression, satisfaction with life, and burnout. A lifestyle wellness behavior measure was developed for the study. RESULTS Average reported perceived stress levels were consistent with ranges found for medical students and residents. Twenty-three percent of residents scored in a range consistent with depression risk. In terms of burnout risk, 13.7% scored in the high emotional exhaustion range and 23.8% in the high depersonalization range. Two thirds reported high life satisfaction. Higher depersonalization and less time in nurturing relationships were associated with greater likelihood of medication use for sleep, mood, and anxiety in females. Higher alcohol use was associated with increased levels of perceived stress, burnout, and depression. The two wellness behaviors most associated with higher well-being were restful sleep and exercise. CONCLUSIONS At the start of residency, well-being measures are consistent with findings in medical school. Restful sleep and exercise were associated with more positive well-being. Future longitudinal data analysis will help clarify the effect of residency training in well-being and lifestyle behaviors. Identification of protective factors and coping mechanisms could guide residencies in incorporating support services for residents.

Integrative medicine (IM) is a clinical paradigm of whole person healthcare that combines appropriate conventional and complementary medicine (CM) treatments. Studies of integrative healthcare systems and theory-driven evaluations of IM practice models need to be undertaken. Two health services research methods can strengthen the validity of IM healthcare studies, practice theory, and fidelity evaluation. The University of Arizona Integrative Health Center (UAIHC) is a membership-supported integrative primary care clinic in Phoenix, AZ. A comparative effectiveness evaluation is being conducted to assess its clinical and cost outcomes. A process evaluation of the clinic's practice theory components assesses model fidelity for four purposes: (1) as a measure of intervention integrity to determine whether the practice model was delivered as intended; (2) to describe an integrative primary care clinic model as it is being developed and refined; (3) as potential covariates in the outcomes analyses, to assist in interpretation of findings, and for external validity and replication; and (4) to provide feedback for needed corrections and improvements of clinic operations over time. This paper provides a rationale for the use of practice theory and fidelity evaluation in studies of integrative practices and describes the approach and protocol used in fidelity evaluation of the UAIHC.

INTRODUCTIONThe Integrative Medicine in Residency (IMR) program, a 200-hour Internet-based, collaborative educational initiative was implemented in 8 family medicine residency programs and has shown a potential to serve as a national model for incorporating training in integrative/complementary/alternative medicine in graduate medical education.INTERVENTIONThe curriculum content was designed based on a needs assessment and a set of competencies for graduate medical education developed following the Accreditation Council for Graduate Medical Education outcome project guidelines. The content was delivered through distributed online learning and included onsite activities. A modular format allowed for a flexible implementation in different residency settings.EVALUATIONTO ASSESS THE FEASIBILITY OF IMPLEMENTING THE CURRICULUM, A MULTIMODAL EVALUATION WAS UTILIZED, INCLUDING: (1) residents' evaluation of the curriculum; (2) residents' competencies evaluation through medical knowledge testing, self-assessment, direct observations, and reflections; and (3) residents' wellness and well-being through behavioral assessments.RESULTSThe class of 2011 (n  =  61) had a high rate of curriculum completion in the first and second year (98.7% and 84.2%) and course evaluations on meeting objectives, clinical utility, and functioning of the technology were highly rated. There was a statistically significant improvement in medical knowledge test scores for questions aligned with content for both the PGY-1 and PGY-2 courses.CONCLUSIONSThe IMR program is an advance in the national effort to make training in integrative medicine available to physicians on a broad scale and is a success in terms of online education. Evaluation suggests that this program is feasible for implementation and acceptable to residents despite the many pressures of residency.