Barriers and Facilitators to Integrative Oncology Services in Australia: A Changed Mind Set Required

Abstract

Objectives: This study aimed to explore barriers and facilitators to integrative oncology (IO) service provision and access in Australia.Design: The study design was mixed method with two substudies: a cross-sectional national cancer service survey of public and private sectors; and focus group interviews and an online survey of cancer survivors. Triangulation analysis of qualitative and quantitative data was used to identify and interrogate meta-themes.Subjects: The cancer service response rate was 93.2% (n = 275/295); 71/275 (25.8%) provided IO. Thirtythree cancer survivors from Anglo-European, Arabic, Vietnamese, and Chinese backgrounds were interviewed, and 121 survivors answered the online survey.Results: IO gaps were substantial, with no services in many regions and cities; a lack of diversity and availability of therapeutic options, including culturally appropriate services; and a mismatch between the high use of natural health products by survivors and types of IO services provided. Two overlapping meta-themes were identified: ''barriers and facilitators'' and ''peoples and institutions''; each with four subthemes, respectively, ''access/provision, affordability/funding, information/evidence, and culture/values'' and ''cancer survivors, healthcare professionals, organizations, and policies.'' While affordability/funding was the greatest barrier to survivors and providers, solutions varied (e.g., building a stronger evidence-base, business model advice) and often conflicted (e.g., public verses private sector funding). The most insidious barrier was professional/corporate cultures and values that influenced hospital policies (or lack thereof), conceptions of evidence and the therapeutic alliance. Survivors called for a change of mindset in the culture of medicine and value-based health care.Conclusions: The barriers and facilitators to IO services were more complex than building the evidence-base and demonstrating value to justify funding. To achieve a better alignment of patients' preferences with service provision, providers require more guidance on clinical governance, business models, local service gaps, and interprofessional collaboration. National strategies and funding models are needed to ensure appropriate, equitable IO service provision.

Integrative oncology in cancer care – implementation factors: mixed-methods systematic review

“…The full text of one study could not be retrieved, and 62 full-text studies failed to meet the criteria and so were eliminated. The remaining 28 studies met our criteria and had been published between 1998 and 202123–50 ((online supplemental table S1), (online supplemental file 2). Twenty-five were single-site studies, mainly from Europe (n = 8), North America (n = 7) and Oceania (n = 6).…”

“…Eight mixed-methods studies were examined using the five relevant criteria. Three (37.5%)30 37 44 fulfilled all the criteria (online supplemental table S5), (online supplemental file 2). In all cases, if a study fulfilled all the relevant criteria, this indicated that it had high methodological quality.…”

“…Five mixed-methods studies,30 31 36 37 48 four quantitative studies32 39 43 50 and two qualitative studies46 49 identified a lack of knowledge among patients and healthcare professionals about the existence of IO services and the circumstances in which IO services were appropriate. These studies showed that patients were unaware of the existence of IO services and thus did not use them.…”

“…Theme: professional responsibility . A mixed-methods study30 and a qualitative study35 showed that BMDs doubted the evidence on which T&CM treatments are based. Thus, as they wished to be responsible BMDs, they did not encourage patients to seek IO services 30 35.…”

“…A mixed-methods study30 and a qualitative study35 showed that BMDs doubted the evidence on which T&CM treatments are based. Thus, as they wished to be responsible BMDs, they did not encourage patients to seek IO services 30 35. Thus, the BMDs’ perceptions that there was a lack of evidence on the utility of T&CM treatments became a barrier to patients’ decisions in favour of using IO services.…”