Using Shared Medical Appointments for Delivering Patient-Centered Care to Cancer Survivors: A Feist-Weiller Cancer Center Pilot Study.

Background: Shared medical appointments (SMAs) have shown promise in the care of patients with conditions such as diabetes; however, the impact of lifestyle medicine-based SMAs on the overall health status of cancer survivors remains poorly understood. Materials and Methods: This cross-sectional survey of patients was conducted to study the impact of a unique lifestyle medicine-based survivorship program on cancer survivors. Results: A total of 64 patients were telephonically contacted for the survey, out of which 39 (60.9%) patients responded. All patients (39 of 39, 100%) found the program to be helpful in some way; 26 patients (66.7%) found SMAs to be significantly helpful, while 13 patients (33.3%) found SMAs as only somewhat helpful. The majority noted feeling a great sense of support (35 of 39, 89.7%), followed by improvement in appetite (21 of 39, 54%) and improvement in pain (14 of 39, 35.9%). All patients reported at least some improvement in subjective well-being (SWB); patients who attended >3 appointments reported significant/very significant improvement in SWB (P = .03). Conclusion: SMAs offer promise in the effective delivery of lifestyle medicine-focused care to cancer survivors. Further prospective studies are needed to validate these findings.

Cooking Up Health: A Novel Culinary Medicine and Service Learning Elective for Health Professional Students.

PURPOSE: The current investigation assessed the feasibility, acceptability, and efficacy of the Cooking Up Health (CUH) culinary medicine elective that was offered to medical students at Northwestern University's Feinberg School of Medicine. The elective included a combination of didactics, plant-based culinary sessions, and service learning, in which students translated nutrition and health connections to elementary school children in at-risk communities. METHOD: Nine medical students enrolled in cohort 1 and 12 in cohort 2. Students completed assessments before and after the course measuring confidence in nutrition and obesity counseling, attitudes toward nutrition counseling, personal dietary intake, and cooking confidence and behaviors. RESULTS: The elective showed high feasibility and acceptability with strong class attendance (96%-99%) and retention (89%-100%). Over the course of the elective, students across both cohorts showed increased confidence in nutrition and obesity counseling (ps < 0.001), cooking abilities (ps < 0.01), and food preparation practices (ps < 0.04). Cohort 1 reported decreased meat consumption (p = 0.045), and cohort 2 showed increased fruit and vegetable intake (p = 0.04). Finally, cohort 2 showed increased knowledge and confidence regarding consuming a plant-based diet (ps < 0.002). Students reported an increased appreciation for the role of nutrition in health promotion and disease prevention and an intention to incorporate nutrition into patient care. CONCLUSION: This study provided preliminary evidence demonstrating feasibility, acceptability, and efficacy of the CUH culinary medicine elective for increasing medical students' confidence in nutrition and obesity counseling of patients and in their ability to use nutrition and cooking for personal self-care. Ultimately, this program of research may provide evidence to support widespread integration of CUH into medical education and has the potential to prepare medical students to properly advise patients on nutrition to combat the rising rates of obesity, diabetes, and preventable diseases related to nutrition.

Introduction to Integrative Medicine in the Primary Care Setting.

Integrative Medicine has been described as "healing oriented medicine that takes account of the whole person (body, mind, and spirit) including all aspects of lifestyle. It emphasizes therapeutic relationships and makes use of all appropriate therapies, both conventional and alternative." National surveys consistently report that approximately one-third of adults and 12% of children use complementary and integrative medicine approaches. Although there are barriers to primary care professionals engaging in discussions about lifestyle change and complementary and integrative medicine options, there is also great potential to impact patient well-being.

Acupuncture-Related Quality of Life Changes Using PROMIS Computer Adaptive Tests in a Pragmatic Trial with Oncology and General Integrative Medicine Patients: The Role of Baseline Acupuncture Expectations.

INTRODUCTION: Acupuncture has been shown to alleviate symptoms and increase general well-being in different medical patient samples. A major challenge in acupuncture clinical research is the availability of comparable and standardized patient-reported outcome measurement (PRO) tools. OBJECTIVES: This study used a pragmatic design to examine longitudinal changes in quality of life (QOL) in a medical patient sample following acupuncture using PROs from the National Institutes of Health's Patient Reported Outcomes Measurement Information System (PROMIS) initiative. It also examined the role of acupuncture expectancies, as well as patient and provider perceptions of acupuncture benefit. DESIGN: Following informed consent, patients completed baseline QOL measures (T1) prior to their first acupuncture session. Subsequent assessments (up to 20) were completed immediately following ensuing acupuncture sessions. Patients completed assessments either on a touch-screen computer at the clinic or from their home computer. RESULTS: Compared with acupuncture-naïve participants, those who received prior acupuncture treatment reported significantly higher anxiety, fatigue, sleep disturbance, and lower positive affect at baseline. By the second assessment, however, these differences became nonexistent. Participants who held greater baseline acupuncture expectations (e.g., their situation would improve a lot, they would have improved coping skills, their symptoms would disappear, their energy would increase) reported significantly higher fatigue, pain interference, and problems with physical functioning. Between T1 and T2, all participants reported significant improvements in anxiety, depression, and fatigue. Exploratory longitudinal models demonstrated significant linear improvements over time in anxiety (p = 0.006), depression (p = 0.007), pain interference (p < 0.001), and sleep disturbance (p = 0.004). No linear reduction over time was found with fatigue (p = 0.587), physical function (p = 0.654), or positive affect (p = 0.247). CONCLUSIONS: Overall, PROMIS computer adaptive tests were able to assess domains of QOL briefly. Although pretreatment acupuncture expectations highlighted subgroup differences in outcomes at baseline, linear-growth models demonstrated the positive effects of acupuncture over time on anxiety, depression, pain interference, and sleep disturbance.