Implementing an Integrative Oncology Paradigm in Cancer Care: The Tuscan Regional Healthcare System.

Introduction: Recent cancer research highlighted specific patient needs, with a growing interest in integrative oncology (IO). Design: This is a narrative review concerning the Tuscan Healthcare System, which represents a virtuous example of progressive integration of complementary medicine in conventional cancer care. Results: The main steps of the process are described, with a specific focus on the 2021 Diagnostic and Therapeutic Care Pathway on Integrative Oncology. Conclusions: Implementing an IO service may contribute to respond to patients' demand for complementary therapies, also providing safety and equity of therapeutic access within public health care systems.

Patient Safety in Complementary Medicine through the Application of Clinical Risk Management in the Public Health System.

Aim: To develop a systematic approach to detect and prevent clinical risks in complementary medicine (CM) and increase patient safety through the analysis of activities in homeopathy and acupuncture centres in the Tuscan region using a significant event audit (SEA) and failure modes and effects analysis (FMEA). Methods: SEA is the selected tool for studying adverse events (AE) and detecting the best solutions to prevent future incidents in our Regional Healthcare Service (RHS). This requires the active participation of all the actors and external experts to validate the analysis. FMEA is a proactive risk assessment tool involving the selection of the clinical process, the input of a multidisciplinary group of experts, description of the process, identification of the failure modes (FMs) for each step, estimates of the frequency, severity, and detectability of FMs, calculation of the risk priority number (RPN), and prioritized improvement actions to prevent FMs. Results: In homeopathy, the greatest risk depends on the decision to switch from allopathic to homeopathic therapy. In acupuncture, major problems can arise, mainly from delayed treatment and from the modalities of needle insertion. Conclusions: The combination of SEA and FMEA can reveal potential risks for patients and suggest actions for safer and more reliable services in CM.