Disparities Between Patient and Hematology/Oncology Physician Expectations for Integrative Oncology in an Ethnically Diverse Population

Purpose: Evidence shows increased patient utilization of various integrative care modalities. In part, patients desire greater self-empowerment to potentially manage their symptoms, improve quality of life and overall outcomes. Measurements of patient and physicians opinions regarding the importance of integrative care are lacking. We aim to compare expectations of what “comprehensive care” means between hematology/oncology physicians and patients.

Methods: Approval from the University of Miami IRB was obtained prior to initiation of data collection. Adult patients (pts) and hematology/oncology physicians (MDs) at an academic tertiary care medical center in Miami, Florida were enrolled to complete a survey. Demographics collected include: age, gender, race, & ethnicity. Clinical information collected include cancer subtype and treating hematologist/oncologist. The survey consisted of 7 questions assessing personal opinions on “comprehensive care”. The questions specifically asked “In addition to standard care, it is important to incorporate/provide” nutrition services, exercise therapy, spiritual/religious counseling, supplement/herbal advice, support groups, music therapy, or other complimentary medicine services (acupuncture, massage, relaxation therapy). Answers were recorded on a 5 point Likert scale (1=highly disagree, 2= disagree, 3=neutral, 4=agree, 5= highly agree) then converted into 2 categories (1,2,3= neutral/disagree vs. 4,5=agree). Fisher’s exact test with 2 sided p-value used to compare significance between MDs & pts responses.

Results: 670 pts and 55 MDs enrolled from June 2013 to May 2014. Pts demographics included a mean age 55 with range 18-88 with 44% male and 56% female. 57% of patients were Hispanic vs. 43% not Hispanic. 81% were white, 11% black/African American, 2% Asian/Pacific Islander, and 6% other. 17% of patients had hematologic disorders (85% malignant 15% benign) vs. 83% of patients had solid oncologic malignancies. MD demographic data will be reported in poster. Survey results: 83% of pts agree that nutritional advice is important vs. 67% of MDs, p=0.01. Significant disparities were also seen for exercise therapy (86% vs. 73% respectively, p=0.02), spiritual/religious counseling (69% vs. 50% respectively, p=0.01), supplement/herbal therapies (86% vs. 56% respectively, p=0.0001), music therapy (66% vs. 30% respectively, p=0.0001), and “other complementary services” such as acupuncture, massage and relaxation therapy (70% vs. 45% respectively, p=0.004). The lone service that did not demonstrate significant disparity of opinion was support groups (72% vs. 68% respectively, p=0.5).

Conclusion: A significant majority of adult hem/onc patients seen at a major academic institution in South Florida feel that it is important to incorporate nutrition advice, exercise therapy, spiritual/religious counseling, supplement/herbal advice, support groups, music therapy, and other complimentary services such as acupuncture, massage and relaxation therapy as part of their “comprehensive care”. With the exception of support groups, MDs tend to value integrative oncology services significantly less than patients do. It is expected that increased availability and utilization of integrative oncology modalities at tertiary hospital sites could improve patient satisfaction and quality of life, and enhance patients’ therapeutic alliance with their medical team and plan as patient and physician definitions of “comprehensive care” more closely merge. This is the first study published to our knowledge that examined disparities between patient and physician expectations for comprehensive care in an ethnically diverse, predominantly Hispanic population.