Underutilization of Integrative Health Approaches for Broad Patient Populations

An abundance of evidence-based research regarding the benefits of yoga and meditation exists, however, the evidence has failed to encroach the medical domain until recent years. Evidence surrounding yoga and meditation generally assesses patient outcomes during specific stages of treatment, but fails to address provider referral motives for complementary and alternative medicine (CAM) approaches. Evidence-based research for supportive oncology treatment has drastically increased in the last decade. One reason for the increase may be due, in part, to an enhanced awareness of intervention efficacy (Koula & Knight, 2018). Until recent years, yoga and meditation services have not been readily utilized as an integrative approach for emotional, mental, and physical health concerns (Sulenes et al., 2015). According to the National Institutes of Health (2018), National Center for Complementary and Integrative Health, the use of yoga in cancer symptom management has increased dramatically since 2007, illustrating improvements in patients’ physical, psychological, and overall qualities of life (National Institutes of Health [NIH], 2018).

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CAM approaches host a range of options for patients enduring a vast array of ailments, symptoms, and diseases. One application from the CAM domain is yoga, defined broadly by Sulenes et al. (2015) as postural adjustments, breathing exercises, and mindfulness or meditation practice. Overall awareness regarding yoga as an integrative health approach has significantly increased over the past decade in a variety of contextual settings (Sulenes et al., 2015). Despite the increase in applicable awareness regarding CAM, and in particular yoga, a discontinuity in provider referral rates remains apparent. For instance, a study by Brems et al. (2013) explored CAM approaches for women with breast cancer. Only 30%-50% of survivors were recommended to complementary treatment services which included yoga. In another study, Birdee et al. (2008) discovered that roughly 22% of yoga users reported medical professionals to recommend yoga as an alternative to regular treatment methods.

Educating healthcare professionals about the benefits of CAM approaches for broad oncology patient populations is one of the most effective means to increase patient utilization of such services. Koula and Knight (2018) conducted a study to 1) assess provider knowledge of yoga and meditation service availability in multidisciplinary cancer care clinics and 2) evaluate whether informative educational sessions about the benefits of and referral methods for yoga and meditation increases provider awareness and likelihood of referral for cancer patients. Similar studies are essential for increasing provider awareness as well as enhancing the knowledge, beliefs, attitudes, and perceptions surrounding the benefits of yoga.

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Ongoing research, specifically targeting providers’ behavior for alternative referral approaches, underscores yoga as an enormously underutilized resource. According to a study conducted by Coulter, Singh, and Der-Mirtirosian (2005), a survey assessing integrated practice physicians’ referral methods identified the least recommended services to include homeopathy, osteopathy, massage therapy, and therapeutic yoga. To date, evidence-based literature indicates yoga as a highly underutilized approach in a broad range of healthcare settings. Research by Koula and Knight (2018) suggests brief educational sessions regarding yoga and meditation as an effective means to increase provider knowledge of perceived benefits. While 67.5% of providers strongly agreed complementary services may improve patient outcomes, only 17.5% stated consistent recommendation of such services. Consequently, research findings across numerous studies verify that efforts targeted toward increasing provider knowledge of benefits and interventions are necessary to increase patient service utilization of integrative health approaches (Koula & Knight, 2018).

References

Brems C., Barnett J.D., Cress-Parret V., et al. Alternative and complementary treatment needs and experiences of women with breast cancer. J Altern Complement Med. 2013; 19: 657-663

Coulter I.D., Singh B.B., Riley D., Der Martirosian C. Interprofessional referral patterns in a medical system. J Manipulative Physiol Ther. 2005; 28: 170-174.

Koula, M. J., & Knight, J. M. (2018). Increasing provider awareness of and recommendations for yoga and meditation classes for cancer patients. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 26(10), 3635-3640. doi:10.1007/s00520-018-4220-3 [doi]

Sulenes, K., Freitas, J., Justice, L., Colgan, D. D., Shean, M., & Brems, C. (2015). Underuse of yoga as a referral resource by health professions students. Journal of Alternative and Complementary Medicine (New York, N.Y.), 21(1), 53-59. doi:10.1089/acm.2014.0217 [doi]

Yoga: in depth. National Center for Complementary and Integrative Health. Website. https://nccih.nih.gov/health/yoga/introduction.htm#hed3. Published October 2008. Updated October 2018. Accessed November 6, 2018