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Ann Thorac Surg 2006;81:205-206
© 2006 The Society of Thoracic Surgeons
Division of Cardiothoracic Surgery, Columbia-Presbyterian Medical Center, MHB 7-435, 177 Fort Washington Ave, New York, NY 10032
(Email: mco2{at}columbia.edu; elo4{at}columbia.edu).
The article by Kshettry and colleagues [1] demonstrates the feasibility and importance of incorporating integrative therapies into the standard care of surgical patients. Partnership between complementary and alternative medicine and conventional medical treatment enables the most holistic and effective management of the patient. Interventions such as the ones described in this study are a logistically feasible way to provide much needed supportive services to our patients. Hospital centers can easily adopt such a program by employing a health educator or wellness coach to provide supportive integrative services throughout the process of surgery. On the other hand, we believe that patients will not be willing or able to pay for this type of intervention. For these integrative services to succeed, they should be offered as a "value-added" hospital service. Future research should focus on the cost effectiveness of these services in order to justify the moderate fixed expense. Encouraging preliminary data from insurance companies suggest that hospital costs could be reduced with the use of such interventions.
The high completion rate and the significant crossover from control to treatment group in Kshettry and colleagues' study suggest that this is a highly desirable intervention that patients not only desire, but are motivated to invest their time and effort in. Also important to note is that the intervention in Kshettry and colleagues' study utilized a multimodality approach incorporating several integrative therapies into one flexible program of treatment. Providing multiple therapies improves the likelihood that patients comply and derive benefit from some aspect of an intervention. Although the benefits derived from the use of integrative therapies may be related directly to their use, improved care may also result from the integration of a therapy into the conventional treatment program. This creates an overall approach that is more in keeping with the patient's belief system and provides the patient with increased feelings of motivation to comply, as well as a sense of control over their own healthcare destiny. In fact, patients are already self medicating with many of these approaches, so we create a credibility gap by not understanding these desires.
Kshettry and colleagues' article proposes a truly integrative strategy. As health care providers we are charged with the task of incorporating the latest technologies in the treatment of our patients to minimize suffering and maximize outcomes. In order to meet this challenge we need to begin thinking globally about the treatments we offer. Integrative therapies represent the globalization of medicine, and we all need to begin incorporating this type of approach into our game plan as surgeons.
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  P. F. White Use of Alternative Medical Therapies in the Perioperative Period: Is It Time to Get on Board? Anesth. Analg., February 1, 2007; 104(2): 251 - 254. [Full Text] [PDF]
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