Well here we are at the end of the course, and after all the subjects that we've been talking about on integrative medicine, integrative oncology specifically the use of herbal medicine in cancer care, this is a good time to talk about how to go about setting up an integrative oncology setting in your medical center or inpatient outpatient and hearing it from a random myself about challenges that we had to face and overcome in setting up our respective centers. So, I'm going to ask Eran first of all. Eran tell us about your experience, things that you add to face and overcome and the process that you went through in setting up your center, your service and the integrative oncology setting. First of all I would say, I mean the initial point is that you have to be determined that this is something you want to do to establish an integrative oncology program within the oncology setting, and to understand that when you do that, you do it with other players with the oncologists, with the nurses, with the social workers, the psycho-oncologists, with the secretaries, with the surgeons and so on but it's a team work and that it is tailored according to the oncology ward, needs and expectations and not according to a theoretical model that someone had suggested in the literature. So, this is I would say the first point. The second challenge that I had to meet beyond the obvious economical aspects and resources and so on, is to understand what are the specific targets or objectives of the project to define them. I mean it's so easy to say well we are here, we will treat anybody but then you need to define what specific target audience you're going to work with. In our case we decided that it would be patients who are diagnosed with cancer of course but they are treated with chemotherapy or other patients that are treated with the in the palliative care setting. So, there are a lot of similarities between the setting your setting your integrity of oncology setting in where I work in my medical center, but they're also very significant important differences. Patients that come to your service are being treated within the framework of a research registry protocol setting. So, they fill up questionnaires at the beginning, in the middle or at the end of the study period, treatments are provided without charge. In our setting, it's more of a semi-private set up in that patient's it's a fee-for-service. Patients pay for the treatments. We do have clinical trials ongoing in which the treatments are given for free but that's for a very small select group but the majority of patients are have to pay now that the treatments are subsidized on the one hand at the same time they still they're not free. So, there are a lot of different setups in which different things have to be addressed but at the end of the day the treatment is the same treatment. Integrative medicine, complementary medicine given within the conventional oncology setting with the collaboration, cooperation of the establishment of the oncologists. But I think it's I would like to hear a bit more about other challenges that you faced when you started your service with respect to the oncologists in the conventional system that we're both working with in. So, maybe you could talk a little bit about that. One of the challenges that are so important when you start to establish a program like that an integrative program is to define the indications for referral because that's something really practical. I mean it's not only what kinds of diseases patients are referred with but to be very specific is it about just stress reduction or anxiety and it's a semi psych oncology service or is it about a hardcore physical symptoms like pain, fatigue, nausea, taste ulceration, constipation, neuropathy, chemotherapy, induced neuropathy and so on. So, one of the challenges that we had is to define with the other health care practitioners the oncologists, nurses and so on the cycle oncologists, the specific referrals. Then to build up, to design a specific flow chart what is happening from the moment I received a referral to the integrative physician consultation and to the whole process of tailoring the treatment plan. It is highly important to acknowledge that each HCP healthcare practitioners, should be part of this treatment plan design. I need the input of the oncologist and the nurse, and the family physician and so on, in order to tell patients I mean that's hidden agenda sometime. Well, it's not just my ideas that are put within the treatment plan but it's something that's come up from the whole team. It's a whole team design shared by everyone with their feedback. I think that's an important aspect that really defines the word integrative because a lot like to use that term but here we're really working with the conventional oncology team, the nurses in the oncologist, the family physician who see these patients on a weekly sometimes daily basis. What about with the patients themselves. What are some of the difficulties that you found in setting up your service with respect to the patients themselves? I would say that we have found several challenges and barriers with patients and it is related to patients expectations and in our region, it's not only the individualistic characteristics of each patient but the relationship to the community and it's not just patient-centered care but community centered care as well. Especially patients that come that are affiliated with the community, with the cultural values like the Arab community and patients that come from the Russian speaking community in Israel for example. We know that there are certain communities and certain types of patients which are really not easy let's say to handle, to communicate with and specifically with men more than women. With the patients that have a desire to talk only about programmatic aspects and those patients are really keen to talk about herbs and nutrition but not to touch the emotional level, the spiritual level and it's I mean what happened a long time is that we understood that it's not just a one man show but it's not just one sessions show if to say. I mean it's not only the first meeting that matters. When I see a patient nowadays, I understand that I have to perceive the whole journey path leading from the first encounter, the first consultation with a integrative physician to the other weekly stations or meetings along the road and I can start and it's a very good start a good starting point to start with herbs and then you can go from that interest in herbs to other modalities such as acupuncture and mind body and manual therapies and spiritual consultation and so on and then the path widens. As with everything as with any new idea or venture you have to have a small group who are totally committed to moving the project or the idea or the concept forward. You need to keep at it and keep going and sometimes they'll be good days and less good days and they'll be a lot of challenges on the way. If you have a mission, if you have a goal which is realistic while being idealistic you'll get there and people will pick up on your energy, on your positive energy, on your desire to help people. At the end of the day that's what we're all there for. Whether you're an oncologist or a nurse oncologists or an integrative physician or an acupuncturist or an herbalists. Whatever you're doing at the end of the day we're all on the same page and if we work together, we can achieve almost anything. So, this is the end of this course but it's really just the beginning. I think we open the stage for a marvelous process of self-education that you went through and we hope you will have the courage to take this path forward and to develop within your centers of care and integrative projects. Thank you for your participation, and we hope to see you soon.
