PRIMUM Palliative Medicine: Prevalence of Integrative Medicine and Care in Palliative Medicine in University Medicine in Germany - a cross-sectional study

Background: Integrative medicine and care are used by approximately 70% of the population. These include external treatments, baths, massages, essential oils, naturopathy, homeopathy, anthroposophic medicine, acupuncture and traditional Chinese medicine. Some of them are included in current oncology and palliative care guidelines. Integrative medicine primarily addresses symptom relieve, quality of life, emotional well-being and spiritual needs which are major issues in palliative care. Objective: The aim of the present study is therefore to investigate whether integrative medicine and care is used in palliative care units of university hospitals in Germany. Methods: All 38 palliative care centers at university hospitals on the list of the Association of University Hospitals in Germany were contacted by email with personalized survey links. If the survey was not completed, a reminder was sent by email. If the survey was still not completed, centers were contacted by telephone and asked to complete the questionnaire or to answer the survey by telephone. The survey consisted of 12 questions. It assessed the number of beds in their palliative care unit, the use of integrative medicine and care, and staff training in integrative medicine and care techniques. Data were collected using the online survey function of RedCap. According to the ethics committee of the University Medical Centre Freiburg, a consultation or vote of the ethics committee was not necessary (request number 25-1015; 16 January 2025). Results: Of 38 palliative care units in university hospitals, 26 (68.4%) responded to the survey. The units had an average size of 10.2 beds (range 6-18). All responding palliative care units reported the use of integrative medicine and care. The most commonly used methods were aromatherapy (100%), massage (88.5%), art therapy (76.9%), washes and medicinal baths (73.1%), and wraps and compresses (73.1%). 16 sites (61.5%) reported that these were used for almost all patients. 16 sites reported that patients received 5 or more of these interventions during a stay. Staff training in integrative medicine and care varied widely between sites. Implication for research and/or (healthcare) practice: This survey focused on the use of integrative medicine and care in university hospitals in Germany and therefore surveyed hospital wards rather than individual patients or health professionals. The survey showed a high prevalence of integrative medicine and care in palliative care units in German university hospitals. Recommendations for the use of integrative medicine and care are included in the 2020 German guideline on palliative care for patients with oncological diseases and the 2022 German guideline on palliative care for patients with neurological diseases. Accordingly, the use of these interventions is partly in line with and partly beyond the recommendations of the guidelines. It is noteworthy that most of the interventions are also associated with human care, which is conveyed through the interventions. This widespread and frequent use in palliative care in all responding university palliative care centers, regardless of the recommendation in the guidelines, suggests that the applications are seen as beneficial in terms of alleviating suffering, emotional comfort or the spiritual needs of palliative care patients. This may suggest to investigate their efficacy in clinical trials and, if confirmed, to make their use available to other seriously ill patients.