Outcomes
CIM, cancer, NRS
CANCER
Outcome measures for the evaluation of training in oncology have been defined based on an international consensus process [a) Physician level.Two main outcomes at the physician level were selected: (1) the perceived consultation skill competency, indicated by three questions on subjective experiences of overburden, tension, and discomfort with the consultation situation; and (2) the perceived stress reaction, indicated by feeling secure at various moments in a CIM consultation (five questions on assessing previous CIM experiences, giving information about the effectiveness of CIM therapies, dealing with questions about unclear evidence, staying informed about interactions between antitumor therapy and CIM, and giving concrete advice). Both instruments were self-developed instruments as they needed to be tailored to the specific KOKON-KTO consultation setting and were measured on numerical rating scales (NRS) ranging from not at all (0) to fully competent/secure (10). The oncology physicians were asked to complete the perceived consultation skill competency instrument after each consultation, and the perceived stress instrument after all conducted consultations.Further outcomes were the level of CIM knowledge in cancer care (multiple-choice questions); expectations regarding the effectiveness of CIM (5-point Likert scale from fully agree (5) to fully disagree (1)) and expectations regarding the side effects of CIM (NRS from very safe (0) to not safe at all (10)). Moreover, the oncology physicians were asked to indicate the duration of the CIM consultation in minutes. If the consultation took more than the anticipated 20 min, the oncology physicians were asked to provide reasons. All these questions were asked at baseline and after the training.Furthermore, to obtain more information about the feasibility of the intervention, the physicians were asked questions after conducting all conversations. The ability of the manual-based consultation to be implemented in the treating oncology physicians’ daily work was measured on a 6-point Likert scale from very good (1) to not at all (6). Furthermore, the oncology physicians were asked to indicate their attitude toward CIM on four levels (the importance of being well informed about CIM, feeling confident during conversations, trying to avoid CIM conversations with patients, wishing that the patient would engage less in CIM) using an NRS from fully disagree (0) to fully agree (10)).b) Patient level.To learn more about the usefulness of the information leaflet about reputable websites on the use of CIM in oncology (KOKON-KTO information leaflet) that all the oncology physicians provided to their patients, the patients were asked whether they used the recommended websites. The response options were: No; Not yet, but I want to use it in the future; and Yes.c) Physician–patient interaction level.As a surrogate variable for indicating the physician–patient interaction, oncology physicians in the intervention group were asked to lead one KOKON-KTO consultation with a standardized cancer patient during the KOKON-KTO workshop. During these consultations, two independent external raters observed whether the oncology physicians followed the structure of the KOKON-KTO consultation [