Supportive Care in Cancer

, Volume 26, Issue 7, pp 2251–2257 | Cite as

Crossing the death threshold: experiencing multi-disciplinary end-of-life integrative oncology training

  • Eran Ben-AryeEmail author
  • Yael Keshet
  • Maria Livas
  • Thomas Breitkreuz
Original Article



Complementary and integrative medicine (CIM) is acknowledged in more and more oncology-care centers as part of supportive and palliative cancer care. However, only limited research is available on medical training of CIM practitioners regarding end-of-life (EOL) care. In this study, we assess the impact of multi-disciplinary EOL training on cultural-diverse groups of CIM-trained healthcare practitioners (HCPs) working in integrative oncology care settings in Germany and Israel.


The authors co-designed an evidence-based patient-centered EOL-training curriculum incorporating palliative and CIM concepts of care. Afterwards, a 3-day course was designed for 25 HCPs working in three anthroposophic-medicine-oriented medical centers in Germany and 14 CIM-trained HCPs from one oncology center in Israel. Qualitative assessment of the EOL-training impact on trainees was assessed 4-month post-intervention. Narratives were analyzed using ATLAS.ti software for systematic coding.


Post-training narrative assessment was reported by 18 German and 14 Israeli HCPs comprising 10 physicians, 12 nurses and paramedical practitioners, and 10 CIM therapists and spiritual care-providers. Content analysis of post-training outcomes suggested participants’ attitude-change regarding their professional role in EOL care as individuals and as members of a team. Participants acquired practical clinical tools to enhance EOL care and to better communicate with patients about death, implementing a patient-centered, cultural-sensitive approach.


EOL training of CIM-trained HCPs enhances communication and palliative clinical skills. Multidisciplinary and international training settings emphasize a cross-cultural perspective and enrich the bio-psycho-social-spiritual model of palliative care.


Integrative oncology Anthroposophic medicine Psycho-oncology Palliative care End of life Doctor-patient communication 



We thank Dr. Chen Shapira, Chief Executive Officer of the Clalit Health Services in Haifa and Western Galilee district and the Carmel Medical Center for the support enabling the integrative palliative EOL training of the Israeli team. We also acknowledge the direction and staff of Paracelsus-Hospital for their hospitality. This manuscript is dedicated to the memory of Mr. Jamal Said Boqaee, who fulfilled his wish to depart from life at home with the courageous companionship of his daughter, following her participation in the EOL training.

Contributions of authors

EBA, ML, and TB organized the trial and collected the data analyzed this study. EBA and TB planned the study. EBA, YK, ML, and TB carried out the analysis and wrote a draft manuscript. All authors participated in the revision of the manuscript.

Funding information

Travel and accommodation expenses of the Israeli team were partially covered by a generous grant from the charitable Hauschka-Foundation, Bad Boll, Germany.

Compliance with ethical standards

Conflict of interests

The authors declare that they have no conflict of interest.


Participation in this study was voluntary and verified by participants’ consent.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Integrative Oncology Program, Lin and Carmel Medical Centers, Clalit Health Services; Faculty of MedicineTechnion - Israel Institute of TechnologyHaifaIsrael
  2. 2.The Oncology ServiceLin Medical CenterHaifaIsrael
  3. 3.Department of Sociology and AnthropologyWestern Galilee Academic CollegeGalileeIsrael
  4. 4.Paracelsus-Krankenhaus UnterlengenhardtBad LiebenzellGermany
  5. 5.Projekt Integrative Onkologie, Medizinische Klinik IIIStädtisches Klinikum KarlsruheKarlsruheGermany
  6. 6.Die FilderklinikStuttgartGermany

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