Pediatric palliative care is a field which focuses on caring for and treating the symptoms and distress typically associated with life-limiting illness. Integrative medicine is supported by evidence and aims to heal the whole person, including all aspects of one’s lifestyle. Therapies offered by integrative medicine often empower patients and families, allowing for a sense of control. This review addresses the merging of integrative medicine philosophy and modalities with the care given to children with life-limiting illness. We review an introduction to integrative medicine, trends in its incorporation in the healthcare setting, application to patients receiving palliative care and the management of specific symptoms. A case study is offered to illustrate these principles.

The food system plays a crucial role in the relationship between environmental, population and individual health. While leading healthcare and environmental organizations call for urgent action to address climate–planetary–human health crises, it is often challenging for healthcare organizations to respond at a systems level to these concerns. Additionally, there is little consensus and limited research exploring how future health professionals should be trained in order to work at both the individual and systems level to address or prevent the negative health impacts related to the current food system. The intervention of a 6-week, hands-on cooking and nutrition course for graduate health professional students which examines these intersections and equips students with clinically applicable skills was examined using matched pre- and post-course surveys and thematic analysis of reflective assignments. Results indicate improved knowledge and confidence in areas including understanding the food system, guiding patients through dietary change, working interprofessionally, and applying basic nutrition concepts to clinical practice.

Millions of Americans experience chronic pain. Integrative Group Medical Visits (IGMVs) often improve access to pain care and patient outcomes. This study assessed the feasibility of novel collection methods for intra-visit clinical information and the PROMIS-29 at three time-points throughout an 8-week pain-focused IGMV series called Easing Pain Holistically (EPH). Outcomes focused on clinically meaningful improvements in participants' pain and pain-related symptoms. Three variations of EPH were piloted with six cohorts within Minnesota's largest safety-net hospital system. Participants completed the PROMIS-29 at baseline, week 4, and week 8. Weekly progress sheets were administered to gather participants' intra-visit clinical changes. The percentage of participants demonstrating clinically meaningful differences on each PROMIS-29 subscale was calculated. Weekly progress sheet and PROMIS-29 collection was feasible. Positive shifts in intra-visit themes from the beginning to the end of each visit were observed. Seven PROMIS-29 mean domain scores improved at week 8, with ∼50% of participants reporting clinically meaningful improvements for Fatigue, Anxiety and Ability to Participate in Social Roles and Activities. Collection of outcomes was feasible and provided a novel viewpoint to assess intra-visit and longitudinal clinical changes. Improvements in function and positive qualitative themes were observed. Future studies could explore the validation of intra-visit patient-reported outcomes, such as the weekly progress sheets, in IGMVs.

Background/Objective: Adolescents experience stress, anxiety, depression, and chronic pain at rates comparable to adults. Opportunity youth are a unique subset of adolescents/young adults with a higher risk of chronic pain and mental health comorbidities. Group Medical Visits (GMVs) for adults are a well-established model supporting whole-person care for chronic pain and co-incident mental health challenges. Research on GMVs among adolescents is limited. This program evaluation explores the feasibility, acceptability, and sustainability of a chronic pain GMV curriculum adapted for opportunity youth at a residential employment-readiness center. Preliminary signals of program impact were explored as a secondary objective of the study. Methods: After completing a chronic pain GMV training program, two pediatricians adapted and piloted the curriculum for opportunity youth through an 8-week Group Visit Series (GVS) offering integrative and lifestyle-based approaches to mental health, stress, and chronic pain. This was a single-site, uncontrolled, mixed-methods pilot program evaluation. Attendance was recorded as a measure of feasibility. A weekly progress sheet captured pre-/post-visit participant feedback, and semi-structured interviews (n = 6), conducted one month post-GVS, were examined using rapid analysis to explore acceptability. Sustainability was observed by program continuation beyond the pilot. Exploratory participant-reported outcomes were collected through PROMIS-29 (n = 6), PROMIS Positive Affect (n = 5), and Patient Global Impression of Change (n = 6). Results: Fourteen participants enrolled, with nine completing ≥3 visits. Weekly progress sheets demonstrated intra-visit changes from pain, fatigue, and concern to calm. Interview analysis yielded concepts of appreciation for skills learned and the group experience. Sustainability was observed. Six of seven PROMIS-29 domains showed positive signals of improvement, with 6/6 (100%) of respondents meeting a minimal clinical important difference (MCID) threshold for depression and 5/6 (83%) for anxiety. PROMIS-Positive Affect and Patient Global Impression of Change showed positive trends at visit 8. Conclusions: This chronic pain and mental health GVS for opportunity youth was found to be feasible, acceptable, and sustainable. Positive trends in participant-reported depression and anxiety scores were also observed. Larger studies beyond program evaluation are needed to confirm these results.