Consultations for holistic pediatric services for inpatients and outpatient oncology patients at a children's hospital

Background: As demand increases for complementary and alternative medical care, pediatric institutions face the need to answer patients' and clinicians' questions about integrating these therapies in hospital settings. Objective: To describe the first year of experience in providing holistic medicine consultations in an urban tertiary care teaching hospital. Design: Prospective cohort. Subjects: Patients seeking consultation from the Center for Holistic Pediatric Education and Research, Boston, Mass, from July 16, 1999, to July 15, 2000. Methods: Review of consultation notes and medical records. Results: Of the 70 physician consultations, most (n = 43) were for oncology patients. Most consultations (n = 44) were accomplished with a single visit. The most common goal for consultation was to obtain help in managing symptoms such as nausea, pain, insomnia, or agitation (n = 50). The most common questions about specific therapies had to do with herbs (n = 41) or dietary supplements (n = 42), but there were also frequent questions about diet and nutrition (n = 33) and mind-body therapies such as guided imagery and biofeedback (n = 28) and massage (n = 25). Approximately 0.3 full-time equivalents of physician time was required to provide clinical consultations, and $7315 was collected of the $26 638 billed for these services. Conclusions: The complementary medicine consultation service was primarily consulted by oncology patients requesting assistance with pain and symptom management. Patients had questions about various therapies, particularly herbs and dietary supplements. Additional research is necessary to determine the cost-effectiveness of an integrated approach to care, particularly for institutions without access to reliable community resources for complementary and alternative medical therapies.