A Mixed-Methods Pilot Study on Clinicians’ Attitudes and Utilization of Complementary and Integrative Health Services for Patient Care at an Academic Medical Center

Abstract

Objective:

To characterize clinicians’ familiarity, attitudes, and utilization patterns related to complementary and integrative health (CIH) services at an academic medical center in the United States.

Methods:

This mixed-methods pilot study surveyed and interviewed clinicians (n = 46), including Department of Integrative Health (DIH) nurses who deliver CIH services via a consult model to hospitalized patients. Self-report questionnaires assessed clinicians’ familiarity, attitudes, and utilization of CIH services. Qualitative interviews explored CIH perceived benefits, barriers, and opportunities for wider service adoption.

Result:

Fifty-six percent of clinicians discussed the benefits of CIH services with patients, and 72% reported positive impacts such as improved sleep, coping, healing, and reduced pain and/or stress. Nurses (n = 25) reporting greater work autonomy viewed CIH services as more integral to their practice. DIH nurses demonstrated a high degree of familiarity and comfort in counseling patients with CIH modalities. Qualitative data highlighted the importance of creating safe, therapeutic environments, empowering patients, and improving health literacy. Challenges included limited education, awareness, and staffing, particularly during evenings and weekends. Proposed improvements encompassed expanded education and staffing, dissemination of effectiveness criteria, and automated electronic health record referrals.

Conclusion:

CIH services are broadly perceived as health-promoting and warrant expansion, but operational and cultural challenges must be addressed. These findings will guide CIH services’ refinement in U.S. academic medical centers and serve as a model for institutions seeking to integrate CIH services into patient care.

Keywords

complementary and integrative health holistic nursing mind/body pain management stress management

Introduction

Academic medical centers in the United States are increasingly utilizing complementary and integrative health (CIH) services as adjunctive therapies in inpatient settings.¹ CIH “integrates” conventional and complementary approaches² to treat patients’ mental, physical, and spiritual well-being holistically. Approaches may include massage therapy, progressive muscle relaxation, meditation, and focused breathing, often offered in combination. CIH services aim to promote physiological and psychological health by targeting patients’ relaxation response.³ Despite the known benefits and increased use of CIH over the past two decades in academic medical centers worldwide,⁴ there remains limited understanding of when, how, and why clinicians refer patients for CIH services. Identifying clinicians’ familiarity and attitudes about CIH services will advance evidence-based practice and equitable care delivery, providing patients with more holistic and preventative treatments.

Since 2003, Congress has increased the budget allocated to the National Center for Complementary and Integrative Health by more than 30%, indicating research about CIH services is a priority—and an opportunity for scientific advancement.⁵ Over the past two decades, scientists have reported that CIH services improve sleep quality,⁶ manage pain,⁷ and stress,^8,9 and support end-of-life care.¹⁰ In addition, CIH services may reduce hospital costs^11,12 and risk of readmission.¹³ Coordinated clinical care, inherent to CIH services, also reduces patients’ length of stay.¹⁴ These findings are encouraging and also underscore the need to understand why clinicians refer patients for CIH services, including the care context and delivery challenges. This understanding will facilitate sustainable embedding of CIH services in academic medical centers and educate broader patient populations about their benefits. Furthermore, it will address a critical need in the field to improve CIH implementation and dissemination.¹⁵

Academic medical centers typically offer services through a consult model, where clinicians (e.g., physicians, physician assistants, nurse practitioners, nurses) refer patients via the electronic health record (EHR). Several centers utilize nurse-led CIH consult models, which are typically funded through philanthropic donors,¹⁶ like the one described in this study. This allows staff to deliver holistic care to patients at no charge.¹⁶ Seminal studies by Dusek and colleagues have highlighted multiple benefits of inpatient nurse-led CIH models for various patient populations. Nurses, due to their significant bedside presence, are particularly adept at identifying ideal candidates for CIH services.¹⁷ However, interviews with CIH clinicians have revealed operational and cultural challenges in integrating services within academic medical centers that prioritize productivity and efficiency.¹⁸

This mixed-methods pilot study builds on prior work by identifying clinicians’ attitudes about utilizing CIH services for patient care at a 650+ bed American Nurses Credentialing Center Magnet Designated academic medical center that serves a broad population of children and adults with diverse medical and surgical needs. The study aims were to characterize clinicians’ utilization, attitudes, and familiarity with CIH, and identify experiences, barriers, and opportunities through qualitative interviews. Although several clinician types were recruited, the study focused on nurses who refer patients for and deliver CIH services, given the nurse-led nature of the services and the predominance of nurse referrals. Clarifying how clinicians are making decisions about CIH services will serve as a model for other academic medical centers implementing these services.

The study was approved by the institutional review board of NYU Langone Health. All enrolled participants provided written informed consent to participate in the study.

Materials and Methods

Study design and reporting guidelines

This mixed-methods study was conducted between January and August 2024. The reporting of the quantitative approach was informed by the Strengthening the Reporting of Observational Studies in Epidemiology recommendations for observational research.¹⁹ The qualitative component was reported in accordance with the Standards for Reporting Qualitative Research.²⁰ Both checklists were used to guide the design, conduct, and analysis of the study to ensure methodological rigor and transparency (see Supplementary Tables S3 and S4 in Supplementary Data).

Participants

Over three hundred clinicians (e.g., registered nurse, nurse practitioner, physician assistant, physician, advanced practice provider) from multiple hospital units and specialties were targeted for recruitment with emails, flyers, and in-person presentations at staff huddles. Nurses from the Department of Integrative Health (DIH) who provide CIH services via a consult model were also recruited to participate in the study. Participants needed to be employed at the study institution and to hold an active, unrestricted professional license (e.g., MD, DO, RN, NP) in their respective discipline to be eligible. Given this was a pilot study, our target sample size was 50 participants. Forty-six non-DIH clinicians and 10 DIH nurses were screened for eligibility. Of these, 38 clinicians (hereafter referred to as non-DIH clinicians) and 10 DIH nurses met eligibility criteria.

Quantitative data collection and analysis

Eligible participants completed questionnaires on CIH utilization, attitudes, and familiarity in REDCap that were adapted from validated instruments.^21,22 CIH attitudes were assessed using a 12-item scale that measured clinicians’ comfort in assessing patients for CIH use, answering CIH-related questions, and the perceived role of CIH in their practice. Higher scores indicate stronger beliefs that CIH therapies are integral to practice.

Perceptions of the effectiveness of CIH services were assessed with an 8-item scale that measured the impact of various sources (e.g., case reports, randomized controlled trials, recommendations of family and friends who have tried the therapy, recommendations of respected colleagues, recommendations of medical professional(s), personal experience, evidence demonstrating physiological mechanisms, and clinical experience) on clinicians’ perceptions of CIH therapies’ effectiveness.

Clinicians were asked about their familiarity and comfort with counseling patients on the pros and cons of 16 different CIH modalities using a 16-item scale. Non-DIH nurses also were surveyed on work autonomy with the Control Over Nursing Practice (CONP) scale,²³ a 23-item instrument that assessed the degree to which the nurses perceived they had the freedom to evaluate and modify nursing practice, implement their own decisions regarding patient care, and exercise authority and accountability for their decisions. Scores range from 23 to 161, with higher scores indicating greater perceived control.

Among eligible participants, two non-DIH clinicians did not complete any questionnaires. Fourteen non-DIH clinicians completed follow-up qualitative interviews, and nine DIH nurses participated in focus groups. Survey responses were analyzed descriptively in R(v.4.3.1)²⁴ and GraphPad,²⁵ and qualitative data were analyzed thematically in ATLAS.ti (v.24).²⁶ Missing data were omitted from analyses. Outcomes are reported from 36 non-DIH clinicians and 10 DIH nurses, unless indicated otherwise. Percentages are rounded to the nearest whole number.

Qualitative data collection and analysis

Following survey completion, 14 non-DIH clinicians participated in semi-structured interviews; 9 DIH nurses participated in focus groups. Interview and focus group guides were developed based on prior studies of clinician experiences with CIH^17,18 and are available in the Supplementary Data. One-on-one interviews with non-DIH clinicians were conducted by the primary investigator (E.M.M.) over WebEx. Focus groups were conducted by three study authors (B.B., K.E.Z., B.D.) who are not members of the DIH (i.e., do not work directly with the research participants). All sessions were recorded and initially transcribed automatically using WebEx. Transcripts were verified for accuracy by three trained coders on the research team (E.M.M., B.B., G.S.P.).

Non-DIH and DIH transcripts were coded and analyzed separately. In the first stage, researchers independently coded each of the transcripts and created initial code lists. In the second stage, coders compared their coding decisions and consolidated code lists through discussion to develop a final coding framework. For both groups, thematically related or duplicate codes were combined into code groups. Code groups were analyzed as themes, while codes that were part of the same code group but were conceptually distinct were analyzed as subthemes. Representative quotations for each subtheme were identified and shared with the larger group for review. A final list of quotations illustrative of themes and subthemes for transcript groups was determined through research team consensus to ensure clarity, conciseness, relevancy, and diversity of perspectives.

Results

Most study participants were between 31 and 50 years old (65%), self-identified as female (80%), and were nurses (93%; Table 1). Among non-DIH clinicians, 81% had referred a patient to DIH, with over half (53%) reporting that they would be extremely likely to do so again. Most non-DIH clinicians (86%, n = 25/29) based their referral on in-person evaluations. Only two (4%) non-DIH clinicians reported not discussing benefits of CIH therapies with their patients, and most reported discussing benefits with up to 25% of their patients (Fig. 1). Notably, 56% of non-DIH clinicians reported discussing potential CIH benefits with 26% or more of their patients. A large majority (73%) believed that services positively impacted patient satisfaction, and nearly all (97%, n = 34/35) felt that expanding services would benefit patient care. Importantly, no negative impacts were reported for any utilization measures, suggesting a positive perception of services among clinicians.

FIG. 1.

CIH utilization. The majority of non-Department of Integrative Health (DIH) clinicians speak with their patients about the possible benefits of CIH services, with only two clinicians (6%) reporting that they talk to none of their patients about the benefits of CIH therapies. CIH, complementary and integrative health.

Table 1.

Sample Demographics

	Non-DIH clinicians (n = 36)		DIH nurses (n = 10)
	N	%	N	%
Age
21–30	7	19	2	20
31–40	14	39	2	20
41–50	10	28	4	40
51+	5	14	2	20
Gender identity
Female	28	78	9	90
Male	3	8	–	–
Transgender	2	6	1	10
No response	3	8	–	–
Years of clinical practice
1–10	16	44	3	30
11–15	7	19	2	20
16+	13	36	5	50
Time dedicated to patient care
<50%	4	11	4	40
51%–75%	6	17	2	20
>75%	25	69	4	40
No response	1	3	–	–

DIH, Department of Integrative Health.

All 46 participants completed surveys assessing CIH attitudes. Ninety-four percent of non-DIH clinicians agreed that CIH services had a role in their practice (Fig. 2A), and 100% of DIH nurses surveyed held this view. Similarly, 75% of non-DIH clinicians felt accountable for assessing their patients for CIH services use (Fig. 2B), and 100% of DIH nurses felt accountable. Eighty-one percent of non-DIH clinicians felt comfortable assessing CIH services use (Fig. 2C) and 74% felt comfortable answering patient questions (Fig. 2D); 100% of DIH nurses reported being fully comfortable on both measures. Interestingly, 14% of non-DIH clinicians (n = 5/35) indicated that they were uncomfortable answering patient questions about CIH services.

FIG. 2.

CIH attitudes. Non-DIH clinicians were asked about their comfort in assessing patients for CIH services use, answering CIH-related questions, and the perceived role of CIH services in their practice. As many as 94% of non-DIH clinicians reported that CIH services have a role in their practice (A), 75% reported feeling accountable for assessing their patients for CIH services use (B), and 81% were comfortable assessing their patients for CIH services use (C). In addition, 74% of non-DIH clinicians were comfortable answering questions about CIH services (D), 97% believed patients have a right to have CIH services integrated into their conventional treatments (E), and 75% were comfortable educating patients about CIH services (F). CIH, complementary and integrative health; DIH, Department of Integrative Health.

The survey also revealed several insights into perceptions of patient rights and clinician responsibilities regarding CIH services. Fifty-three percent of non-DIH clinicians strongly agreed that patients have the right to access integrated CIH care (Fig. 2E); 90% of DIH nurses felt this way. All 10 DIH nurses, but only 17% of non-DIH clinicians, strongly agreed that they are accountable for educating patients (Fig. 2F). Further, 100% of DIH nurses reported being able to find reputable CIH resources for their patients easily, and 80% reported being able to locate reliable information on CIH; in contrast, 58% of non-DIH clinicians reported being able to find reputable resources easily, and 47% found it easy to locate reliable information (Table 2).

Table 2.

Resources and Information on CIH Therapies

	Non-DIH clinicians (n = 36)		DIH nurses (n = 10)
	N	%	N	%
I can easily find reputable CIH resources for my patients
Strongly agree	7	19	4	40
Agree	6	17	3	30
Slightly agree	8	22	3	30
Neither agree nor disagree	5	14	—	—
Slightly disagree	2	6	—	—
Disagree	7	19	—	—
Strongly disagree	1	3	—	—
How easy is it for you to find reliable information on CIH therapies?
Very easy	5	14	2	20
Easy	12	33	6	60
Neither difficult nor easy	13	36	—	—
Difficult	5	14	2	20
I don’t know how to find this information	1	3	—	—

CIH, complementary and integrative health; DIH, Department of Integrative Health.

When surveyed on which 8 information sources would convince them of CIH effectiveness (Fig. 3), 17 of the 36 (47%) non-DIH clinicians and 5 of the 10 (50%) DIH nurses reported that all 8 sources would have a definite or high impact on convincing them of therapeutic effectiveness. Both groups reported that their clinical experience would be the most impactful, followed by personal experience for DIH nurses, and randomized clinical trials and colleague recommendations for non-DIH clinicians.

FIG. 3.

CIH source effectiveness. Non-DIH clinicians and DIH nurses reported on which sources would convince them of CIH services’ effectiveness. Of the 8 sources surveyed, DIH nurses were more likely to report that they rely on personal and clinical experience as compared with non-DIH clinicians. CIH, complementary and integrative health; DIH, Department of Integrative Health.

Clinicians were assessed on how familiar they were with 16 types of CIH therapeutic modalities and whether they were comfortable counseling patients on the pros and cons of the modalities. On average, non-DIH clinicians reported understanding the proposed medicinal use and feeling comfortable counseling patients about the pros and cons of 3 of the 16 modalities surveyed, and being unfamiliar with 2. DIH nurses reported that they were familiar and comfortable counseling patients on an average of 6 modalities, and being unfamiliar with 1. Most of the modalities that the DIH team reported being most familiar with (aromatherapy, energy medicine, massage, meditation, relaxation therapy) are the modalities that are provided by the team through the consult service (Fig. 4; Supplementary Tables S1 and S2). As a group, non-DIH clinicians were the most familiar with meditation (81%) and massage (78%), and were the most comfortable counseling patients on meditation (47%). They were the least or not familiar with hypnosis (83%, n = 29/35), naturopathy (81%), and Tai Chi/Qi Gong (75%).

FIG. 4.

CIH familiarity. Familiarity with each of the 16 modalities surveyed is represented in the figure. The black portion of each pie chart represents the percentage of clinicians surveyed who are familiar with each modality. For example, the shaded part of the circle next to aromatherapy represents 69% (25 of 36) of non-DIH clinicians and 100% (10 of 10) of DIH clinicians who reported being familiar with aromatherapy (see Supplementary Tables S1 and S2 for survey responses for both groups). As a group, more than half of non-DIH clinicians were familiar with 7 of the 16 modalities and more than half of DIH clinicians were familiar with 14 of the 16 modalities. CIH, complementary and integrative health; DIH, Department of Integrative Health.

In terms of ease of accessing reliable CIH information, 47% of non-DIH clinicians found it very easy/easy, 14% found it difficult, and 36% found it neither easy nor difficult (Table 2). Eighty percent of DIH nurses reported that it was very easy/easy to find reliable information, while 20% reported that it was difficult.

Non-DIH nurses were assessed on their work autonomy as it related to their attitudes about CIH services. Scores ranged from 66 to 161. Nurses who reported greater autonomy at work (indicating they felt greater control with respect to making decisions about patient care) also reported that they believed CIH services were more integral to their practice, r = 0.59, p < 0.01 (Fig. 5).

FIG. 5.

Nurse autonomy. Non-DIH nurses (n = 26) were asked about their autonomy at work with the Control Over Nursing Practice (CONP) survey. Higher reported levels of autonomy at work were significantly positively correlated with reports that CIH services were more integral to their clinical practice. CIH, complementary and integrative health; DIH, Department of Integrative Health.

Qualitative interviews provided rich context for service referral and delivery. Non-DIH clinicians reported that they referred patients to CIH services when patients were experiencing psychological or emotional distress, including when patients felt overwhelmed about their diagnosis or hospitalization, or when they lacked social support. CIH referrals were also made to help patients cope with complex diagnoses, chronic conditions, and/or loneliness, and sometimes were utilized as a last resort when all other options had been exhausted. It was also reported that CIH services assisted patients with pain management when conventional pain management approaches were not fully effective, or to complement traditional approaches like medication. Non-DIH clinicians utilized services for patients with longer length of stays or for those readmitted with complications. Further, they reported that patients would sometimes request services themselves, particularly if they had positive experiences during prior hospitalization. Non-DIH clinicians also noted the importance of timing and patient receptivity in making referrals to ensure that patients were willing and ready to be visited by the DIH team.

Both non-DIH and DIH clinicians reported multiple patient benefits from CIH services, including improved stress and pain management, enhanced health literacy, and increased patient empowerment (Tables 3 and 4). However, several barriers to service implementation were identified, such as limited staff availability during evenings and weekends, lack of patient and staff education and awareness, and difficulties in coordinating services with patients’ schedules, particularly for those with shorter hospital stays. Finally, non-DIH clinicians indicated they do not always remember to utilize services as an option for patient care.

Table 3.

Key Themes and Subthemes from Qualitative Interviews with Non-DIH Clinicians

Themes	Subthemes	Evidence for subthemes
Patient experience	- Complement to conventional medicine- Support for chronic conditions- Enhanced coping- Pain management- Anxiety/stress reduction- Improved patient satisfaction	“[I]ntegrative health helps patients who are anxious and stressed, giving them extra tools they can use, like guided breathing or aromatherapy, to cope better … I love watching someone do a breathing technique … you can see their heart rate go down from 121 to 96.” (Subject 21)“[Patients] really feel like it helps … with their healing process [and] their mood. [T]hat’s a really big struggle while being in the hospital; it’s not just physical health but emotional health too.” (Subject 24)
Clinical decision-making	Consideration of:- Patient’s psychological needs and pain- Length of hospital stay and complexity of case- Patient receptivity and readiness- Timing within patient’s treatment course	“Most of the time when I use integrative health patients [are] having some coping issues … usually [it’s] anxiety related to fear of the unknown … I would talk to the patient about it and say, hey, listen, we have this great program … It helps you actually learn how to relax so that you can cope with your diagnosis and the illness and being in the hospital and away from your family.” (Subject 20)
Challenges and barriers	Operational:- Limited staffing, esp. nights and weekends- Lack of outpatient services- Workflow/timing constraints- Limited integration with EHRCultural/educational:- Varied acceptance of CIH among medical staff- Not prioritized in acute settings- Perceived as “alternative” rather than complementary- Need for more evidence-based validationCommunication:- Uncertainty about service availability- Limited feedback on consult outcomes- Lack of structured appointment times- Documentation challenges	“I don’t think [integrative health is] as accepted in the surgical world … a lot of people don’t really see the benefit of integrated practices. They don’t view it as real medicine.” (Subject 45)
Suggested improvements	Education:- Enhanced staff education- More visibility of services offered- Better support for clinicians interested in CIH approaches- Earlier introduction of CIH in care process- More focus on preventive/lifestyle approaches- Better connection to community resourcesOperational:- Increasing staffing- Expansion to outpatient services- More structured scheduling system- EHR enhancements with prompts/reminders to consider CIH- Better integration into standard workflowCommunication:- Provide more detailed documentation of patient interactions- Better coordination with unit schedules and patient availability- Better communication on patient plan of care between clinical teams	“I think the challenges are we have a lot of new people that may not be educated on integrative health and what your role is here and how much it can help and benefit the patient.” (Subject 20)“Due to staffing constraints, no one was able to come for at least a day. So by the time [integrative health] came patients would go home.” (Subject 24)

CIH, complementary and integrative health; EHR, electronic health record.

Table 4.

Key Themes and Subthemes from Focus Groups with DIH Nurses

Themes	Subthemes	Evidence for subthemes
Patient benefits	- Managing stress and promoting healing- Enhanced coping- Pain management	“It’s hard for patients in a hospital setting to … be calm because there’s so much going on. It’s just a very stressful environment. So when they give me feedback that they’re going to use whatever tool I gave them in the future, [it] really fulfills me as a nurse.” (Focus Group 2)
Core clinical values	- Facilitating patient health literacy- Empowering patients- Creating a safe, therapeutic environment- Assessing patient readiness and willingness- Taking time to listen- Supporting both patients and families	“[W]ellness and holistic health [are] part of health literacy, but not everybody recognizes that. So having conversations with patients about getting proper sleep, deep breathing, things that are important to their health that they may not think about … I definitely think education is a big thing when it comes to seeing patients and letting them understand or allowing them to understand what it is that they need to do.” (Focus Group 3)“You’re creating a therapeutic environment in which [patients] feel safe. I appreciate having the skills of a nurse and being able to understand medically complex diagnoses and treatment plans, and then being able to offer some antidotes or an intervention that’s not as invasive as some of the interventions that they are experiencing [while hospitalized]. And to be an advocate while they’re here in our hospital.” (Focus Group 1)
Challenges and barriers	Operational:- Patient unavailability due to tests/procedures- Multiple interruptions during sessions- Limited staff resourcesCultural/Educational:- Lack of understanding about CIH from other clinicians- Lack of systematic education for new cliniciansEmotional/professional impact:- Emotional toll of work- Need for self-care and team support- Importance of personal boundaries	“I think it comes down to knowledge barriers about what we do and what we don’t do and it’s a little bit tricky sometimes because we have so many new teams coming in all the time, and I don’t think we have a standard way of educating new providers coming in about our services and what they are. Certainly, there is a component-we are involved in training the new nurses who come in through the Nurse Residency Program, but not every nurse comes through that if they’re an experienced nurse. We cover so many areas in the hospital so it’s really difficult to train everyone in what we do and a lot of people are not familiar with our scope of practice.” (Focus Group 1)“We see a lot of suffering and we have to take time between patients. This isn’t like a service that you just run from one patient to the next.” (Focus Group 1)
Suggested improvements	Education:- Enhanced staff education- Enhanced preadmission awareness and post-discharge follow-up- Family educationOperational:- Better integration with primary care- More systematic approach to consults- Clearer protocolsCommunication:- Enhanced communication systems- Improvements in continuity of care across providers	“If patients knew ahead of time that integrative health exist[s], this is what integrative health is, then I feel like when we come, they’ll have that idea already in their mind, like this exists for them.” (Focus Group 2)“A lot of our patients say ‘this was so helpful. How can I continue working with you after discharge?’ and so I would love to see a model where, you know, similar to like, post-ER visits or post-surgery visits where you do a follow-up call.” (Focus Group 1)

CIH, complementary and integrative health; DIH, Department of Integrative Health.

Suggested improvements included enhancing patient and staff education, embedding clinical decision support to automate referrals through the EHR, improving care coordination, and expanding DIH staffing to cover evenings, weekends, and outpatient settings. Findings highlight the potential for CIH services in patient care while also identifying areas for improvement in implementation and utilization.

Discussion

This pilot study examined clinician attitudes, referral patterns, and delivery methods related to a nurse-led CIH consult model in an academic medical center. Findings highlight the critical role of nurses in the referral process and their importance in determining suitable patients for services. The high utilization rate (80%) and positive perceptions of CIH services among non-DIH clinicians underscore the broad support for these services. However, differences in comfort levels between DIH and non-DIH clinicians when answering patient questions about CIH modalities point to a need for increased education, aligning with prior research among health professionals^17,18 despite growing global use.²⁷

Findings emphasize the benefits of embedding CIH services within nursing departments, revealing a positive correlation between nurses’ work autonomy and their likelihood of viewing services as integral to care. This aligns with research showing that strengthening nurse autonomy leads to broader intervention utilization,²⁸ improved evidence-based practice adoption, and better patient outcomes.^29–31 The reliance on clinical experience for assessing intervention effectiveness highlights the need for standardized, evidence-based protocols for services.³² Nursing is well positioned to lead in this area, given its holistic approach by nature.³³

Despite strong support for CIH services, significant operational and cultural barriers to wider adoption persist. Clinicians reported a lack of awareness among colleagues, suggesting a need for increased staff education. Findings point to opportunities for creating structured pipelines and implementing clinical decision support in the EHR to automate referrals. Embedding alerts to remind clinicians across the system that services are an option could address some of the reported challenges from clinicians in this study that they sometimes forget that services are an option for patient care. Such improvements, along with disseminating criteria for effective CIH services use and implementing scheduled consults, could address these reported challenges and improve care delivery. These strategies align with successful implementations in other medical fields³⁴ and could significantly enhance CIH services utilization and integration within academic medical centers.

Limitations

This study has several limitations that should be considered when interpreting the results. Though every effort was made to recruit a wide range of clinicians with varying degrees of familiarity and attitudes about CIH therapies, the final sample was relatively small and consisted predominantly of clinicians who were already familiar with and had utilized CIH services, particularly nurses. This participation bias may have skewed the results toward positive attitudes of CIH therapies and limited the generalizability of the findings. The overrepresentation of nurses is likely due to the nurse-led nature of the DIH team and its organizational placement within the Departments of Nursing. In addition, the use of primarily descriptive analyses, without assessments of statistical significance, restrict our ability to draw robust conclusions about differences between DIH and non-DIH clinicians’ experiences and attitudes. Finally, the single-center design may limit the applicability of findings to other health care settings. Future work could address these limitations by employing a larger, more diverse sample of health care professionals and conducting multicenter studies. Such approaches would allow for a more comprehensive exploration of how attitudes and familiarity with CIH services differ across various job roles and utilization groups, ultimately providing a more nuanced understanding of CIH integration in health care settings.

Conclusion

This pilot study demonstrates that clinicians utilize CIH services as a complement to conventional medical treatments, particularly when patients require additional support or relief. CIH services effectively address patients’ emotional distress, pain management, and the social isolation often associated with hospitalization. The broad consensus among clinicians on the health-promoting benefits of CIH services underscores the importance of continuing and expanding these services. However, the study also reveals critical operational and cultural barriers that must be addressed to facilitate wider CIH services utilization and adoption across health care systems. These findings provide valuable insights into refining CIH services within academic medical centers and developing targeted strategies to educate both staff and patients about the benefits of integrative approaches. Moreover, this research, in conjunction with previous studies,^11,17,18,35 offers a comprehensive roadmap for other academic medical centers seeking to implement CIH services in their hospitals. By highlighting the nurse-led model’s effectiveness and identifying areas for improvement, this study contributes to the growing body of evidence supporting the integration of holistic care approaches in modern health care settings.

Footnotes

Acknowledgments

The authors would like to express our heartfelt gratitude to our funding partners, the Lerner family, whose generous support and commitment have made this study possible. Their belief in our mission and the resources they have provided have been instrumental in advancing their goals. Without their continued dedication and collaboration, the work of our Lerner Health Promotion program would not be achievable. The authors are deeply appreciative of their trust and investment, and they look forward to the ongoing success of our partnership.

Author Disclosure Statement

The authors declared no conflicts of interest regarding the research, authorship, and/or publication of this article.

Funding Information

The authors thank the Lerner family for their continued support of the Lerner Health Promotion program.

Supplemental Material

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