I'm delighted to interview Yehudit Tapiro. Yehudit Tapiro is the Chief Nurse Oncologist in the Oncology Service in Zebulon Medical Center in Northern Israel. Thank you for coming. My pleasure. I would like to ask you, Yehudit, about your professional experience as a chief nurse working in an oncology department, where integrative consultation and treatment is available to patients undergoing chemotherapy, and ask you about referrals to integrative medicine consultation and treatment. Who do you refer and what's the consideration when you consider referral? First of all, we bless the addition of the integrative care to our patient. It gives them a great benefit and we help to develop it more. All the nurses, we feel, automatically almost, the patient that gets the complicated chemotherapy protocol that is on bound to have more adverse events and need more symptoms balance and management. This is automatically. In addition, every patient that report to me that he suffers so many symptoms or adverse event, I send a referral to. We have some difficulties. Not all the patient are fit for this kind of intervention, and somebody acting a suspicion to the idea, they don't know what it is, they never heard of it. They are most times from the Arab community, but after we sit with them and explain to them about the idea, they tend to accept. But, nevertheless, sometimes they go to the first appointment, they meet with the integrative physician doctor, but afterwards, they find it difficult due to logistic difficulties to get here every time. People from the far north of Israel, it takes a long time to get to here. It doesn't exist in our clinic in Zebulon, which is a little less Southern, but they have to drive all the way to Lynn and sometimes it's difficult for them and they tend to give it up, which is very unfortunate for them. They lose the benefit of the treatment, which is in my opinion is significantly helping, supporting. Do you identify other groups of patients who have difficulties in in term of referral to integrative medicine consultation or adherence to the treatment that we weekly provide? Other than geographic problems, I don't see. I think that they're blessed also that they have this kind of intervention that is free to them. They can get it for free. Sometimes the alternative treatment was only for the rich people. Not all the population could get it, but with this intervention, it's free for all and I think they get the benefit and they say thank you. They appreciate the intervention. What are the main indications that you think are important for referral as a nurse? Which conditions you tend to refer more patients to our consultation? As I said before, the complicated chemotherapy protocol, they have many symptoms. Sometimes I can say that without your intervention, maybe they couldn't be able to complete the chemotherapy session, which of course will help the odds to recover. Sometimes I can think of at least two cases that it would be the case if you didn't do your intervention. Many psychological difficulties. How cheap to cope with the treatment, diagnosis, change of places in the family, all the things that happened to the patient, to the person since he heard that he has life threatening disease. So it's also not just the bio-physical symptoms like fatigue, nausea and so on, but also the psychological aspects like depression, anxiety, insomnia, and coping in terms of the relation. Breathing problems. It contributes to the outcome. You have also specific training on the top of what you do in oncology nursing in spiritual care provision. Yes. I practice it, I started to practice it, it's so meaningful and so important for the patient. I have the blockage in myself before in the past when I tried to start a conversation about the person that was afraid from his dying. I didn't start. I couldn't start, but now I deal a little and I get a lot. It's like scratching the surface with the little finger and it opens. It's unbelievable. I had a conversation about it for an hour and a half, and I believe very much that it's essential to discuss these matters with the patient. Essential, and I also refer to you, which you have spiritual care provider, certified. I'm not certified. I only learned the main issues. So, that's another referral indication, not just the psychological aspect, but the spiritual concerns as well. All of these are components that the patient in the persons, all the models in the person in the center, a holistic method, holistic approach that contains all the needs of the patient. In order to give the patient all he needs, we have to give him answer to what he tell us, what are the problems, what are the needs. This is the holistic approach and I very much try to work by it all the time. Can you share with us, in what sense you're involved in this process of working with the integrative physicians and practitioners beside referral? Where are you actually involved? Are you involved also in the design of the treatment programs or in the evaluation? Please elaborate on that. I feel very much involved. First of all, in my referral, I decide what are the symptoms, I diagnose, I make the assessment and I gave you my assessment. Then after you meet with the patients, you tell me your intervention plan and I can offer my opinion. I can look if it's answering the main problems as I see it and we have a dialogue all the time. If you think something, you'll tell me. If I see something, I'll tell you. It's very important for the benefit of the patient. We have an open line, open communication. Yes. From the patient's perspective, do you think the patient is perceiving this collaboration is something useful, that there is no dichotomy between the conventional supportive care and the integrative supportive care? I think the patients take the integrative care as another treatment option on top of the palliative conservative treatment and I think they very much appreciate it. I think it's important for the patient that they see that we care for them. We want to give them everything a minute in order to help them. They see it and appreciate it. Appreciate it. It's really important and I'm not sure that they are aware for the integrative part. They take from us-. The collaboratin that we have. -they take from us and they go to you and they take from you, we say together as complimentary. They take what they can and need. Do you think that the collaboration that was established between the nurses and the integrative practitioners can also help or alleviate the concerns of the caregiver of the family member? Yes, I think it does because sometimes as I said I tell you a husband is very anxious, you have to support him. If the husband is the sick one, the wife sometimes feel very helpless because he doesn't eat, everything that she did all in life for him she can't do now and she needed an intervention, and I think it helps for everything in the family. Their large family, the children, the family members see the good treatment that patient is getting, and it's giving them a relief and gives them a good feeling to know that he is in good hands and he gets such an advanced treatment I think it's really important. So, in conclusion if you look at the future, what do you see collaboration ongoing development of collaboration and dialogue between oncology nurses and integrative petitions, what is your vision? Where we can take this initial projects and expand it? First of all, I hope that there will be an integrative care [inaudible] as well, I have to say it. Second, I believe that more nurses will learn this kind of intervention. They learn all the integrative ways, and as part of the holistic intervention, each nails in the oncology work will be able to combine this method as well as much as we do now. We do talk to the patient about these difficulties, hardships, psychological to certain level. Spiritual now as well, but more and more and more and I see it coming. With you agent, we will get everywhere. So, you're talking basically about the integrative modalities that nurses could learn and implement them as part of the toolbox of support with palliative care. I want to ask you if you think that when a nurse like you is practicing spiritual care or maybe complimentary integrative practices. Do you think it can impact her own professional status or personal burnout? We all the time talk about burnout, talk about dealing with these emotional burden when we treat patients with advanced cancer, do you think it can impact the nurse herself? I can learn for myself. The process that I went through studying the spirituality and we get new staff like five wishes [inaudible] to talk with the patient about the wheels in the end of life and to talk about the issues that actually are connecting to the how to go of the patient to their heart, to their mind, to the spirit, and I for myself I found a new energy. I feel now, more driven to help me also asking myself these questions and being aware of all the subject of burnout, compassion fatigue. It helps. It really helps. It's a new interest. It's a new something that gives you more interest and more drive to be at work and to do the best you can for the patients, and as you give more, you get more. It's bidirectional. Yes. The patients appreciated it very much that you talk to them, that you're there for them and I hear it all the time. In oncology, as long as their most sick, the same way they appreciate you more. The professional care giver and you can see it in all our diplomas. Thank you letters and so. Yeah. Thank you very much for sharing these ideas with us and thank you for coming today. Thank you for inviting me, good luck.