The study, led by Elio Rossi of the Regional Center for Integrative Medicine in Florence and published in the journal Supportive Care in Cancer, surveyed 176 oncologists, nurses, psycho-oncologists and other professionals working in oncology departments across the Tuscan Regional Health Service, one of the few public health systems in Europe that has formally embedded complementary and integrative medicine (CIM) into its cancer care network. The results offer a rare quantitative window into how the medical workforce on the front lines of cancer treatment actually perceives therapies — acupuncture, traditional Chinese medicine, homeopathy, nutritional counseling and more — that have long existed at the contested boundary between evidence-based oncology and alternative practice.

The survey instrument itself was carefully constructed. The Tuscan Regional Working Group “Integration of Complementary Medicine in the Regional Oncology Network” approved a 15-item questionnaire comprising 14 multiple-choice questions and a single open-ended question, allowing respondents both to quantify their views and to add free-text nuance. The survey was administered anonymously via Google Forms beginning in November 2024, with data collection closing in December 2024. The anonymous, digital-first design was intended to minimize social desirability bias — the tendency of professionals to give answers they believe their institutions expect — and the internal review board and the heads of the oncology departments of the Tuscan Oncology Network approved the protocol in July 2024.

The composition of the respondent pool lends the findings particular weight. Medical oncologists made up the largest single group at 39.2 percent, followed closely by nurses at 33 percent, with psycho-oncologists accounting for 4.5 percent and the remainder drawn from other professional categories working within cancer units. This distribution matters because these are precisely the clinicians who manage the daily reality of cancer treatment — the chemotherapy side effects, the pain, the anxiety, the sleep disruption — that integrative interventions claim to alleviate. Their assessments are not abstract opinion; they are grounded in direct observation of patients navigating both conventional anticancer therapy and optional CIM services.

When asked to evaluate the impact of integrative oncology services on cancer patients, the respondents delivered a verdict that was broadly positive, though far from unanimous. Just under a third — 32.4 percent — rated the services as useful, and 29.5 percent went further, judging them very useful. A further 23.3 percent described the impact as fair. On the skeptical side, 11.4 percent rated the impact as poor and 3.4 percent called it irrelevant. Taken together, more than 61 percent of professionals embedded in a conventional oncology environment judged publicly delivered integrative services as useful or very useful — a striking level of internal endorsement for a field that has historically faced deep institutional skepticism.

Referral behavior told a more layered story. Asked how frequently they recommend that patients visit the public integrative oncology clinics, 29 percent of respondents said “sometimes,” 22.2 percent said “rarely,” 15.9 percent “fairly often,” 15.3 percent “often,” 9.1 percent “very often,” and 8.5 percent said they never recommend them. The pattern suggests that while outright rejection of integrative services is a minority position, enthusiasm is tempered: most professionals refer selectively rather than systematically. Among the oncologists specifically, 47.7 percent reported recommending complementary and integrative medicine to their cancer patients — meaning that, within this network, recommending CIM is close to a coin-flip proposition among the very physicians prescribing chemotherapy, immunotherapy and radiotherapy.

What clinicians recommend is as revealing as how often they do so. Acupuncture dominated the list, cited by 51 percent of respondents as their most frequently recommended intervention, followed by nutritional counseling at 27 percent and generic integrative medicine consultations at 11 percent. Techniques drawn from traditional Chinese medicine, energy-based movement exercises, homeopathy and other modalities trailed behind. This hierarchy is consistent with the current state of clinical evidence: acupuncture has accumulated a relatively robust evidence base for chemotherapy-induced nausea, certain pain syndromes and, in some trials, aromatase inhibitor–related arthralgia in breast cancer, while nutritional counseling sits comfortably within mainstream supportive care. Homeopathy’s position on the list, despite its more contested scientific standing, reflects both its cultural entrenchment in Italy and the fact that Tuscan public clinics have long offered it under regulated conditions.

The Tuscan program itself is an institutional experiment unlike most. Beginning with regional resolutions in 2015 and 2016, the Region of Tuscany formally directed its local health authorities and university hospitals to integrate complementary medicine services into the oncological network of the Tuscan Tumor Institute, creating a regional referral center and a mapped network of integrative oncology outpatient clinics. The model rests on a specific architecture: CIM practitioners work alongside — not instead of — conventional oncology teams, interventions are positioned strictly as complementary to, never as substitutes for, standard anticancer treatment, and a regional working group coordinates training, clinical protocols and quality control. Prior work by the same group, published in 2023, described the operational process of building this integration within the public health system, and the new survey represents the first systematic effort to measure how the professionals inside that system judge the results.

The findings arrive amid a rapidly expanding international literature on clinician attitudes toward complementary medicine in oncology. Recent surveys from Germany, France, China, Iran, Tunisia and multinational cohorts have documented a consistent paradox: use of complementary therapies among cancer patients is high — systematic reviews suggest prevalence rates ranging from roughly a quarter to more than half of patients depending on the population — yet many clinicians feel underinformed about the evidence, undertrained in the modalities, and uncertain about safety issues such as herb–drug interactions. Studies have also documented the darker edge of unregulated use, including patients who refuse or delay conventional treatment in favor of alternatives, a pattern associated with worse outcomes. The Tuscan model is explicitly designed to counter this risk by bringing CIM inside the regulated perimeter of the public system, where interactions can be monitored and patients can be steered away from dangerous substitutions.

The authors are candid about both the promise and the limits of their results. They conclude that the integration of complementary and integrative medicine into oncology appears feasible, and they argue that shared clinical practice and open dialogue between conventional oncologists and CIM practitioners may reduce the mutual prejudices and institutional barriers that have historically kept the two worlds apart — ultimately benefiting patients. At the same time, they emphasize that further studies are warranted to better assess the clinical impact and generalizability of the approach. A cross-sectional survey of professionals in a single Italian region captures perceptions, not hard clinical endpoints: it can establish that the workforce finds the services acceptable and useful, but it cannot, by itself, prove that acupuncture or any other intervention improves survival, tumor response or even patient-reported quality of life at the population level. Nor can it fully rule out selection effects — professionals who chose to respond may differ systematically from those who did not.

Even so, the study lands at a moment of genuine momentum for integrative oncology internationally. Major cancer centers in North America and Europe have steadily expanded supportive and integrative oncology services, and professional societies have issued consensus definitions framing the field as the evidence-based use of complementary therapies alongside conventional treatment. The Italian data add a distinctive dimension to this conversation: evidence that a fully public, region-wide implementation — not a boutique program at a wealthy academic center — can achieve meaningful buy-in from the oncologists and nurses who must make it work in practice.

For patients and clinicians watching this debate unfold, the Tuscan experience suggests a pragmatic middle path. Rather than the sterile binary of uncritical embrace versus blanket dismissal, the model treats integrative oncology as a matter of clinical governance: which interventions, delivered by whom, under what oversight, for which symptoms, and with what monitoring. The survey’s numbers — broad but measured endorsement, selective referral patterns, and a clear preference for the best-evidenced modalities like acupuncture and nutritional support — read less like a manifesto for alternative medicine and more like the cautious verdict of working clinicians judging a service by its usefulness at the bedside. Whether that verdict translates into measurable improvements in patient outcomes will be the question that determines whether Tuscany’s experiment becomes a template or a cautionary tale — and the authors have made clear that the studies needed to answer it are the necessary next step.

Evidence from this systematic review underscores a critical gap in the public’s understanding of complementary medicine. Despite rising interest, many people lack the essential knowledge to make informed decisions, which can lead to misinformed choices that impact health outcomes. This inadequacy highlights the pressing need for effective educational strategies aimed at consumers and caregivers alike. With a fragmented marketplace offering diverse therapies, navigating the complexities of what constitutes safe and effective complementary medicine is crucial. The researchers delve into various educational interventions that target these gaps, emphasizing the need for evidence-based information.

The review synthesizes a wealth of studies examining different forms of educational interventions, ranging from workshops and seminars to online resources and counseling sessions. Each method’s efficacy is evaluated, providing insights into which formats effectively enhance understanding and engagement. The findings reveal that knowledge gained through structured educational interventions often translates into improved attitudes toward complementary medicine. Such shifts may empower consumers to approach their health more holistically, leveraging multiple modalities and fostering a greater sense of agency over their healthcare decisions.

Moreover, the research identifies key characteristics of successful educational interventions—namely, the importance of tailoring content to the specific audience’s needs and preferences. For instance, caregivers, who play a vital role in managing patients’ health, require specific information that is both accessible and relevant. Understanding the unique challenges they face can significantly enhance the effectiveness of educational initiatives. This tailored approach not only increases uptake but also cultivates sustained interest in complementary therapies.

An intriguing aspect of the review is the role of technology in disseminating information. Digital platforms are increasingly utilized to bridge the gap between consumers and credible information about complementary medicine. The rise of online health forums, webinars, and mobile applications presents unique opportunities to reach a broader audience. However, the review also highlights the importance of ensuring that the information spread through these channels remains evidence-based and reliable, as misinformation can easily proliferate in the digital age.

In examining the results of various studies, the review emphasizes the positive outcomes associated with educational interventions. Not only did participants often report increased understanding, but many also expressed heightened confidence in their ability to make informed health decisions. This newfound confidence is critical in an era where patients are encouraged to take an active role in their health management. As healthcare transitions toward more patient-centered models, the benefits of enhanced literacy in complementary medicine become increasingly apparent.

The researchers also address the potential ethical considerations surrounding the promotion of complementary therapies. While many individuals find solace in these approaches, the necessity for transparency and informed consent remains paramount. Educators and healthcare providers must carefully navigate the delicate balance between promoting complementary medicine and ensuring that consumers are fully informed of the risks and benefits associated with various treatments. This aspect of the discourse is particularly vital in fostering trust between practitioners and patients, enabling more collaborative health decisions.

Furthermore, the review sorted through myriad studies, identifying a spectrum of outcomes based on differing demographics. Age, cultural context, and prior experiences with complementary therapies all play significant roles in determining an individual’s receptiveness to educational interventions. Highlighting these variances underscores the need for a multifaceted approach to education, one that respects and acknowledges the diverse backgrounds and beliefs of consumers seeking alternative health solutions.

As the review concludes, the authors present a clarion call for further research into best practices for educating the public on complementary medicine. Emphasizing the ongoing evolution of health education, they advocate for a commitment to continuous improvement and adaptability in teaching methods. The landscape of healthcare is ever-changing, and as such, educational strategies must remain dynamic to keep pace with emerging trends and consumer interests.

Given the complexity of healthcare decisions today, this systematic review serves as a foundational document for those interested in advancing the knowledge and understanding of complementary medicine. The urgency of enhancing health literacy cannot be overstated, as it is a cornerstone of effective health management and improved outcomes. By empowering both consumers and caregivers with knowledge, the research sets the stage for a more informed public that can navigate the intricate world of health choices.

In summary, this study by Naseri and colleagues offers critical insights into the realm of complementary medicine education. By addressing the deficiencies in public knowledge and advocating for targeted educational interventions, the research supports a shift toward more informed health decisions. The overarching aim is clear: to ensure that individuals are empowered, knowledgeable, and capable of making the best possible choices for their health through the integrated use of both conventional and complementary medical approaches.

Through this systematic review, the authors highlight not just the current state of educational interventions but also the imperative for ongoing developments in this field. It is an invitation for stakeholders—healthcare providers, educators, and policymakers—to engage with the findings and take actionable steps toward improving complementary medicine literacy among consumers and caregivers alike.

Subject of Research: Educational interventions for consumers and caregivers in complementary medicine literacy.

Article Title: Improving complementary medicine literacy: a systematic review of educational interventions for consumers and caregivers.

Article References: Naseri, K., Shahin, W., Allahham, A. et al. Improving complementary medicine literacy: a systematic review of educational interventions for consumers and caregivers. BMC Complement Med Ther 25, 419 (2025). https://doi.org/10.1186/s12906-025-04931-w

Image Credits: AI Generated

DOI: https://doi.org/10.1186/s12906-025-04931-w

Keywords: Complementary medicine, health literacy, educational interventions, consumer education, caregivers, health decision-making.