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| Potential Barrier | Recommendation | Practical implications |
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| Geographical factor: 68% of the Arab patients receiving chemotherapy reside >20 km from the IOP in Haifa OS | Opening a second site of IOP activity in Haifa periphery (zone 2 or 3) | Minimizing distance-bias may help patients to overcome initial hesitations regarding the first IP visit and enable them to attend weekly CM sessions |
| Not having an Arab CM practitioner in the IOP staff | Inclusion of an Arab CM practitioner (preferably a dual practitioner) in the IOP | Improving verbal communication with patients, enhancing the IOP attentiveness to their needs, and concerns and promoting development of traditional Arab-oriented therapies |
| Gap between patients’ expectations and IOP objectives and CM repertoire | Increasing IP awareness of patients’ expectations; developing integrative modalities that will resonate more with traditional Arab medicine | Matching patients’ expectations with IP goals of treatment is essential and should be continuously monitored, especially with regard to QOL-oriented care rather than “attacking” cancer cells |
| Suboptimal matching of CM modalities to patients’ cultural and religious codes and beliefs | Raising the IP’s and CM practitioner’s awareness of cultural and religious codes within the Arab society | The IOP staff need to consider cultural appropriateness of certain CM modalities (e.g., touch), reluctance concerning unfamiliar treatments (e.g., acupuncture, guided imagery), and gender issues (patient treated by a CM practitioner of the opposite sex, presence of another person in the room, etc.) |
| Suboptimal communication between the IOP and the other OS sectors | Improving IP-oncologist-nurse- social worker communication in order to enhance coordinated comprehensive care | Closer monitoring of patient compliance may also reveal the patient’s difficulties and barriers to seeking integrative care |
| Lack of communication with the patient’s family physician (FP) | Initiating a structured form of communication with the patient’s FP via summary letter e-mailed from the patient’s medical file | The FP often operates within the cultural milieu of the patients, care givers, and the extended family circle Integrative care-oriented medical education courses are needed to familiarize FPs with the IOP activity |
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