Evaluation of a hospice based reflexology service: a qualitative audit of patient perceptions

Complementary therapy in palliative care: A synthesis of qualitative and quantitative systematic reviews

BACKGROUND

Interventions delivered in palliative care are complex and their evaluation through qualitative and quantitative research can lead to contrasting results. In a systematic review of trials, the effectiveness results of complementary therapies in palliative care were inconclusive; however, our qualitative synthesis showed participants perceived them to be beneficial.

AIM

Use a novel methodology to synthesise evidence from qualitative and quantitative systematic reviews on complementary therapy in palliative care to explore the following: (1) If interventions delivered in trials reflect how participants in qualitative studies report they are delivered in real-life settings and (2) whether quality of life measures used in trials capture perceived benefits that are reported in qualitative studies.

METHODS

Two matrix tables were formulated. In one, key components in delivery of the complementary therapy from the qualitative synthesis which are as follows: (1) relationship with therapist, (2) comfortable environment, (3) choices (e.g. area of massage) and (4) frequent sessions, were plotted against intervention description, to explore matches and mismatches. In the other, items included in quality of life scales were compared with perceived benefits of complementary therapy.

RESULTS

None of the trials included all four key delivery components. The five quality of life scales used in the trials failed to capture the range of perceived benefits from the complementary therapies and many included inappropriate or redundant items.

CONCLUSIONS

By integrating qualitative and quantitative review data, we determined the reasons trials may be inconclusive. This methodological exemplar provides a framework for understanding complexity in outcomes across trials and a direction for future research.

The effectiveness of aromatherapy, massage and reflexology in people with palliative care needs: A systematic review

BACKGROUND

Aromatherapy, massage and reflexology are widely used in palliative care. Despite this, there are questions about their suitability for inclusion in clinical guidelines. The need to understand their benefits is a public priority, especially in light of funding pressures.

AIM

To synthesise current evidence on the effectiveness of aromatherapy, massage and reflexology in people with palliative care needs.

DESIGN

A systematic review of randomised controlled trials (PROSPERO CRD42017081409) was undertaken following international standards including Cochrane guidelines. The quality of trials and their pooled evidence were appraised. Primary outcomes on effect were anxiety, pain and quality-of-life.

DATA SOURCES

Eight citation databases and three trial registries were searched to June 2018.

RESULTS

Twenty-two trials, involving 1956 participants were identified. Compared with a control, four evaluated aromatherapy, eight massage and six reflexology. A further four evaluated massage compared with aromatherapy. Trials were at an unclear risk of bias. Many had small samples. Heterogeneity prevented meta-analysis. In comparison with usual care, another therapy or an active control, evidence on the effectiveness of massage and aromatherapy in reducing anxiety, pain and improving quality-of-life was inconclusive. There was some evidence (low quality) that compared to an active control, reflexology reduced pain.

CONCLUSIONS

This review identified a relatively large number of trials, but with poor and heterogeneous evidence. New clinical recommendations cannot be made based on current evidence. To help provide more definitive trial findings, it may be useful first to understand more about the best way to measure the effectiveness of these therapies in palliative care.

Aromatherapy, massage and reflexology: A systematic review and thematic synthesis of the perspectives from people with palliative care needs

BACKGROUND

Effectiveness evidence of complementary therapies in people with advanced disease is uncertain, and yet people are still keen to engage in complementary therapy. Insights into people's experiences of complementary therapy in palliative care, the perceived benefits, and how they want it delivered, can inform clinical guidelines and suggest ways to test therapies more appropriately in future evaluations.

AIMS

Explore in people with advanced disease (1) the experiences and perceptions of benefits and harms of aromatherapy, massage, and reflexology and (2) how they would like these therapies delivered.

DESIGN

A systematic review and thematic synthesis of qualitative studies. Database search terms were related to palliative care, aromatherapy, reflexology and massage. Citations and full texts were reviewed independently against predefined inclusion criteria. Studies were appraised for quality. This review is registered at PROSPERO (22/11/2017 CRD42017081409).

DATA SOURCES

MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, KoreaMed and ProQuest with a bibliography search to June 2018.

RESULTS

Five qualitative studies in advanced cancer were identified. Three analytical themes were identified: (1) Experience during the therapy (enhanced well-being and escapism), (2) beyond the complementary therapy session (lasting benefits and overall evaluation), and (3) delivery of complementary therapy in palliative care (value of the therapist and delivery of the complementary therapy).

CONCLUSIONS

People with advanced cancer experience benefits from aromatherapy, reflexology and massage including enhanced well-being, respite, and escapism from their disease. Complementary therapy interventions should be developed in consultation with the target population to ensure they are delivered and evaluated, where feasible, as they wish.

What do patients and family-caregivers value from hospice care? A systematic mixed studies review

BACKGROUND

It is not known which attributes of care are valued the most by those who experience hospice services. Such knowledge is integral to service development as it facilitates opportunities for continuous improvement of hospice care provision. The objectives of this mixed-studies systematic review were to explore patients' and their family carer views and experiences, to determine what they valued about adult hospice care in the UK.

METHODS

ASSIA, PubMed, CINAHL and PsycINFO were searched from inception, up until March 2017 to identify qualitative, quantitative, and mixed-methods studies. Four additional searching techniques supplemented the main search and grey literature was included. A three-stage mixed-method systematic review was conducted with a sequential exploratory design. Thematic synthesis was used with qualitative data, followed by a narrative summary of the quantitative data. The qualitative and quantitative syntheses were then juxtaposed within a matrix to produce an overarching synthesis.

RESULTS

Thirty-four studies highlighted that what patients and carers valued was generally context specific and stemmed from an amalgamation of hospice service components, which both individually and collectively contributed to improvements in quality of life. When the syntheses of qualitative and quantitative studies were viewed in isolation, the value placed on services remained relatively consistent, with some discrepancies evident in service availability. These were commonly associated with geographical variations, as well as differences in service models and timeframes. Through an overarching synthesis of the qualitative and quantitative evidence, however, notable variations and a more nuanced account of what people valued and why were more prominent, specifically in relation to a lack of social support for carers, disparate access to essential services, the underrepresentation of patients with a non-cancer diagnosis, and the dissatisfaction with the range of services provided.

CONCLUSION

Review findings strengthen the existing evidence base and illuminates the underpinning elements of hospice care most valued by patients and their families. With large disparities in the availability of services, however, the underrepresentation of patients with non-malignant diseases and the limited evidence base demonstrating the adequate addressment of the social needs of carers, there continues to be considerable gaps that warrants further research.

Fasciatherapy and Reflexology compared to Hypnosis and Music Therapy in Daily Stress Management

BACKGROUND

Patients suffering from stress symptoms due to every-day life who are looking for a non-pharmacological response to their relief expectation are many. Furthermore, early reckoning of the day-to-day stress which may lead to clinical diagnosis is the best way of preventing the stress-related diseases. Among the many alternative medicinal options, there is little evidence that fasciatherapy (Fs) and reflexology (Rf) are effective in this field.

PURPOSE

assess incidence of fasciatherapy Danis Bois Method (DBM) and of reflexology on patients' stress level in everyday-life, and provide a more informed choice among the numerous mind and body techniques by comparing them with hypnosis (Hp) and music therapy (Mt).

SETTINGS

Specialized Complementary and Alternative Medicine (CAM) centres for outpatients.

PARTICIPANTS

308 individuals (average age = 50.53 SD 14.37, 93 males, 215 females) going to the centres for health care, but free from serious diseases and not heavily medicated respecting the inclusion criteria and providing valid forms.

RESEARCH DESIGN

Four armed, non-randomized observational pragmatic trial with pretest-posttest repeated measures, on separate samples of natural groups.

INTERVENTION

According to the centre participants where they used to be treated, they were exposed to a single semi-standardized session of a technique of their choice: Fs, Rf, Hp, Mt. Volunteers had a controlled non-intervention resting (Rt) session.

MAIN OUTCOME MEASURES

Mean STAI-Y assessing anxiety as reflecting the stress level: MANCOVA and ANCOVA performed with Tukey's HSD.

RESULTS

MANCOVA indicates a significant reduction of anxiety (p < .01) in each condition, resting included. ANCOVA performance adjusting on stress level in T0 (41.73) and on the mean sumscore of the trait (44.89), Fs (-13.92), Rf (-15.92), and Hp (-15.88) were equally effective on the stress level decrease. Mt (-10.0) and Rt (-6.38) showed the same level of effectiveness.

CONCLUSIONS

The results suggest fasciatherapy DBM, hypnosis, and reflexology could be used as non-pharmacological and safe interventions in stress management. Though showing a lesser efficiency, music therapy could be useful in different circumstances.

Perspectives on reflexology: A qualitative approach

INTRODUCTION

Reflexology is the systematic practice of applying some pressure to particular points on the feet and hands to impact on health of related parts of the body.

OBJECTIVE

To explore the practitioners' perspectives of reflexology in Malaysia.

METHODS

Data was collected using face-to-face semi-structured interviews with practitioners in Malaysia. The interviews were conducted in the Malay language and recorded. Interview conversations were translated and transcribed verbatim. Responses relating to different themes were identified in each of the interviews and a coding frame was developed. For each theme, the relevant data enabled a description of the range of views and experiences. Data collection and analysis were conducted concurrently and recruitment was stopped when saturation had been reached. All respondents gave written consent for their participation.

RESULTS

The findings show that reflexology treatment nowadays has been accepted as one of the ways to maintain general health. Practitioners believe that reflexology is able to detect some problems in to the body, which can make patients aware of a health condition and seek further treatment. However, if reflexology is not performed correctly, it may cause negative effects such as pain and bruises. Some practitioners voiced concern that illegal activities are taking place in unethical reflexology centers.

CONCLUSIONS

Empowering the practitioner as a professional would help gain the public's trust and confidence in their treatment. Strict enforcement of regulation related to illegal conduct in reflexology centers will improve people's perception of the practice.

Revisiting reflexology: Concept, evidence, current practice, and practitioner training

Reflexology is basically a study of how one part of the human body relates to another part of the body. Reflexology practitioners rely on the reflexes map of the feet and hands to all the internal organs and other human body parts. They believe that by applying the appropriate pressure and massage certain spots on the feet and hands, all other body parts could be energized and rejuvenated. This review aimed to revisit the concept of reflexology and examine its effectiveness, practices, and the training for reflexology practitioners. PubMed, SCOPUS, Google Scholar, and SpringerLink databases were utilized to search the following medical subject headings or keywords: foot massage, reflexology, foot reflexotherapy, reflexological treatment, and zone therapy. The articles published for the last 10 years were included. Previous systematic reviews failed to show concrete evidence for any specific effect of reflexology in any conditions. Due to its non-invasive, non-pharmacological complementary nature, reflexology is widely accepted and anecdotal evidence of positive effect reflexology in a variety of health conditions are available. Adequate training for practitioners is necessary to ensure the consistency of service provided.

Reflexology: its effects on physiological anxiety signs and sedation needs

To investigate whether reflexology has an effect on the physiological signs of anxiety and level of sedation in patients receiving mechanically ventilated support, a single blinded, randomized controlled design with repeated measures was used in the intensive care unit of a university hospital in Turkey. Patients (n = 60) aged between 18 and 70 years and were hospitalized in the intensive care unit and receiving mechanically ventilated support. Participants were randomized to a control group or an intervention group. The latter received 30 minutes of reflexology therapy on their feet, hands, and ears for 5 days. Subjects had vital signs taken immediately before the intervention and at the 10th, 20th, and 30th minutes of the intervention. In the collection of the data, "American Association of Critical-Care Nurses Sedation Assessment Scale" was used. The reflexology therapy group had a significantly lower heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate than the control group. A statistically significant difference was found between the averages of the scores that the patients included in the experimental and control groups received from the agitation, anxiety, sleep, and patient-ventilator synchrony subscales of the American Association of Critical-Care Nurses Sedation Assessment Scale. Reflexology can serve as an effective method of decreasing the physiological signs of anxiety and the required level of sedation in patients receiving mechanically ventilated support. Nurses who have appropriate training and certification may include reflexology in routine care to reduce the physiological signs of anxiety of patients receiving mechanical ventilation.

Positive patient experiences in an Australian integrative oncology centre

Background

The purpose of this study was to explore the experiences of cancer patients’ utilising complementary and integrative therapies (CIT) within integrative oncology centres across Western Australia.

Methods

Across four locations 135 patients accessed CIT services whilst undergoing outpatient medical treatment for cancer. Of the 135 patients, 66 (61 ± 12 y; female n = 45; male n = 21) agreed to complete a personal accounts questionnaire consisting of open-ended questions designed to explore patients’ perceptions of CIT. All results were transcribed into nVivo (v9) and using thematic analysis, key themes were identified.

Results

Of the 66 participants, 100% indicated they would “recommend complementary therapies to other patients” and 92% stated “CIT would play a significant role in their future lifestyle”. A mean score of 8 ± 1 indicated an improvement in participants’ perception of wellbeing following a CIT session. Three central themes were identified: empowerment, support and relaxation. Fourteen sub-themes were identified, with all themes clustered into a framework of multifaceted views held by cancer patients in relation to wellbeing, role of significant others and control.

Conclusions

Exploration of patients’ experiences reveals uniformly positive results. One of the key merits of the environment created within the centres is patients are able to work through their cancer journey with an increased sense of empowerment, without placing them in opposition to conventional medical treatment. In order to effectively target integrative support services it is crucial to explore the experiences of patients in their own words and use those forms of expression to drive service delivery.

Complementary therapy: perceptions of older people with lung or colorectal cancer

AIM

To explore how older people with lung and colorectal cancer view registered complementary therapy (CT) services in Northern Ireland.

BACKGROUND

A literature review highlighted gaps around information, access, and communication between patients and health professionals regarding CT services.

METHODS

Using structured interviews, a survey of 68 patients in one hospital and one hospice was conducted in Belfast, Northern Ireland.

RESULTS

All respondents felt that CT services should be better promoted and more easily accessible to older people with cancer. Some patients were concerned about the lack of written information provided regarding CT services, which they believed led to poorer uptake and uncertainty regarding the potential benefits. Others were concerned that engaging in or disclosing CT usage might negatively affect existing relationships with medical professionals.

CONCLUSION

Patients should be offered high quality written information on CT services to enable choice, improve knowledge, and promote wider access. Increased physician education may facilitate provision of such information.

A Survey of the Use of Complementary and Alternative Medicine in Illinois Hospice and Palliative Care Organizations

This research assesses complementary and alternative medicine (CAM) use and administration for patients and family caregivers in Illinois hospice and palliative care organizations. An online survey was administered to a sample of 108 contacts of Illinois organizations listed in the National Hospice and Palliative Care Organization website, and 90.3% of the responding organizations offered some type of CAM. The top 5 most frequently offered CAM modalities to patients were pet therapy (64.5%), music therapy (61.3%), massage therapy (54.8%), art therapy (29.0%), and energy therapies (25.8%); these were the same top 5 offered to families but with different frequencies. Findings regarding utilization, administration, financing, and spiritual/cultural competency are discussed with policy recommendations for data collection, administrative improvements, and integration of CAM providers into service delivery.

Facilitating nurses’ knowledge of the utilisation of reflexology in adults with chronic diseases to enable informed health education during comprehensive nursing care

An integrative literature review of identified scientific evidence, published from January 2000 to December 2008, of the utilisation of reflexology as complementary and alternative medicine (CAM) modalities to promote well-being and quality of life in adults with chronic diseases was done to facilitate nurses to give informed health education during comprehensive nursing care to patients with chronic diseases. Selected accessible databases were searched purposefully for research articles (N = 1171). Pre-set inclusion criteria were applied during the study selection process. The methodological study quality was reviewed and appraised with appropriate tools from the Critical Appraisal Skills Programme (CASP) and the American Dietetic Association’s (ADA) Evidence analysis manual (n = 21). Evidence extraction, analysis and synthesis of studies (n = 18) were done through the evidence class rating and level of strength as prescribed in the manuals of ADA and CASP. Findings indicate statistically significant reduction in the frequency of seizures in patients with intractable epilepsy, an improvement of sensory and urinary symptoms associated with multiple sclerosis and clinically significant reduction of anxiety and pain in patients with cancer and fibromyalgia syndrome. These findings can be utilised by nurses to inform patients with these chronic diseases about alternative ways of treatment. Opsomming‘n Geïntegreerde literatuur oorsig van ge-identifiseerde wetenskaplike bewyse, gepubliseer vanaf Januarie 2000 tot Desember 2008, was gedoen oor die gebruik van refleksologie as aanvullende en alternatiewe behandelingsmodalitieit om welsyn en lewenskwaliteit te bevorder by volwassenes met kroniese siekte om verpleegkundiges te fasiliteer om ingeligte gesondheidsvoorligting te gee gedurende omvattende verpleegsorg aan pasiente met kroniese siektes. Geselekteerde toeganklike databasisse was doelbewustelik deursoek vir navorsingsartikels (N = 1171). Vooraf bepaalde insluitingskriteria was toegepas tydens die selekteringsproses. Die studie gehalte is nagegaan en beoordeel met toepaslike instrumente van die Critical Appraisal Skills Programme (CASP) en die American Dietetic Association (ADA) se Evidence analysis manual (n = 21). Bewys uitreksel, analisering en sintese van studies (n = 18) was gedoen deur die bewysklas gradering en vlak van bewysterkte soos beskryf in die handleidings van ADA en CASP. Bevindings dui op ‘n statisitese beduidenisvolle verlaging in die frekwensie van konvulsies by pasiënte met epilepsie, ‘n verbetering van sensoriese en urinêre simptome ge-assosieer met veelvuldige sklerose en ‘n kliniese beduidenisvolle afname in angstigheid en pyn by pasiënte met kanker en fibromialgiese sindroom. Hierdie bevindings kan deur verpleegkundiges gebruik word om pasiente met hierdie kroniese siektes in te lig omtrent alternatiewe maniere van behandeling.

The outcomes of palliative care day services: a systematic review

This systematic review evaluates the evidence underpinning the provision of palliative day care services (PDS) to determine whether such services have a measurable effect on attendees' wellbeing. The majority of studies reviewed were qualitative and elicited individual perceptions of the benefits PDS. Although it was difficult to determine the quality of many studies, it would appear that attendance at PDS had a positive impact on attendees' quality of life. Fewer studies utilized validated outcome measures to determine the effect of PDS on attendees' wellbeing and small sample sizes combined with high attrition rates influenced the significance of some the results. However little quantitative evidence was offered to prove that PDS had an impact on attendees' quality of life or wellbeing. The review concludes that dying people find attending PDS a valuable experience that allows them to engage with others and to be supported in a restorative environment. However, further well-powered empirical studies are required to provide quality evidence to determine whether or not attendance at PDS does indeed have a positive impact on the wellbeing of attendees.

The experience of using complementary therapies after a diagnosis of cancer: a qualitative synthesis

This article describes a qualitative synthesis of published research on cancer patients' experiences of complementary therapies. We conducted a systematic search for qualitative studies on this subject published between 1998 and 2007. Twenty-six refereed journal articles met the inclusion criteria. These 26 articles were repeatedly read by the research team and key concepts emerging from them were identified. Differences and variations were examined in association with treatment, therapy type and by stage of cancer (early stage, mid-treatment, advanced cancer, palliative care and long term 'survivors'). Six overarching concepts were located, which describe the key aspects of patients' experiences of the use of complementary and alternative medicine after a diagnosis of cancer: Connection; Control; Well-being; Transformation; Integration; and Polarization. These are described in a 'line of argument' synthesis, and differences associated with treatment type and stage of disease are noted. The findings are presented in a table showing the six concepts according to treatment type and stage; as a composite story; and in a diagrammatic model showing the individual, practitioner and organizational levels. The synthesis identified various specific ways in which complementary therapies supported cancer patients, as well as occasional negative effects. The most notable barrier was the perceived polarization of complementary therapies and biomedicine; patients reported better experiences in integrated settings.

The conjoint use of music therapy and reflexology with hospitalized advanced stage cancer patients and their families

Advanced stage cancer patients experience debilitating physical symptoms as well as profound emotional and spiritual struggles. Advanced disease is accompanied by multiple changes and losses for the patient and the family. Palliative care focuses on the relief of overall suffering of patients and families, including symptom control, psychosocial support, and the meeting of spiritual needs. Music therapy and reflexology are complementary therapies that can soothe and provide comfort. When used conjointly, they provide a multifaceted experience that can aid in the reduction of anxiety, pain, and isolation; facilitate communication between patients, family members, and staff; and provide the potential for a more peaceful dying experience for all involved. This article addresses the benefits of the combined use of music therapy and reflexology. Two case studies are presented to illustrate the application and benefits of this dual approach for patients and their families regarding adjustment to the end of life in the presence of anxiety and cognitive impairment.

Does the experimental design capture the effects of complementary therapy? A study using reflexology for patients undergoing coronary artery bypass graft surgery

AIM

Our purpose was to pilot test whether reflexology may reduce anxiety in patients undergoing Coronary Artery Bypass Graft Surgery in Iceland.

BACKGROUND

Nurses need to study the effects of complementary therapies in general and particularly those that may be beneficial to decrease patients' anxiety. It has been assumed that reflexology lessens anxiety, but research is needed to substantiate such expectations.

DESIGN

A pilot study using randomized design with experimental and control groups.

METHODS

Nine patients were recruited and randomly assigned into groups with five patients assigned into an experimental group receiving reflexology for 30 minutes and four patients into control group which rested for 30 minutes. Anxiety and physiological variables were measured pre- and post-reflexology sessions once a day over five days.

RESULTS

The anxiety scores were lower for patients in the control group on all measures. Systolic blood pressure lowered significantly more in the control group than in the treatment group. No significant changes were observed for other variables. Patients' comments and responses overwhelmingly suggested increased well-being due to both experimental and control intervention.

CONCLUSION

This study showed little evidence to support reflexology as a mean of reducing anxiety in CABG patients. Several methodological problems were identified that need to be considered further.

RELEVANCE TO CLINICAL PRACTICE

It is suggested that reflexology should be tailored to individual needs and research methods used that allow for capturing its holistic nature. Further scholarly work is warranted to explore several methodological issues in studying complementary therapies in a highly complex treatment situation.

CAM and cancer care: champions for integration

The paper reviews challenges and developments in the integration of complementary therapies in cancer care. These issues are examined by reflecting on papers published in CTNM in the last 10 years by champions of CAM in cancer care. Given the aim of the journal to encourage an inclusive readership, multidisciplinary and user perspectives are included. The paper argues for better information, improved service provision and CAM choices in public healthcare, leadership support, funded research and audit, and user and non-users views.

Multicomponent psychosocial support for newly diagnosed cancer patients: participants’ views

The diagnosis and treatment of cancer carries a heavy psychological burden, particularly in the first year after diagnosis. The purpose of this study was to investigate and report qualitatively on patients who had completed a 10-session programme consisting of education, social interaction, psychological support, exercise and complementary therapies for newly diagnosed cancer patients. A thematic analysis of data obtained from purposefully selected focus groups revealed that peer support was the most highly valued aspect of the service and that a variety of needs were being met. The relaxed atmosphere, sensitivity of staff and complementary therapies were particularly appreciated. The findings also indicated that patients would like the option of diversional activities and a period of structured group therapy in addition to the services offered and that the revision of information-giving procedures would enhance psychological support. Opportunities for staff development are identified.