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Goel AR, Henderson CR, Reid MC. Do Palliative Care Providers Use Complementary and Integrative Medicine? A Nationwide Survey. J Pain Symptom Manage 2022; 63:599-609. [PMID: 34788656 PMCID: PMC9121789 DOI: 10.1016/j.jpainsymman.2021.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 11/20/2022]
Abstract
CONTEXT Given the high prevalence of burdensome symptoms in palliative care (PC) and increasing use of complementary and integrative medicine (CIM) therapies, research is needed to determine how often and what types of CIM therapies providers recommend to manage symptoms in PC. OBJECTIVES To document recommendation rates of CIM for target symptoms and assess if, CIM use varies by provider characteristics. METHODS Nationwide survey's of physicians (MD and DO), physician assistants, and nurse practitioners in PC. RESULTS Participants (N = 404) were mostly female (71.3%), physicians (74.9%), and cared for adults (90.4%). Providers recommended CIM an average of 6.82 times per-month (95% CI: 6.04-7.60) and used an average of 5.13 (95% CI: 4.90-5.36) out of 10 CIM modalities. Respondents recommended mind-body medicines (e.g., meditation, biofeedback) most, followed by massage, and acupuncture and/or acupressure. The most targeted symptoms included pain; followed by anxiety, mood disturbance, and distress. Recommendation frequencies for specific modality-for-symptom combinations ranged from little use (e.g., aromatherapy for constipation) to occasional use (e.g., mind-body interventions for psychiatric symptoms). Finally, recommendation rates increased as a function of pediatric practice, noninpatient practice setting, provider age, and proportion of effort spent delivering palliative care. CONCLUSION To the best of our knowledge, this is the first national survey to characterize PC providers' CIM recommendation behaviors and assess specific therapies and common target symptoms. Providers recommended a broad range of CIM but do so less frequently than patients report using CIM. These findings should be of interest to any provider caring for patients with serious illness.
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Affiliation(s)
- Anurag Ratan Goel
- Departments of Medicine and Pediatrics (A.R.G.), Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Charles R Henderson
- Department of Human Development (C.R.H.), Cornell University, Ithaca, New York, USA
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Havyer RD, Lapid MI, Dockter TJ, McCue SA, Stelpflug AJ, Bigelow ML, Robsahm MM, Elwood T, Strand JJ, Bauer BA, Cutshall SM, Sloan JA, Walton MP, Whitford KJ. Impact of Massage Therapy on the Quality of Life of Hospice Patients and Their Caregivers: A Pilot Study. J Palliat Care 2020; 37:41-47. [PMID: 33213233 DOI: 10.1177/0825859720975991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Evidence for massage therapy (MT) in hospice patients remains limited. We conducted a prospective pilot study on MTs impact on quality of life of hospice patients and caregivers. Patient-caregiver dyads were enrolled if patients scored ≥5 on pain, depression, anxiety, or well-being using the revised Edmonton Symptom Assessment System Revised (ESAS-r). The patient received MT weekly for up to 3 massages with assessments completed at baseline, after each massage, and 1 week after the final massage for patients and at baseline and 1 week after final massage for caregivers. A satisfaction survey was completed at study completion. A pro-rated area under the curve (AUC) was utilized to assess the primary endpoints of change in ESAS-r for patient ratings of pain, depression and anxiety as well as the Linear Analogue Self-Assessment (LASA). Median difference scores (end of study value)-(baseline value) for each participant and caregiver were calculated. Of 27 patients and caregivers enrolled, 25 patients received MT. Fifteen patients completed all 3 MT sessions and were given the final symptom assessment and satisfaction survey and their caregivers completed final assessments. The proportion of patients considered success (AUC > baseline) in the primary endpoints were the following: pain 40.9%, depression 40.9%, anxiety 54.5%, LASA 54.5%. Median difference scores were largely zero indicating no significant temporal change in symptoms. Patients were highly satisfied with MT. This pilot study indicated that MT was a feasible and well-received intervention in our population of patients with inadequately controlled symptoms.
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Affiliation(s)
- Rachel D Havyer
- Mayo Clinic Center for Palliative Medicine, 195110Mayo Clinic, Rochester, MN, USA.,Division of Community Internal Medicine, Department of Medicine, 384842Mayo Clinic, Rochester, MN, USA
| | - Maria I Lapid
- Mayo Clinic Center for Palliative Medicine, 195110Mayo Clinic, Rochester, MN, USA.,Mayo Clinic Hospice, 384842Mayo Clinic, Rochester, MN, USA.,Department of Psychiatry and Psychology, 384842Mayo Clinic, Rochester, MN, USA
| | - Travis J Dockter
- Biomedical Statistics and Informatics, 384842Mayo Clinic, Rochester, MN, USA
| | - Shaylene A McCue
- Biomedical Statistics and Informatics, 384842Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Theresa Elwood
- Mayo Clinic Hospice, 384842Mayo Clinic, Rochester, MN, USA
| | - Jacob J Strand
- Mayo Clinic Center for Palliative Medicine, 195110Mayo Clinic, Rochester, MN, USA.,Mayo Clinic Hospice, 384842Mayo Clinic, Rochester, MN, USA
| | - Brent A Bauer
- Division of Integrative Medicine & Health, Department of Medicine, 384842Mayo Clinic, Rochester, MN, USA
| | - Susanne M Cutshall
- Division of Integrative Medicine & Health, Department of Medicine, 384842Mayo Clinic, Rochester, MN, USA
| | - Jeff A Sloan
- Biomedical Statistics and Informatics, 384842Mayo Clinic, Rochester, MN, USA
| | - Monica P Walton
- Department of Psychiatry and Psychology, 384842Mayo Clinic, Rochester, MN, USA
| | - Kevin J Whitford
- Mayo Clinic Center for Palliative Medicine, 195110Mayo Clinic, Rochester, MN, USA.,Mayo Clinic Hospice, 384842Mayo Clinic, Rochester, MN, USA.,Division of Hospital Internal Medicine, Department of Medicine, 384842Mayo Clinic, Rochester, MN, USA
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Arentz S, Hunter J, Deed G. Integrating Traditional and Complementary Medicine Recommendations into Clinical Practice Guidelines for People with Diabetes in Need of Palliative and End-of-Life Care: A Scoping Review. J Altern Complement Med 2020; 26:571-591. [PMID: 32673080 DOI: 10.1089/acm.2020.0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objectives: This study was conducted before an evidence review on Traditional and Complementary Medicine (TCM) to update the clinical practice guidelines (CPGs): "Deciding palliative and end-of-life (P/EoL) care for people with diabetes." The aim was to frame the PICO (population/problems, interventions/comparisons, and outcomes), ascertain their importance, and identify other modifying factors for grading recommendations. Design: A systematic scoping review mapped information about diabetes P/EoL problems and outcomes, TCM use, provision, benefits and risks, and stakeholder preferences and values. Thirteen electronic databases were searched in 2017/18 until no new information was identified. Relevant data were extracted, rated for quality, directness, and relevance, and synthesized using triangulation methods. Excluded was diabetes prevention or treatment, as this is not an important P/EoL problem. Results: Of the 228 included articles, except for diabetes P/EoL problems, insufficient direct evidence led to data being extrapolated from either adults with diabetes or any P/EoL diagnosis. The findings affirmed that caring for people with diabetes in need of P/EoL care is complex due to multiple fluctuating needs that are influenced by the P/EoL trajectories (stable, unstable, deteriorating, terminal, or bereaved), multimorbidity, and difficult-to-manage chronic and acute problems. The only problem specific to diabetes P/EoL care, was unstable glycemia. Over 50 TCM interventions commonly used by patients and/or provided by services were identified, of which, many might simultaneously address multiple problems and 18 had been appraised in systematic reviews. Physical and psychologic symptom reliefs were most often evaluated; however, these were only one aspect of a "good death." Other important outcomes were the quality and location of care, personal agency, relationships, preparations for the dying process, spirituality, and affirmation of the whole person. Other important modifying factors included opportunity costs, affordability, availability, preferences, cultural appropriateness, and alignment with beliefs about the meaning of illness and death. Conclusions: There is a role for TCM in the multidisciplinary holistic P/EoL care of people with diabetes. Due to the paucity of evidence specific to this population, the generalizability of some of these results is broader and the updated CPG will also need to consider indirect evidence from other patient groups. Along with recommendations about indications for TCM use, the CGP should provide guidance on ceasing unnecessary interventions, reducing polypharmacy and managing unstable glycemia is required. Before ceasing a TCM, a broader risk-benefit analysis is recommended, as unlike many conventional therapies, there may be multiple benefits warranting its continuation.
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Affiliation(s)
- Susan Arentz
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Jennifer Hunter
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Gary Deed
- Metabolism Ageing Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Harte J, Leahy H, McCarthy J, O'Brien T. Exploring patients' interest in complementary therapies in a specialist palliative care unit. Int J Palliat Nurs 2019; 25:108-110. [PMID: 30892993 DOI: 10.12968/ijpn.2019.25.3.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND: The use of complementary therapy has become increasingly integrated into specialist palliative care units (SPCUs). OBJECTIVE: To evaluate patients' interest in and experience of complementary therapies during their inpatient stay in a SPCU. METHOD: All 179 patients admitted to the SPCU over a 3-month period were assessed on admission. Those deemed suitable to participate by the researcher/clinical nurse specialist were invited to participate in this research. A standardised paper questionnaire was completed by the participating patients. RESULTS: 71 patients (40%) completed the study. Those excluded had cognitive impairment, fatigue, communication difficulties or were imminently dying. Some declined to participate. A variety of age groups and diagnoses were represented. Only 27% of participants had a previous experience of using complementary therapies in the past 12 months. The majority (52%) were 'very interested' in receiving complementary therapy, while 13% reported having 'no interest'. Massage and reflexology were identified as the most popular forms of complementary therapy. The primary anticipated benefits associated with complementary therapy were relaxation and improvement in general wellbeing. CONCLUSION: This research has indicated a high level of interest in complementary therapies in the study population, across a wide age range regardless of diagnosis or level of disease.
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Affiliation(s)
- Joanne Harte
- Staff Nurse, Marymount University Hospital and Hospice, Cork, Ireland
| | - Helen Leahy
- Clinical Nurse Specialist in Palliative Care, Marymount University Hospital and Hospice, Curraheen, Co Cork, Ireland
| | - Jill McCarthy
- Clinical Nurse Specialist in Palliative Care, Marymount University, Hospital and Hospice, Curraheen, Co Cork, Ireland
| | - Tony O'Brien
- Consultant Physician in Palliative Medicine, Marymount University Hospital and Hospice, Curraheen, Co Cork, Ireland
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McPhail P, Sandhu H, Dale J, Stewart-Brown S. Acupuncture in hospice settings: A qualitative exploration of patients' experiences. Eur J Cancer Care (Engl) 2018; 27:e12802. [PMID: 29323766 DOI: 10.1111/ecc.12802] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 11/28/2022]
Abstract
Whilst acupuncture has the potential to impact on many aspects of health and well-being, including end-of-life care, there is little research regarding patients' experiences of its effects within the context of palliative care in hospice settings. The aim of this study was to address this gap, by exploring patients' experiences of acupuncture within this setting. In-depth, semi-structured interviews were conducted with a sample of eighteen patients who had received acupuncture as part of hospice care. Transcription of data, with thematic analysis, identified two overarching themes: (1) participant perceptions of the effects of acupuncture including pain control, improved physical and emotional health, spiritual well-being and awareness of health as a holistic phenomenon; and (2) factors which participants believed enabled acupuncture to have these effects including the quality of the practitioner relationship, engagement of participants in the process of their treatment and prior expectations that acupuncture could work. Acupuncture was found to be a highly acceptable, accessible and popular treatment with positive holistic effects reported across the domains of physical, mental and spiritual health and no serious adverse effects. By enabling awareness of the holistic nature of health and well-being, acupuncture was experienced as having the potential to contribute to a better death, an emergent theory that needs testing in further studies. In the meanwhile, the results of this study offer encouragement to hospices currently providing or considering investing in acupuncture provision.
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Affiliation(s)
- P McPhail
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - H Sandhu
- Division of Health Sciences, Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - J Dale
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - S Stewart-Brown
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Dain AS, Bradley EH, Hurzeler R, Aldridge MD. Massage, Music, and Art Therapy in Hospice: Results of a National Survey. J Pain Symptom Manage 2015; 49:1035-41. [PMID: 25555445 PMCID: PMC4480160 DOI: 10.1016/j.jpainsymman.2014.11.295] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 11/19/2014] [Accepted: 11/22/2014] [Indexed: 10/24/2022]
Abstract
CONTEXT Complementary and alternative medicine (CAM) provides clinical benefits to hospice patients, including decreased pain and improved quality of life. Yet little is known about the extent to which U.S. hospices employ CAM therapists. OBJECTIVES To report the most recent national data regarding the inclusion of art, massage, and music therapists on hospice interdisciplinary teams and how CAM therapist staffing varies by hospice characteristics. METHODS A national cross-sectional survey of a random sample of hospices (n = 591; 84% response rate) from September 2008 to November 2009. RESULTS Twenty-nine percent of hospices (169 of 591) reported employing an art, massage, or music therapist. Of those hospices, 74% employed a massage therapist, 53% a music therapist, and 22% an art therapist, and 42% expected the therapist to attend interdisciplinary staff meetings, indicating a significant role for these therapists on the patient's care team. In adjusted analyses, larger hospices compared with smaller hospices had significantly higher odds of employing a CAM therapist (adjusted odds ratio 6.38; 95% CI 3.40, 11.99) and for-profit hospices had lower odds of employing a CAM therapist compared with nonprofit hospices (adjusted odds ratio 0.52; 95% CI 0.32, 0.85). Forty-four percent of hospices in the Mountain/Pacific region reported employing a CAM therapist vs. 17% in the South Central region. CONCLUSION Less than one-third of U.S. hospices employ art, massage, or music therapists despite the benefits these services may provide to patients and families. A higher proportion of large hospices, nonprofit hospices, and hospices in the Mountain/Pacific region employ CAM therapists, indicating differential access to these important services.
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Affiliation(s)
- Aleksandra S Dain
- Icahn School of Medicine at Mount Sinai, New York, New York, USA; James J. Peters VA, Bronx, New York, USA
| | - Elizabeth H Bradley
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Rosemary Hurzeler
- The John D. Thompson Hospice Institute for Education, Training, and Research, Inc., Branford, Connecticut, USA
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