Current Status of Complementary Therapies Provided by Hospice Palliative Care in South Korea

Purpose

The aim of this study was to investigatecomplementary therapiesprovided at hospice palliative care facilities in South Koreaas designated by the Ministry of Health and Welfare.

Methods

The survey was conducted via e-mail from September 2 to September 23, 2020, with responsesfrom 109 therapists and 59 managers from 55 different hospice care facilities.

Results

Hospices provided an average of 3.67 different types of therapies, ranging from 1 to 7 different types. The most common types of therapies were horticultural therapy (81.4%), music therapy (79.7%), art therapy (76.3%), and aromatherapy (57.6%). The average frequency of sessions was once a week, the median duration was 60 minutes. Most therapists (96.3%) had qualifications, but the certification-issuing organizations and training intensiveness varied greatly. None of the therapists were employed on a full-time basis, and their average monthly income was KRW 270,000. Therapists and managers gave average scores of 8.90 and 8.38 out of 10, respectively, regarding the positive impact of complementary therapies on patients.

Conclusion

In order for patients and their families to benefit from complementary therapiesat hospice care facilities, in addition tobetter terms of employment for therapists, evidence-based guidelines for different types of therapies are needed so that therapy sessions can be conducted according to the theoretical underpinnings and characteristics of the type of therapy. It is expected that the results of this study will be used for policy-making in support of therapy as an essential hospice service.

Evidence-Based Management of Depression in Palliative Care: A Systematic Review

Depression can be quite common in the palliative care population. The estimated prevalence ranges from 24% to 70%. Depression in this population leads to a decreased quality of life and may lead to a desire for an earlier death. We conducted a systematic review to establish a better understanding of the available treatment interventions, both pharmacological and nonpharmacological specific to the palliative population. PubMed, PsycINFO, and CINAHL databases were searched using the MeSH terms: Palliative Care, Palliative Medicine, Terminal Illness, End of Life Care, and Depression or Depressive Disorder, as well as the keywords palliative care, care palliative, and depression. We considered all published peer-reviewed articles written in English and pertaining to humans. Articles were hand searched from citations. The Mixed Methods Appraisal Tool was used for study quality appraisal. Thirty-nine eligible articles were found; 29 articles examined nonpharmacological options, while 10 focused on pharmacological options. The 29 articles discussing nonpharmacological methods discussed 22 interventions. Of the 22 interventions, 10 showed therapeutic benefit. Of the 10 studies focusing on pharmacological interventions, seven showed therapeutic benefit. This is the first systematic review that examined both nonpharmacological and pharmacological methods to treat depression in the palliative setting. There is evidence to indicate that methylphenidate and antidepressants can provide a therapeutic benefit for palliative care patients with depressive symptoms. This benefit may be enhanced when these medications are used in combination. The use of music therapy or future-focused psychotherapy may also be beneficial in the treatment of depression.

Use of non-pharmacological interventions for comforting patients in palliative care: a scoping review

BACKGROUND

Palliative care aims to provide the maximum possible comfort to people with advanced and incurable diseases. The use of non-pharmacological interventions to promote comfort in palliative care settings has been increasing.However, information on implemented and evaluated interventions, their characteristics, contexts of application, and population is scattered in the literature, hampering the formulation of accurate questions on the effectiveness of those interventions and, consequently, the development of a systematic review.

OBJECTIVE

The objective of this scoping review is to examine and map the non-pharmacological interventions implemented and evaluated to provide comfort in palliative care.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

This scoping review considered all studies that focused on patients with advanced and incurable diseases, aged 18 years or older, assisted by palliative care teams.

CONCEPT

This scoping review considered all studies that addressed non-pharmacological interventions implemented and evaluated to provide comfort for patients with advanced and incurable diseases.It considered non-pharmacological interventions implemented to provide not only comfort but also well-being, and relief of pain, suffering, anxiety, depression, stress and fatigue which are comfort-related concepts.

CONTEXT

This scoping review considered all non-pharmacological interventions implemented and evaluated in the context of palliative care. This included home care, hospices or palliative care units (PCUs).

TYPES OF SOURCES

This scoping review considered quantitative and qualitative studies, and systematic reviews.

SEARCH STRATEGY

A three-step search strategy was undertaken: 1) an initial limited search of CINAHL and MEDLINE; 2) an extensive search using all identified keywords and index terms across all included databases; and 3) a hand search of the reference lists of included articles.This review was limited to studies published in English, Spanish and Portuguese in any year.

EXTRACTION OF RESULTS

A data extraction instrument was developed. Two reviewers extracted data independently. Any disagreements that arose between the reviewers were resolved through discussion, or with a third reviewer. When necessary, primary authors were contacted for further information/clarification of data.

PRESENTATION OF RESULTS

Eighteen studies were included covering 10 non-pharmacological interventions implemented and evaluated to provide comfort. The interventions included one to 14 sessions. The interventions lasted between five and 60 minutes. Most of the interventions were implemented in PCUs and hospice settings. Ten of the 18 interventions were implemented and evaluated exclusively in cancer patients.

CONCLUSIONS

Ten non-pharmacological interventions were identified, of which the most common were music therapy and massage therapy. Their characteristics differed significantly across interventions and even in the same intervention. They were mostly implemented in palliative care units and hospices, and in patients with a cancer diagnosis. These data raise questions for future primary studies and systematic reviews.

IMPLICATIONS FOR RESEARCH

Future research should focus on the implementation of interventions not only with cancer patients but also with non-cancer patients and patients receiving palliative care at home. Systematic reviews on the effect of massage therapy and music therapy should be conducted.

'Worried to death': the assessment and management of anxiety in patients with advanced life-limiting disease, a national survey of palliative medicine physicians

Background

Anxiety adversely affects quality of life and is common in adults with advanced life-limiting disease. There are no UK-wide guidelines on the assessment and management of anxiety in this specific population and there is little evidence regarding drug treatments. This study aimed to explore how palliative care physicians assess and manage anxiety in their patients, and to identify barriers encountered.

Methods

A cross-sectional survey was undertaken of all physicians working in specialist palliative care in the UK who were members of the Association for Palliative Medicine. This was conducted in February 2014 using an online questionnaire.

Results

The response rate was 23% (230/980) and 61% of respondents were consultants. Most did not use tools to screen for anxiety (87%) and almost all used the clinical interview to diagnose anxiety (99%). Only 8% used psychiatric criteria. Most physicians reported difficulties managing anxiety (93%). Only 33% thought they had adequate training in this area. Most had difficulty accessing psychological and/or psychiatric services (71%, 64% respectively). The majority used a combination of pharmacological and non-pharmacological treatments for anxiety. The most frequently prescribed first-line medications for patients with a prognosis of days to weeks were benzodiazepines (93%), usually lorazepam. The use of benzodiazepines over antidepressants was statistically significant (p < 0.001). For patients with a prognosis of months, antidepressants were most frequently prescribed first-line (60%), significantly more than benzodiazepines (p < 0.001). However, benzodiazepine use was still common in this prognostic group with 47% prescribing it first-line, sometimes in combination with an antidepressant.

Conclusion

This is the first national survey on the assessment and management of anxiety in palliative care. Findings demonstrate the infrequent use of screening tools, variation in prescribing practice, potentially inappropriate use of benzodiazepines for patients with a prognosis of months, training gaps and poor access to psychological and psychiatric services in the UK. This highlights the need for formal training, further research into the pharmacological management of anxiety in this population and evidence-based national guidance to support clinical decision-making and service development.