Death With Dignity: End-of-Life Issues for the HIV/AIDS Patient

Application of Community-Based Participatory Research Methods to a Study of Complementary Medicine Interventions at End of Life

Community-based participatory research (CBPR) principles can be successfully applied to the design and implementation of a complementary medicine study for adults with end-stage AIDS. The Yale Prevention Research Center partnered with Leeway, Inc., an AIDS-dedicated nursing facility, and other academic and clinical entities to conduct a randomized, controlled pilot trial of meditation and massage on quality of life at the end of life. Using CBPR principles, a methodology was developed that was scientifically rigorous, highly respectful, and acceptable to the 91% minority study population. Using continuous, open communication among all involved parties, challenges were satisfactorily addressed in a timely manner. Fifty-eight residents (97% of those eligible) with end-stage AIDS participated from November 2001 to September 2003. Subjects received 1-month interventions of meditation, massage, combined meditation and massage, or standard care. The study of quality-of-life in end-stage AIDS poses unique challenges well met by applying CBPR principles to an academic-community research partnership.

A Randomized Controlled Trial of Meditation and Massage Effects on Quality of Life in People with Late-Stage Disease: A Pilot Study

CONTEXT

Certain meditation practices may effectively address spiritual needs near end-of-life, an often overlooked aspect of quality of life (QOL). Among people subject to physical isolation, meditation benefits may be blunted unless physical contact is also addressed.

OBJECTIVE

To evaluate independent and interactive effects of Metta meditation and massage on QOL in people with acquired immunodeficiency syndrome (AIDS).

DESIGN

Randomized controlled blinded factorial pilot trial conducted from November 2001 to September 2003.

SETTING

An AIDS-dedicated skilled nursing facility in New Haven, Connecticut.

PARTICIPANTS

Fifty-eight residents (43% women) with late stage disease (AIDS or comorbidity).

INTERVENTIONS

Residents were randomized to 1 month of meditation, massage, combined meditation and massage, or standard care. The meditation group received instruction, then self-administered a meditation audiocassette daily. A certified massage therapist provided the massage intervention 30 minutes per day 5 days per week.

OUTCOME MEASURE

Changes on Missoula-Vitas QOL Index overall and transcendent (spiritual) scores at 8 weeks.

RESULTS

The combined group showed improvement in overall (p = 0.005) and transcendent (p = 0.01) scores from baseline to 8 weeks, a change significantly greater (p < 0.05) than the meditation, massage, and control groups.

CONCLUSIONS

The combination of meditation and massage has a significantly favorable influence on overall and spiritual QOL in late-stage disease relative to standard care, or either intervention component alone.