Complementary Therapy Services Research Articles

Feasibility of implementing pranic healing as a complementary service: A case study at Sanglah General Hospital, Denpasar

Background and purpose: WHO supports the implementation of complementary therapy services in health facilities to increase comprehensive health services coverage. Sanglah Hospital is developing the pranic healing service as part of the development of Indonesia’s medical tourism and traditional health. This study aims to determine the extent to which the feasibility, obstacles, challenges, and opportunities of the pranic healing service implemented at Sanglah Hospital.Methods: This study employed a mixed-methods design with a case study approach. The data were collected from March to April 2020 using in-depth interview with 23 informants by collecting information on acceptance, readiness, requests, and service management. Documents and archival records were also collected. The survey data were collected using a self-administered questionnaire from 40 respondents by collecting information on patients’ requests and acceptance aspects. The qualitative data analysis was performed thematically and presented in a narrative form. The survey data were analyzed using univariate analysis.Results: The pranic healing service received support from the Ministry of Health and the hospital management, had a good acceptance from health workers and patients, was the only complementary service of its kind in health facilities throughout Indonesia and had the potential for the development of medical tourism. Obstacles and challenges found were related to workforce management, regulatory readiness, referral systems, and the development of inpatient services.Conclusion: Pranic healing service could be implemented at Sanglah Hospital because they had substantial support and because of demand and acceptance aspects. However, obstacles and challenges on the implementation and practicality aspects should be overcome for the sustainability of this service. The pranic healing has a good potency since to date, it is the only one available in Indonesia which is also potential for the development of medical tourism.

CN50 - The perceptions of parents/guardians regarding their child/adolescent’s experience of reflexology or non specific foot massage

BackgroundChildren and adolescents with cancer are at risk of experiencing distress in relation to their cancer diagnosis, treatment and treatment-related procedures. Complementary therapies such as reflexology may be used to help alleviate distressing symptoms; however, there is a dearth of research regarding the experience of reflexology from the perspective of children/adolescents with cancer and/or the parents/guardians of those who have received these treatments. Objective: To ascertain the perceptions of parents/guardians regarding their child/adolescent’s experience of reflexology or non-specific foot massage. MethodsChildren and adolescents aged between 7 and 18 years attending a national children’s hospital for cancer treatment were invited to participate in a randomised controlled trial using a Mixed Between Group Repeated Measures design following receipt of ethical approval from the hospital’s Research Ethics Committee. In total, 75 children/adolescents either consented or assented to take part in the study. Of these, 39 were randomized to the intervention group (reflexology) and 36 to the control group (non-specific foot massage). Semi-structured interviews were undertaken with parents/guardians using an interview guide. Interviews were analysed using Braun and Clarke’s (2006) thematic analysis. ResultsThe overarching theme which emerged across the interviews was participants’ perceptions of the foot treatments in general as a means of supporting the child during treatment for cancer. This central theme is discussed under a number of subthemes, namely psychological wellbeing, perceived physiological impact, time and space, a safe relationship and service development. ConclusionsThe parents/guardians views regarding the foot treatments in general were consistently positive. The implications of the study findings and the future delivery of the complementary therapy service will be discussed. Legal entity responsible for the studyUCD. FundingChildhood Cancer Foundation. DisclosureAll authors have declared no conflicts of interest.

Supportive care needs and associated factors among Chinese cancer survivors: a cross-sectional study.

To investigate the unmet supportive care needs (SCNs) of Chinese cancer survivors and to identify factors associated with the unmet SCNs of cancer survivors. A cross-sectional survey of Chinese cancer survivors was conducted using validated scales of the Cancer Survivors Unmet Needs scale (CaSUN), physical symptom concerns (Cancer Survivors Survey of Needs-CSSN subscale), and a single-item measure of global quality of life (QoL) perception. There were 330 participants, with a mean score of 7.1 (0-10) in overall QoL. The reported rate of the 19 symptom concerns ranged from 19.4 to 72.2%. The level of unmet SCNs (moderate and strong need) ranged from 12.1 to 59.1%. The top five unmet needs included concerns about the cancer re-occurring (59.1%), accessing the best medical care (52.7%), accessing complementary therapy services (51.5%), changes to beliefs (48.2%), and survivor expectations (47.6%). The strength of unmet SCNs was negatively correlated with participant age (P < 0.05), average time since diagnosis (P < 0.05), and overall QoL (P < 0.01) and positively correlated with all symptom concerns (all P < 0.001). Study findings call attention to cancer survivors' unmet SCNs and related factors. Underscored areas in developing survivorship care included paying special attention to existential survivorship, empowering survivor management of chronic symptoms, particularly for younger survivors, as well as for survivors with poor QoL, and those with a shorter time since diagnosis. This tailored survivorship care should be developed and delivered by a multidisciplinary team to support cancer services, with a greater capacity to deliver individualized, unmet SCN-driven care to survivors.

The efficacy of complementary therapy for patients receiving palliative cancer care.

Involving patients in their own care is associated with improved health outcomes. Complementary therapies are popular among patients and enable them to receive the palliative care they want and need. However, the range of complementary therapy services available to patients need to be evaluated for efficacy. This study evaluated the complementary therapy services offered at one cancer outpatient clinic in the UK, with the aim of evaluating the effect of complementary therapies on patient wellbeing and to systematise concerns and categories of wellbeing in order to improve service provision. A sample of 60 patients rated their feelings of wellbeing on a Likert scale before and after a series of six complementary therapies. They were also asked which concerns they had and, after treatment, were asked about factors that may influence their wellbeing. The data were analysed quantitatively by t-test and Wilcoxon signed ranks and the results show a statistically significant improvement in wellbeing. The concerns were assigned into super categories to aid service provision and the other factors that influence general wellbeing were assessed to categorise areas of patient needs that may be addressed in patient care. These results highlight important areas for investigation, which have implications for service provision in palliative cancer care.

Complementary therapy for people with cancer; the patient’s perspective

IntroductionDespite widespread use, there remains a paucity of research exploring cancer patients’ experiences of receiving complementary therapy treatment. We wanted to gain insight into the experiences of patients using a complementary therapy outpatient service offering aromatherapy, massage, reflexology and Reiki. At this London Cancer Centre, therapies are offered to patients as a self-referral service as part of their treatment pathway at any stage of treatment or follow up. MethodsNew patients (n=96) attending the outpatient complementary therapy service for the first time were asked about their main concerns. The MyCaW (Measure your concerns and wellbeing) evaluation tool was used to collect data. Follow up MyCaW data from these patients was also collected after 4 sessions of complementary therapy. Patients were able to choose which therapy they wished to receive at each session. ResultsPatient reported outcomes after receiving 4 sessions of complementary therapies demonstrated significant improvements (indicated by at least a 1 point change in MYCAW scores) across a range of concerns. The greatest improvements were seen in relaxation, sleep problems, and pains/aches. ConclusionQualitative comments collected from this evaluation indicate that complementary therapies can address both physical and emotional concerns often simultaneously and provide a unique therapeutic space for patients. Many patients have not had this experience before and this may introduce them to new methods of addressing complex multi dimensional issues resulting from living with a cancer diagnosis.

Who accesses complementary therapies and why?: An evaluation of a cancer care service

IntroductionAdvances in cancer diagnosis and treatment have resulted in longer survival, meaning patients are living with a chronic-type condition. Therefore the needs of such patients have changed placing greater emphasis on survivorship, such as impact on quality of life and sleep patterns. Evidence suggests complementary therapies positively impact not only on the cancer patient's quality of life but also on family members and friends. MethodologyThis service evaluation examines self-reported benefits following a course of complementary therapy offered by a local cancer charity. ResultsAnalysis of self-reported sleep scores and perceived quality of life experiences confirmed a number of trends relating to the demographics of people accessing the complementary therapy service. ConclusionResults suggest the complementary therapies provided by Action Cancer significantly improved clients' quality of life. Based on these findings the authors make a number of recommendations in relation to the use of complementary therapies by cancer patients.

Patient preferences on the integration of complementary therapy with conventional cancer care.

Complementary therapy use by patients with cancer is highly prevalent, although little is known about the optimal model of integration with conventional care. This study explored patient preferences regarding integration in an Australian context. Cancer patients participated in focus groups conducted by an experienced facilitator. Transcripts of discussions were subjected to thematic analysis. Fourteen female and four male patients took part in eight focus groups. Eleven had received conventional cancer treatment for early-stage disease, and seven for advanced stage. Participants had sound understanding of the distinction between complementary and alternative medicines. There were differing views on whether complementary therapy and conventional cancer services should be colocated. Some participants described colocation as discordant with their reasons for using complementary therapy. Participants valued guidance from oncology health professionals regarding complementary therapy that was tailored to their individual needs. In addition to medical oncologists, nursing staff and affiliated complementary therapists were considered to be appropriate sources for guidance. Additional themes identified in the analysis were also informative: patients achieve autonomy and self-expression through complementary therapies; the knowledge and attitudes of health professionals and limited consultation time are barriers to integration; self-funding of complementary therapies is acceptable to participants. The study findings suggest that while patients have diverse views regarding the optimal integration model, there is no strong preference for geographic colocation of complementary therapy with conventional cancer care. Patients valued personalized information and guidance regarding complementary therapy from health professionals involved in their cancer care.

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

To explore how older people with lung and colorectal cancer view registered complementary therapy (CT) services in Northern Ireland. A literature review highlighted gaps around information, access, and communication between patients and health professionals regarding CT services. Using structured interviews, a survey of 68 patients in one hospital and one hospice was conducted in Belfast, Northern Ireland. 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. 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.

Pounds, shillings and pence: Ways to Cost NHS complementary therapy services – The SEAT and BISCUIT studies

Background To inform their decisions, commissioners need to know if particular services reduce NHS costs and procur cost savings elsewhere within the system. A review of service evaluations of NHS complementary therapy services found that most did not investigate the impact of these services on NHS costs such as GP consultations, hospital visits and medications. Two recent studies have attempted to tackle the challenges in economic evaluation of NHS complementary therapy services, using different approaches. The SEAT study evaluated an Alexander Technique (AT) service in a hospital pain clinic. The BISCUIT study focused on the economic evaluation of the Bristol Homeopathic Hospital. The aim of this presentation is to reflect on these two studies’ approaches to economic evaluation, compare their usefulness and present results. Methods The SEAT study recruited 43 service users via the hospital pain clinic who attended weekly Alexander Technique lessons over six consecutive weeks. They self-reported personal and NHS costs at the first session, six weeks and 3 months after baseline. As part of the BISCUIT study, 15 case participants who attended the Bristol Homeopathic Hospital and 19 community control participants were matched for GP practice, condition, age and sex and reported personal and NHS costs at five time points over 15 months. In addition, GP medical record data was extracted on NHS resource use and sick notes for all 34 BISCUIT participants. SEAT and BISCUIT data were priced using a variety of different sources (i.e. NHS reference costs, British National Formulary, Unit Costs of Health and Social Care). SEAT data were analysed for NHS and personal costs whereby standard weekly costs were calculated at three time points and compared. BISCUIT data were analysed from a NHS cost and societal cost perspective whereby annual costs for cases and controls were compared. Results For the SEAT study, we found that total costs for AT service users did not decrease between baseline (mean £55.53 [95% CI £39.97 to £71.10]) and three months (mean £61.19 [95% CI £14.89 to £107.49]). However NHS and personal costs associated specifically with pain reduced substantially from £27.43 (95% CI 19.26 to £35.60) to £11.68 (95% CI £4.55 to £18.81). Results for the BISCUIT study are still undergoing analysis. For both the SEAT and BISCUIT studies, we found that there was substantial variability. Conclusions The SEAT and BISCUIT studies are breaking new ground in finding commissioner friendly approaches to costing NHS complementary therapy services. At this conference, we would like to disseminate our learning so that future evaluators of NHS complementary therapy services can incorporate cost analyses into their research design. This would be of key interest to healthcare commissioners considering the funding of NHS complementary therapy services.

A review of the complementary therapy service in a Specialist Palliative Care Service in Bridgend

A review of the complementary therapy service in a Specialist Palliative Care Service in Bridgend

A mixed-methods evaluation of complementary therapy services in palliative care: yoga and dance therapy

To inform service provision and future research, we evaluated two complementary therapy services: yoga classes and dance therapy [The Lebed Method (TLM)]. Both were run as 6-week group courses. Patients completed the Measure Yourself Concerns and Wellbeing questionnaire pre- and post-course. Mean change over time was calculated for patient-nominated concern and well-being scores. Qualitative data regarding factors affecting health other than the therapy and benefits of the service were analysed using content analysis. Eighteen patients participated (mean age 63.8 years; 16 female; 14 cancer diagnoses); 10 were doing yoga, five TLM, and three both yoga and TLM; 14 completed more than one assessed course. Patients' most prevalent concerns were: mobility/fitness (n= 20), breathing problems (n= 20), arm, shoulder and neck problems (n= 18), difficulty relaxing (n= 8), back/postural problems (n= 8), fear/anxiety (n= 5). Factors affecting patients' health other than the therapy were prevalent and predominantly negative (e.g. treatment side effects). Patients reported psycho-spiritual, physical and social benefits. Concern scores improved significantly (P < 0.001) for both therapies; improved well-being was clinically significant for yoga. Evaluations of group complementary therapy services are feasible, can be conducted effectively and have implications for future research. Yoga and TLM may be of benefit in this population.

Complementary therapy and support services for formal and informal caregivers in Italian palliative care hospices: an exploratory and descriptive study

The present study is aimed to assess the availability and use of complementary medicine (CM) therapies in Italian palliative care hospices, and the support services available to caregivers and hospice staff. A national sample of 30 hospices meeting study criteria provided data by means of telephone interviews. All hospices offered spiritual assistance and at least one other form of CM, with the most common being massage therapy (n = 24) and relaxation therapy (n = 10). When offered complementary therapies, 65% or more of the patients accepted them. Twenty-nine hospices provided spiritual and psychological support to caregivers during patient stays, but only 12 offered support at home. All hospices offered support services to their staff, both in individual and group formats. Despite limited empirical support, CM has become an important part of palliative care for end-of-life patients in Italy, as in many other countries.

Aromasticks in cancer care: An innovation not to be Sniffed at

To evaluate the effects of a new aromatherapy intervention introduced within an acute cancer care setting in the UK. Aromatherapy is a popular complementary therapy within oncology settings and is known to help relieve patients' anxiety. A new method of delivering aromatherapy to patients was adopted by a complementary therapy service at a UK hospital; aromasticks are similar in design to the Vicks® Vapour Inhaler®, with the intention of helping patients manage anxiety, nausea and sleep disturbance. A retrospective service evaluation. Patients referred to the complementary therapy service were, if appropriate, offered an aromastick. If the offer was accepted patients' details were captured on an evaluation form. One week later the patients were followed up by a different therapist. Frequency of using the aromastick and perceived benefits were documented. A total of 160 patients were included in this evaluation. 77% (n = 123) of all patients reported deriving at least one benefit from the aromastick. In anxious patients, 65% reported feeling more relaxed and 51% felt less stress. 47% of nauseous patients said that the aromastick had settled their nausea and 55% of those experiencing sleep disturbances felt that aromastick helped them sleep. The results also suggest that the effects of the aromastick may be directly proportional to the frequency of their use. Evidence demonstrating physiological changes associated with aroma inhalation plus the data presented in this paper highlight the potential for aromasticks within the clinical setting. Although the results of this evaluation of patient perspectives are not controlled, the data does underline the worth of further investigation. Future research is needed to show that aromasticks represent a tool patients can use to self-manage their own symptoms and help them retain an internal locus of control.

Workplace complementary and alternative therapies for hospital‐site staff

PurposeWorkplace wellness schemes are emerging in NHS settings, including complementary and alternative therapy services aimed at improving employee wellbeing. The aim of this study is to explore the impact of one such therapy service on service users based at a large UK teaching hospital.Design/methodology/approachIn‐depth semi‐structured interviews were undertaken with seven staff members who participated in at least one workplace complementary or alternative therapy. An Interpretative Phenomenological Analysis approach was taken in the design of interviews and the analysis of interview data.FindingsThe following themes were elucidated: having positive but tentative expectations of therapies; enhancing health and wellbeing through therapy; appreciation for the “Q‐active” therapy service as part of a workplace wellness programme; and work influencing therapy use and vice versa.Originality/valueThe study adds to the limited research literature evaluating workplace health interventions by using an interview‐based qualitative approach to access employees' experiences of this type of workplace complementary and alternative therapies. Valuable insights were gained about the significance of this particular aspect of a larger workplace health programme. The emergent themes build on the existing literature on individuals' expectations and experiences of complementary and alternative therapies and also on the potential benefits of such a service for workplace health promotion.

Patient choice and evidence based decisions: The case of complementary therapies

Current government policies simultaneously pursue the development of 'patient-led' and 'evidence-based' approaches to healthcare. The objective of this study was to explore how primary care clinicians and Primary Care Trust (PCT) managers balance these potentially competing tensions when considering popular, controversial treatments, like complementary therapies, in consultations (clinicians) or funding decisions (PCT managers). We selected two case sites where complementary therapies were offered on NHS premises in England. We interviewed 18 PCT managers and clinicians, conducted an observation of a PCT meeting on complementary therapies and collected documentary data from referral databases and service funding bids. All interviews were taped, transcribed and analysed thematically. Interview, observation and documentary data were used to compare reported beliefs and behaviour to observed and documented behaviour. The majority of clinicians and PCT managers claimed that research evidence guided their decisions; those who did not felt increasingly marginalized. However, discrepancies between reported and observed behaviour suggest that perceptions of research evidence, rather than fact based knowledge, predominated when considering complementary therapies. In the case of NHS complementary therapy service provision, patient preference may be largely insignificant in clinician and PCT managerial decisions, with decisions based mainly on 'evidence rhetoric' devised from collectively agreed, unchallenged, tacit perceptions of research literature. If a patient-led NHS is to become a reality, NHS professionals need to cede the power that they wield with evidence rhetoric and acknowledge the legitimacy of patient preferences, views and alternative sources of evidence.

The impact of NHS based primary care complementary therapy services on health outcomes and NHS costs: a review of service audits and evaluations

BackgroundThe aim of this study was to review evaluations and audits of primary care complementary therapy services to determine the impact of these services on improving health outcomes and reducing NHS costs. Our intention is to help service users, service providers, clinicians and NHS commissioners make informed decisions about the potential of NHS based complementary therapy services.MethodsWe searched for published and unpublished studies of NHS based primary care complementary therapy services located in England and Wales from November 2003 to April 2008. We identified the type of information included in each document and extracted comparable data on health outcomes and NHS costs (e.g. prescriptions and GP consultations).ResultsTwenty-one documents for 14 services met our inclusion criteria. Overall, the quality of the studies was poor, so few conclusions can be made. One controlled and eleven uncontrolled studies using SF36 or MYMOP indicated that primary care complementary therapy services had moderate to strong impact on health status scores. Data on the impact of primary care complementary therapy services on NHS costs were scarcer and inconclusive. One controlled study of a medical osteopathy service found that service users did not decrease their use of NHS resources.ConclusionTo improve the quality of evaluations, we urge those evaluating complementary therapy services to use standardised health outcome tools, calculate confidence intervals and collect NHS cost data from GP medical records. Further discussion is needed on ways to standardise the collection and reporting of NHS cost data in primary care complementary therapy services evaluations.

Efficacy of complementary therapies yet to be proven

The findings of this Marie Curie Cancer Care-funded paper, based on a systematic review submitted to the Cochrane Review, suggest that more studies with much more meticulous research methodology are required before commissioners of healthcare can make thorough evidence-based decisions that determine which complementary therapy services can be funded. A more rigorous standard of research is also required to assist nurses in their provision of such therapies or advise about such measures to patients with cancer.

A Survey of Hospices' Use of Complementary Therapy

As people live longer with chronic illnesses, the need for hospice services will increase. Complementary therapies have been shown to increase ease, relieve pain, and improve quality of life; all relevant for people with chronic illness at the end of their lives. The first aim of this study was to identify complementary therapy services available to, and provided for, clients receiving hospice care in Nevada and Montana. The second aim was to identify differences in those therapies for urban and rural hospice clients. Using a descriptive survey design, data were collected from surveys sent to all hospice administrators in Nevada and Montana (N=54). A 50% (n=27) response rate was obtained. Most (70.4%, n=19) of the participating hospices offered complementary therapy; slightly more than half (52.9%, n=9) provided the services for less than 25% of their clients. No significant differences were found between rural and urban hospices.

Designing a 'NHS friendly' complementary therapy service: a qualitative case study.

BackgroundProvision of complementary therapy services within the NHS is scarce and contested. However, their adoption may be more likely in a service model that is designed to the specifications of clinicians and Primary Care Trust (PCT) managers. Our objective was to identify the features of a 'NHS friendly' service to inform service designers who wish to develop NHS complementary therapy services.MethodsUsing a case study approach, two sites offering complementary therapies on NHS premises were studied using interview and documentary data. We conducted interviews with 20 NHS professionals, including PCT managers and clinicians. We used descriptive content analysis to analyse interview data. We collected and analysed documentation, such as referral data, funding bids and evaluations, to compare reported and documented behaviour.ResultsIdeally, a 'NHS friendly' complementary therapy service should offer a limited number of therapies for a specific condition for high priority patient populations (e.g. acupuncture for addictions). In this service model, the therapies should be perceived to have 'good' evidence for conditions where there are 'effectiveness gaps' (i.e. current treatments are limited). The service should be evaluated and regularly promoted. Inter-professional relationships would flourish through opportunities for informal contact and formal interactions, such as observations of consultations. However, the service should include gatekeeper mechanisms to control demand and avoid picking up 'unmet need' (i.e. individuals currently not accessing NHS services). The complementary therapy service should pay for itself and reduce NHS costs elsewhere, such as hospital admissions.ConclusionThe service design model identified in this study is problematic. For example, it is contradictory to provide specific interventions for specific conditions within a holistic healthcare framework. It is difficult to avoid providing for 'unmet need' while concurrently filling 'effectiveness gaps'. In addition, demonstrating the impact of a community service on reducing hospital admissions is challenging. Those seeking to establish a NHS complementary therapy service might be well-advised to meet as many of the criteria of a 'NHS friendly' model as possible, recognising that its full realisation may be impossible. However, during periods of innovation and financial security, some relaxation of expectations may occur.

The status of complementary therapy services in Canadian palliative care settings

Little is known about complementary therapy services (CTs) available in Canadian palliative care settings. An online survey was e-mailed to multiple Canadian palliative care settings to determine the types and frequency of CTs provided and allowed, who are the CT providers, funding of CT services, and barriers to the provision of CTs. The response rate was 54% (74/136). Eleven percent of surveyed palliative care settings provided CTs, and 45% allowed CTs to be brought in or to be used by patients. The three most commonly used CTs were music (57%), massage therapy (57%), and therapeutic touch (48%). Less than 25% of patients received CTs in the settings that provided and/or allowed these therapies. CTs were mostly provided by volunteers, and at most settings, limited or no funding was available. Barriers to the delivery of CTs included lack of funding (67%), insufficient knowledge of CTs by staff (49%), and limited knowledge on how to successfully operate a CT service (44%). For settings that did not provide or allow CTs, 44% felt it was important or very important for their patients to have access to CTs. The most common reasons not to provide or allow CTs were insufficient staff knowledge of CTs (67%) and lack of CT personnel (44%). Overall, these findings were similar to those reported in a US-based hospice survey after which this survey was patterned. Possible reasons for these shared findings and important directions regarding the future of CT service provision in Canadian palliative care setting are discussed.