Setting up a pilot study
Articles - Integrated Healthcare

Setting up a pilot study of complementary therapies in a specialist palliative care setting

by Janet Leitch, RN, MICHT .

Introduction

According to NICE (2004)' a significant number of people with cancer have reported using complementary therapies, yet there is little evidence on the effectiveness of these therapies for the relief of pain, anxiety or distress, or for improving quality of life. However, complementary therapies, such as massage and aromatherapy, are rising in popularity and are increasingly being used in palliative care to improve the quality of life of patients (Wilkinson et al. 1999). Research within palliative care is scant and there are limited randomised controlled trials to draw any firm conclusions from. However, a recent randomized controlled trial assessing the effects of massage and aromatherapy on 103 cancer patients in a palliative care setting demonstrated a statistically significant reduction in anxiety after each massage, and the patients who received aromatherapy also noted improvements in their disposition, physical comfort and their quality of life (Wilkinson et al, 1999). Barnett (2001) also suggests that complementary therapy promotes quality of life by providing comfort, aiding relaxation, and promoting a sense of emotional and psychological well-being.

Complementary therapies (aromatherapy, reflexology, massage and reiki) had been available for some time at the Marie Curie Centre Belfast within the In-patient Unit and Day Therapy setting. However, the therapies were being delivered on an ad hoc basis by a variety of staff and volunteers, and although highly valued by the patients, there was no structure in place to effectively evaluate the patients' experience and also to coordinate and monitor the standards of therapies delivered.

Against this background a proposal was put forward to Senior Nurse Management for a 'Nurse Therapist' whom, in line with Clinical Guidance, would work a 25 hour week and be responsible for the provision and implementation of a complementary therapy service. A six month pilot study was agreed to, running from November 2004 - April 2005. The remainder of this article will now focus upon the aims, integration and development of this pilot study.

Potential scope of practice

Mane Curie Centre Belfast provides holistic, multi-disciplinary care to patients with life-threatening and life-limiting disorders. There is a nineteen bed In-patient Unit in Belfast and four Satellite Day-Care Units in Belfast, Newtownards, Lisburn and Downpatrick. In order to create a professionally credible service, a structure was required which incorporated: the provision of high quality, patient-centred care; appropriate choice of therapeutic intervention: cost-effectiveness; safety; policies and standards; education and training: research and development; audit; evaluation strategies: and practice development.

Throughout the UK. Marie Curie Hospices supply Complementary Therapy Services in Penarth, Bradford, Edinburgh, Solihull, Glasgow, Newcastle, Belfast, Edenhall, Caterham and Tiverton. A total of 65 therapists provide the following therapies: aromatherapy; bowen therapy; hypnotherapy; IHM; kinesiology; massage (therapeutic, sports and remedial); music therapy; reflexology; reiki; Shiatsu; spiritual healing: and stress management.

Aims and objectives of the pilot study

  • To develop a complementary therapy service that is flexible and responsive to patient needs and delivered by appropriately trained staff.
  • To evidence the perceived benefits to patients and families through evaluation.
  • To demonstrate the need to further develop and expand complementary therapy services within a palliative care setting.

Role of the Nurse Therapist

  • To communicate and work closely with all members of the multi-disciplinary team and volunteer complementary therapists.
  • To be responsible for recruiting, managing and developing a team of volunteer complementary therapists, including maintaining an up-to-date register of therapists who meet the criteria set out in the complementary therapy policy,
  • To offer monthly support and supervision sessions to the volunteer complementary therapists.
  • To identify needs in relation to the development of complementary therapies and co-ordinate the introduction of other therapies.
  • To address issues of quality, training, audit, research and development in complementary therapies in collaboration with the education department.

Policy and procedures

In order to ensure safe and professional practice a policy for complementary therapy within Marie Curie Centre Belfast was developed incorporating National Guidelines for the use of Complementary Therapies in Supportive and Palliative Care.

Documentation

Documentation was designed and continues to be developed and
improved. Documentation consists of five parts: referral form: patient information leaflets; consent form; patients' notes; and an evaluation form at the end of treatment (if appropriate),

Integration into the multi-disciplinary team

Integration of the new service began by attending weekly team multi-disciplinary meetings. A brief introduction of the new service was given. To obtain a baseline and to establish understanding and experiences of complementary therapy, a questionnaire was given to the multi-disciplinary team members attending on the first week of the pilot study. After twelve months the same questionnaire will be used to establish change in knowledge and experiences.

The benefits of complementary therapies observed by the multi-disciplinary team (in descending order) were as follows: relaxation improved sense of well-being; reduced anxiety; promoted sleep reduced pain; felt pampered; invoked pleasant memories (aroma) reduced breathlessness; diversion therapy; fatigue management.

Treatments carried out in the In-Patient Unit

The Nurse Therapist provides aromatherapy, reflexology and Indian head massage (IHM), Monday to Friday, in the In — Patient Unit. On Fridays only, three volunteer therapists provide aromatherapy, reflexology and reiki to relatives and carers, Reiki is also provided on request to Patients in accordance with the National Guidelines (2003).

Treatments carried out in the Satellite Units

There are four Satellite Units located at Lagan Valley Hospital, Downpatrick Hospital, Newtownards Hospital and Belfast Day Therapy Unit, Each of these units have a Volunteer Therapist or Nurse Therapist offering two or more of the following: aromatherapy, reflexology and IHM. A retrospective audit of these satellite units will be conducted later in the year.

Development of the Complementary Therapy Service

Partnership with Link Nurses.

  • Wound Care Nurse - the use of essential oils in wound and odour management. Proactive measures in the prevention of pressure sores.
  • Infection Control Nurse - trial in the use of a skin protection lotion to prevent contact dermatitis.
  • Mouth Care Nurse - the implementation of the use of essential oils in mouth care.

Development of the Volunteer Team

Since commencement of the pilot study, the following have been introduced/implemented: a volunteer therapists' register; more efficient use of existing volunteer therapists ; coordination of complementary therapy to Satellite Units; recruitment of new volunteer therapists; induction programme; education programme; training and development programme; mentorship programme; clinical supervision; monthly departmental meetings: new therapies; extension of service to relatives/carers; extension of service to Marie Curie staff.

Education

  • As part of the induction programme for new staff, a power point presentation is now given explaining the evolution of complementary therapy in the In-Patient Unit.
  • Presentations have also been given to nursing and medical staff.
  • A simple foot and hand massage demonstration has been given to nursing staff, to enable them to feel confident in this procedure. Therapeutic application of creams has also been demonstrated.
  • Relatives/carers are taught to give a gentle foot massage to enable them to participate in therapeutic touch which benefits both patient and relative/carer.
  • Two articles have been published in BUZZ (the hospice's bimonthly in — house magazine), one explaining the role of the Nurse Therapist and the other providing information about reflexology,
  • Complementary therapy is now included in the monthly Professional Development Forum Programme,
  • A Complementary Therapy Information Folder has been compiled to disseminate knowledge on recent research findings.

Evaluation

Despite the obvious challenge, several methods of evaluation have been used throughout the pilot study and continue to be developed. Initially, a standard tick box evaluation form was used and although positive it was not giving insight into the patients' personal experience. A simple quick response sheet was piloted which asks the patient to describe in just a few words how they found their treatment. This allowed patients to express their comments about the service in a way that was not too taxing. The following comments are just a handful noted from patients taking part in the study:

  • "Massage has really helped ease my back"
  • "It has helped me relax and sleep better"
  • "This is the first peace I have had in a long time"
  • "Massage has helped my breathing"
  • "I feel my body relaxing -1 feel happy now".

As a further means of evaluation a qualitative nursing approach will be undertaken by using patients' case studies.

Delivery of the Complementary Therapy Service

Table I (below) details the complementary treatments which have been provided in the In — Patient Unit and the four Satellite Units from 1st November 2004 - 30th April 2005. Unfortunately, no recordings of family members receiving complementary therapy were made and those taken for reiki are inaccurate. This will be addressed in future by the use of a complementary therapy database.

Auditing

To influence practice and improve quality of care, auditing is necessary to measure the complementary therapy service. Initially, a baseline audit was taken from analyses of a questionnaire given to a representative number of the multi-disciplinary team at the beginning of the pilot study. This questionnaire was to establish the current level of knowledge or experience the clinical staff had with regards to complementary therapy. The same questionnaire will be repeated annually, Retrospective audits on documentation will be carried out from the In — Patient Unit and Satellite Units later in the year.

Table I - Therapies audited in the In — Patient and Satellite Units (Nov 04 - April 05)

Comp Therapy

No. treatments

No. patients

Aromatherapy

285

81

Indian Head Massage

4

4

Reflexology

174

69

Reiki

4

4

Total

467

467

Our thanks to Today's Therapist Magazine for allowing us to share past articles