Hospices take the lead in offering alternatives
Clinical research might help to validate modalities
"When we talk about hospice, it’s a multidimensional model, addressing the patient’s physical, social, psychological, and spiritual realms. None of these realms operates in and of itself," says Kathy Egan, MA, CRNH, director of the Hospice Institute of the Florida Suncoast in Largo. "To me, that’s the whole basis for complementary therapies in hospice. When I was in nursing school in the early 1970s, I was trained to do therapeutic touch. We were also taught to care for the physical, psycho-social and spiritual aspects of the patient."
Three years ago, Hospice of the Florida Suncoast started training its staff and volunteers in therapeutic touch. It also started surveying staff on the kinds of alternative therapies they were using with their patients. The list includes guided imagery, neuro-linguistic programming, hypnosis, meditation, relaxation, music therapy, systemic desensitization, biofeedback, herbology, acupuncture, homeopathy, aroma therapy, and massage therapy, Egan explains.
"We’ve always done a lot of nonpharmacological adjuvant therapies. Now our patients are asking for them. We’ve also noticed that these kinds of therapies can be very supportive of medical interventions," she says. "We have dedicated resources to bring in speakers and send our staff to be trained or certified. We’ve even trained staff at our contract nursing homes and a local hospital," Egan says. The hospice doesn’t hire holistic therapists on staff, but nurses and other professionals often bring complementary skills to the job. "It’s part of what we hire people for."
Two years ago, Franciscan Health System Hospice in Tacoma, WA, launched a pilot program called Comfort Therapy, offering up to eight free sessions of massage, music, art, or hypnosis/relaxation therapy to enrolled hospice patients. A brochure for patients and families describes the role of these therapists and how the therapies might help. The hospice has also been doing randomized controlled clinical trials on the effects of massage therapy on pain intensity, analgesic use, and quality of life. Preliminary results suggest that massage patients enjoy immediate relaxation benefits as well as greater overall reductions in pain level than the control group.
Implementing these comfort therapy modalities required approval from the health system’s administration, including the Risk Management Department, but this was not a significant hurdle, says Mark J. Rake-Marona, Franciscan’s regional hospice director. Nor have physicians shown much opposition to the program, although they are given an opportunity to strike off comfort care therapies when they sign the medical orders or plan of care.
In launching this program, the hospice invited alternative practitioners from the community to brown-bag lunches to talk about their modalities and perhaps give a demonstration to the hospice’s staff. "At this point, we’re able to put our arms around four comfort therapies," says Janice Kampbell, CRNH, the hospice’s community liaison nurse. The agency plans to further investigate other modalities, including aroma therapy, color therapy, acupuncture, Reiki, and therapeutic touch. Bastyr University, a school of naturopathy in Seattle, is also interested in placing residents at the hospice.
"The program got very popular very fast, growing from 20 to 200 visits per month and from 18% to over 50% of our patients participating," in less than two years of operation, Kampbell says. The hospice contracts with community therapists, who have received a brief training in hospice care and have discounted their usual rates for this program. They also assemble quarterly for a support meeting, to debrief and share stories about their hospice work.
Comfort Therapy was launched with "the luxury of not having identified other needs for a large component of our donations, so the finances took care of themselves. We also felt it would generate memorial donations," Rake-Marona says. "We just decided we wanted to do it and to do it with professionals who could do [the therapies] optimally," he explains. "[Complementary therapies] expands hospice beyond just being crisis-centered, given current short lengths of stay, and returns our focus back to what gives quality to people’s lives. I’d say it has the potential to breathe life into your hospice program because it brings a different quality to the care we provide day-to-day."
Says Rake-Marona, "I’d encourage the hospice movement to legitimize and validate everything we do bringing complementary therapies out of the closet and establishing criteria and protocols."
[Editor’s note: For information on the National Hospice Organization Council of Hospice Professionals’ Allied Therapies Section, contact Emil Zuberbueler at (214) 265-0405. For information on Franciscan Hospice’s Comfort Therapy program, contact Rev. Susan Cutshall, MDiv, at (253) 591-6808, Ext. 1275584.
Contact the American Holistic Medical Association at 6728 Old McLean Village Dr., McLean, VA 22101. Telephone: (703) 556-9728. Fax: (703) 556-8729. E-mail: [email protected]. Or contact the American Holistic Nurses Association at 4101 Lake Boone Trail, #201, Raleigh, NC 27607. Telephone: (800) 278-2462. Contact the National Association of Nurse Massage Therapists, Bobbi Harris, president, at P.O. Box 1268, Osprey, FL 34229. Telephone: (813) 966-6288. Fax: (813) 918-0522. Contact Nurse Healers-Professional Associates Inc. at 1211 Locust St., Philadelphia, PA 19107. Telephone: (215) 545-8079. Fax: (215) 545-8107. E-mail: [email protected]]
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