Integrative palliative care is growing popular among patients as well as providers seeking non-pharmacological methods of controlling symptoms and improving quality of life.
These types of programs involve a range of complementary therapies, including aromatherapy, massage, acupuncture, dietary changes and mindfulness-based treatments, among others.
The evidence base for these therapies has been growing in recent years, Leila Kozak, director of the Integrative Palliative Care Institute (IPCI), said at the National Hospice and Palliative Care Organization (NHPCO) Annual Leadership Conference.
“Integrated palliative care is patient-centered care that recognizes that pharmacological interventions are extremely useful, but sometimes can also produce overwhelming side effects,” Kozak said. “By using integrative therapies along with conventional pharmacological interventions, we can frequently decrease the dosage of drugs, decreasing side effects and providing a higher quality of life.”
Case in point, in a 2017 study of 1,321 hospice patients in the United Kingdom, patients reported significant improvement in symptoms such as pain, shortness of breath, anxiety and nausea after receiving complementary therapies. However, patients did not report improvement in relation to their constipation, fatigue, insomnia or appetites.
Also in 2017, The Joint Commission developed a standard that required accredited health care organizations to provide non-pharmacological treatment for pain management in hopes of reducing opioid utilization.
Kozak became interested in integrative palliative care during the early 2000s when she was running a randomized clinical trial of massage and meditation among hospice patients. She developed a survey to examine if and how these therapies were being used among hospices in Washington state.
The survey revealed a number of obstacles to scaling these complementary services.
“This project started by identifying the challenges encountered in our field, which were the increase in demand for integrative therapies by patients and families, the need of care organizations to offer non-pharmacological interventions to satisfy The Joint Commission requirements, the lack of evidence-based educational resources for systematic effective implementation of integrative therapies and the lack of available continuing education,” Kozak said.
Kozak and her colleague William Collinge, associate director of IPCI, then set about finding solutions.
They enlisted a team of experts to develop a continuing education course oriented around integrative therapies and their applications in hospice and palliative care and how to communicate with patients and families about the services’ potential. The project was funded by a grant from the National Cancer Institute.
The team developed nine one-hour modules that provided background on integrative therapies and an examination of their cultural roots, followed by deep dives into specific interventions. Following the course, they polled participants on their comfort level discussing and delivering these therapies and compared those results with a control group.
The group that underwent the training often began tangible efforts to expand these services shortly thereafter.
“We had some pretty impressive increases in confidence levels, and they were highly statistically significant compared to the control subjects,” Collinge said. “When we look at the outcomes for the practice behaviors, the direct actions, there was a very significant increase in actions taken in direct engagement with patients and families, direct encounters, advocacy actions, and also highly significant increases in organizational actions.”
