A key component of palliative care is understanding that chronic conditions may not be cured, but rather need to be managed, sometimes for many years.
Pharmacological drugs have their limitations — and they have side effects. They’re not effective in a lot of conditions, especially toward the end of life or in chronic illness care, said Dr. William Collins, associate director of the Palliative Care Institute at Western Washington University.
Collins and Dr. Leila Kozak, the institute’s director, are among those leading the push for integrative therapies, a suite of care offerings that include acupuncture, massage, music therapy and aromatherapy.
“What’s happening now through these last 20 or 30 years, is that some of these approaches, things like massage, acupuncture, mind-body interventions, have been actually studied, and there is evidence that they help people with symptom management,” Kozak said.
In the past, these treatments were often called alternative medicine, but Collins said that is inaccurate. They are integrated into the holistic patient treatment plan and work in concert with other treatments, he said.
Kozak explained that the institute has been conducting a series of studies for more than a decade, designed to provide empirical evidence that integrative therapy benefits the patients it treats. Both Kozak and Collins said the results clearly benefit integrative therapy.
Dr. Kate Brazzale, the chief medical officer at Suncoast Hospice in Florida, agrees. Brazzale said that studies are developing new ways to offer less subjective and more objective support for palliative care in general and integrative therapy in particular.
“Palliative medicine has become more sophisticated in developing tools to provide less subjective measurement of patient wellness or outcomes. I totally foresee that not only are we seeing patients embrace these therapies more, but I also think we will see the physicians who have been through traditional training, like myself, start embracing these therapies more because we have these more objective tools and measurements, and that is what we’ve been trained to look out for,” she said.
One of the outcomes of the research done by Collins and Kozak is a nine-course, online program targeting care providers. Kozak said the program has been a success. A recent study found clinicians who took the training reported greater facility with integrative therapies.
“They were able to bring these integrative therapies into their practice. That’s in a nutshell what we’ve been doing with regards to this program,” Collins said.
That training is critical, as an increasing number of patients are demanding integrative therapy as part of their treatment plans. Brazzale said she believes several reasons are behind the advancing call for integrative therapy.
Patients have greater access to information about their condition, for example. Then, with the seismic shock of the pandemic came some erosion in trust in the system, Brazzale said.
“I see a lot of patients who have already done a lot of their own research or family, friends or radios or TVs and heard about things that they think may be helpful. I think it is definitely something we should be offering by way of palliative, whole life, whole patient-centred care,” she said.
Another element is a continuing shift toward treating patients holistically, looking at all aspects of care and treatment. The fragmented one-specialist-at-a-time health care model stood out to Brazzale when she came to the United States from England.
“Complementary therapy, along with palliative therapy, is one of the few aspects of health care in the United States that looks at the whole patient, the whole patient, mind, body, spirit. I think the complementary therapies go further in looking at the whole patient than even conventional medicine in this specialist field does,” Brazzale said.
Collins and Kozak have both seen growth in demand, with the public’s interest fueling a growth in offerings from old-school mainstream medicine.
“The general public, for a number of decades, actually, has expressed a lot of interest in these therapies. It’s only more recently that mainstream medicine has said, ‘Okay, we’ll start integrating them by popular demand,’” Collins said.
In Collins mind, the complementary approach will continue to thrive and grow as patients and providers become more versed.
“I think the public has known for a long time that conventional medicine has its limitations. We have a tremendous amount of chronic illness in our society, and conventional medicine can only go so far,” he said. “The emergency room services are the best at what they do. But the diseases of civilization are chronic long-term degenerative conditions that don’t respond so well to conventional medicine, acute care approaches. That is a strength of integrative therapies and people have had frustration, and they’ve looked for alternatives for a long time.”
