A feasibility study of caregiver-provided massage as supportive care for Veterans with cancer.

PURPOSE: To assess the feasibility of using a multimedia program to teach caregivers of Veterans with cancer how to offer basic massage for supportive care at home. METHODS: Feasibility was assessed according to partner availability, compliance with watching training materials and practicing massage regularly, compliance with data collection; perceived study materials burden; clarity of instructional and other study materials. Pre- and post-massage changes in patients' symptom scores were measured using a numerical rate scale. A semistructured exit interview was answered by patient and caregiver at the end of the study. RESULTS: A total of 27 dyads were recruited. Veterans were 78% male. Forty-eight percent were diagnosed with hematologic malignancies (85%, advanced stage); 52% were diagnosed with solid tumors (64% advanced stage). Caregivers were 78% female; 81% were spouses. Out of the 27 pairs, 11 completed 8 weeks of data and practiced massage weekly. The majority of attrition (69%) was due to caregivers' burden. Caregivers reported instructional materials were clear, high quality, and easy to use. Patients were highly satisfied with receiving touch from their partners regularly. Post-massage symptom scores showed statistically significant decreases in pain, stress/anxiety, and fatigue. Perceived burden of data collection instruments was high, particularly for patients. CONCLUSION: It is feasible to use the TCC program to train caregivers of Veterans with cancer to offer massage for supportive care at home. Future studies should evaluate ways of providing support to caregivers, including offering massage to them, and easing the burden of data collection for patients.

Touch, Caring, and Cancer: randomized controlled trial of a multimedia caregiver education program.

PURPOSE: A randomized controlled trial was conducted to evaluate outcomes of a multimedia instructional program for family caregivers in simple touch-based techniques to provide comfort to cancer patients at home. METHODS: A multilingual 78-min DVD and 66-page manual were produced for homebased instruction. Content addresses attitudes and communication about touch in cancer, psychological preparation for giving and receiving touch, safety precautions, massage techniques for comfort and relaxation, acupressure for specific cancer-related symptoms, and practice in the home setting. Materials were produced in English, Spanish, and Chinese versions. A community-based multiethnic sample of 97 adult patient/caregiver dyads was randomized to experimental (massage) or attention control (reading) groups for 4 weeks. Massage dyads received the program and instructions to practice at least three times per week, while control caregivers read to their patients for the same frequency. Self-report instruments assessed change in symptom severity, quality of life, perceived stress, and caregiver attitudes. RESULTS: Significant reductions in all symptoms occurred for patients after both activities: 12-28 % reductions after reading vs. 29-44 % after massage. Massage caregivers showed significant gains in confidence, comfort, and self-efficacy using touch and massage as forms of caregiving. CONCLUSIONS: Multimedia instruction in touch and massage methods may offer family members a viable means of enhancing self-efficacy and satisfaction in caregiving while decreasing patient pain, depression, and other symptoms. Family members may be able to learn and apply safe and simple methods that increase patient comfort and reduce distress.

Introducing spirituality, religion and culture curricula in the psychiatry residency programme.

A growing body of research suggests that religion and spirituality may have a positive effect on mental and physical health. Medical schools have been increasingly offering courses in spirituality and health, particularly about the multi-cultural dimensions of religion and spirituality. There is a trend towards integrating the teaching of cross-cultural issues related to spirituality and religion into medical education. This trend is particularly evident in the field of psychiatry, where an increasing number of residency programmes are developing curriculum in this area. This article describes a specific curriculum in spirituality, religion and culture that was introduced in 2003 at the University of Washington Psychiatry Residency Program in Seattle, Washington. Reflections about the present and future of subject areas such as spirituality and religion in medical education and psychiatry residency are discussed.

Might massage or guided meditation provide "means to a better end"? Primary outcomes from an efficacy trial with patients at the end of life.

This article reports findings from a randomized controlled trial of massage and guided meditation with patients at the end of life. Using data from 167 randomized patients, the authors considered patient outcomes through 10 weeks post-enrollment, as well as next-of-kin ratings of the quality of the final week of life for 106 patients who died during study participation. Multiple regression models demonstrated no significant treatment effects of either massage or guided meditation, delivered up to twice a week, when compared with outcomes of an active control group that received visits from hospice-trained volunteers on a schedule similar to that of the active treatment arms. The authors discuss the implications of their findings for integration of these complementary and alternative medicine therapies into standard hospice care.

A Mobile and Web-Based Self-Directed Complementary and Integrative Health Program for Veterans and Their Partners (Mission Reconnect): Protocol for a Mixed-Methods Randomized Controlled Trial.

BACKGROUND: Complementary and integrative health (CIH) is a viable solution to PTSD and chronic pain. Many veterans believe CIH can be performed only by licensed professionals in a health care setting. Health information technology can bring effective CIH to veterans and their partners. OBJECTIVE: This paper describes the rationale, design, and methods of the Mission Reconnect protocol to deliver mobile and Web-based complementary and integrative health programs to veterans and their partners (eg, spouse, significant other, caregiver, or family member). METHODS: This three-site, 4-year mixed-methods randomized controlled trial uses a wait-list control to determine the effects of mobile and Web-based CIH programs for veterans and their partners, or dyads. The study will use two arms (ie, treatment intervention arm and wait-list control arm) in a clinical sample of veterans with comorbid pain and posttraumatic stress disorder, and their partners. The study will evaluate the effectiveness and perceived value of the Mission Reconnect program in relation to physical and psychological symptoms, global health, and social outcomes. RESULTS: Funding for the study began in November 2018, and we are currently in the process of recruitment screening and data randomization for the study. Primary data collection will begin in May 2019 and continue through May 2021. Projected participants per site will be 76 partners/dyads, for a total of 456 study participants. Anticipated study results will be published in November 2022. CONCLUSIONS: This work highlights innovative delivery of CIH to veterans and their partners for treatment of posttraumatic stress disorder and chronic pain. TRIAL REGISTRATION: ClinicalTrials.gov NCT03593772; https://clinicaltrials.gov/ct2/show/NCT03593772 (Archived by WebCite at http://www.webcitation.org/77Q2giwtw). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/13666.

Acupuncture is underutilized in hospice and palliative medicine.

Acupuncture is a complementary and alternative medical modality. A considerable body of acupuncture research has accumulated since 1998. Acupuncture has been integrated into palliative care settings in the United Kingdom but is yet to be widely offered in the United States. The literature was searched to identify clinical trials involving acupuncture, palliative care, hospice, chronic obstructive pulmonary disease, bone marrow, and cancer. Twenty-seven randomized controlled clinical trials of acupuncture were found that reported on conditions common to the hospice and palliative care setting, including dyspnea, nausea and vomiting, pain, and xerostomia, and 23 reported statistically significant results favoring acupuncture use for the conditions investigated. Acupuncture is safe and clinically cost-effective for management of common symptoms in palliative care and hospice patients. Acupuncture has potential as adjunctive care in palliative and end-of-life care, and the evidence warrants its inclusion in reimbursed palliative and end-of-life care in the United States.

Compassionate intention as a therapeutic intervention by partners of cancer patients: effects of distant intention on the patients' autonomic nervous system.

OBJECTIVE: This double-blind study investigated the effects of intention on the autonomic nervous system of a human "sender" and distant "receiver" of those intentions, and it explored the roles that motivation and training might have in modulating these effects. DESIGN: Skin conductance level was measured in each member of a couple, both of whom were asked to feel the presence of the other. While the receiving person relaxed in a distant shielded room for 30 minutes, the sending person directed intention toward the receiver during repeated 10-second epochs separated by random interepoch periods. Thirty-six couples participated in 38 test sessions. In 22 couples, one of the pair was a cancer patient. In 12 of those couples, the healthy person was trained to direct intention toward the patient and asked to practice that intention daily for three months prior to the experiment (trained group). In the other 10 couples, the pair was tested before the partner was trained (wait group). Fourteen healthy couples received no training (control group). OUTCOME MEASURES: Using nonparametric bootstrap procedures, normalized skin conductance means recorded during the intention epochs were compared with the same measures recorded during randomly selected interepoch periods, used as controls. The preplanned difference examined the intention versus control means at the end of the intention epoch. RESULTS: Overall, receivers' skin conductance increased during the intention epochs (z = 3.9; P = .00009, two-tailed). Planned differences in skin conductance among the three groups were not significant, but a post hoc analysis showed that peak deviations were largest and most sustained in the trained group, followed by more moderate effects in the wait group, and still smaller effects in the control group. CONCLUSIONS: Directing intention toward a distant person is correlated with activation of that person's autonomic nervous system. Strong motivation to heal and to be healed, and training on how to cultivate and direct compassionate intention, may further enhance this effect.

Replicable functional magnetic resonance imaging evidence of correlated brain signals between physically and sensory isolated subjects.

OBJECTIVES: Previous electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) experiments have suggested that correlated neural signals may be detected in the brains of individuals who are physically and sensorily isolated from each other. Functional MRI and EEG methods were used in the present study in an attempt to replicate these findings. DESIGN/SETTINGS: Subjects were electrically and magnetically shielded because of the characteristic surroundings of the scanner room. During the experiment, the nonstimulated subject was placed in the scanner with sensory isolating goggles covering the subject's eyes. The stimulated subject was placed 30 feet away and sat in front of a video monitor that presented an alternating schedule of six stimulus-on/stimulus-off conditions. The stimulus- on condition consisted of a flickering checkerboard pattern whereas the stimulus-off condition consisted of a static checkerboard. Stimulus-on/-off conditions were presented in the sequence on/off/on/off/on/off. The duration of these intervals was randomly assigned but consistently provided a total of 150 seconds of flicker and 150 seconds of static. Sessions were repeated twice to assess possible replication of the phenomenon. OUTCOME MEASURES: Changes in fMRI brain activation (relating to blood oxygenation) and EEG signals were measured in the nonstimulated subjects. Changes occurring during stimulus-on conditions were statistically compared to changes occurring during the stimulus-off conditions. RESULTS: Statistically significant changes in fMRI brain activation and EEG signals were observed when comparing the stimulus-on condition to the stimulus-off condition in nonstimulated subjects (p < 0.001, corrected for multiple comparisons). For fMRI, these changes were observed in visual brain areas 18 and 19 (Brodmann areas). One of the subjects replicated the results. CONCLUSIONS: These data replicate previous findings suggesting that correlated neural signals may be detected by fMRI and EEG in the brains of subjects who are physically and sensorily isolated from each other.

Evidence for correlations between distant intentionality and brain function in recipients: a functional magnetic resonance imaging analysis.

This study, using functional magnetic resonance imaging (fMRI) technology, demonstrated that distant intentionality (DI), defined as sending thoughts at a distance, is correlated with an activation of certain brain functions in the recipients. Eleven healers who espoused some form for connecting or healing at a distance were recruited from the island of Hawaii. Each healer selected a person with whom they felt a special connection as a recipient for DI. The recipient was placed in the MRI scanner and isolated from all forms of sensory contact from the healer. The healers sent forms of DI that related to their own healing practices at random 2-minute intervals that were unknown to the recipient. Significant differences between experimental (send) and control (no send) procedures were found (p = 0.000127). Areas activated during the experimental procedures included the anterior and middle cingulate area, precuneus, and frontal area. It was concluded that instructions to a healer to make an intentional connection with a sensory isolated person can be correlated to changes in brain function of that individual.

Work environment facilitators to the availability of complementary and alternative therapies in perinatal hospices.

Increasingly, patients and clinicians are considering palliative care interventions during pregnancy for the maternal-fetal dyad, when a life-limiting diagnosis is confirmed. Nurses are at the forefront of providing hospice and palliative care that includes planning interventions for infants nearing the end of life. However, little is known about the work environment facilitators to the availability of complementary and alternative medicine (CAM) therapies. Using a national database of perinatal hospice and palliative care providers, we described the types of CAM therapies available and explored the influence of the nurse work environment on the availability of CAM therapies with multivariate regression analysis. This study showed that having an education environment where clinicians are trained, along with a highly educated RN support staff, and a BSN educated staff were critical to the availability of CAM therapies. The clinical implications for hospice and palliative nurses caring for infants and their families were discussed.

Electroencephalographic evidence of correlated event-related signals between the brains of spatially and sensory isolated human subjects.

OBJECTIVE: To determine whether correlated event-related potentials (ERPs) can be detected between the brains of spatially and sensory isolated human subjects. DESIGN AND SETTING: Simultaneous digitized electroencephalograms (EEGs) were recorded from the occipital area in pairs of human subjects placed in sound attenuated rooms separated by 10 meters. One person relaxed in one of the rooms while the other received visual stimulation while in the other room. Prior to each experiment, members of the pair were randomly designated as sender and receiver. Sessions were subsequently repeated with subjects reversing their roles. Previous to each session, the sender was instructed "to attempt sending an image/thought." The receiver was instructed "to remain open to receive any image/thought from his/her partner." Alternating stimulus-on/stimulus-off conditions were presented throughout the session to the sender, while a stimulus-off condition was presented to the receiver. SUBJECTS: Thirty-seven (37) female, and 23 male subjects (n = 60; 30 pairs) participated in the study. Subjects knew each other well and claimed to have previous experience of being emotionally/psychologically connected to one another. OUTCOME MEASURES: A Runs test was applied to compare EEG "hits" in the receiver's EEG during the sender' stimulus-on condition versus sender's stimulus-off conditions. Test results at p < 0.01 were considered evidence of correlated brain signals. Pairs in whom at least one member had significant results were invited back for replication. RESULTS: Of the 60 subjects tested, 5 (4 women/1 man) showed significantly higher brain activation (p < 0.01) during their sending partner's stimulus-on condition as compared to stimulus-off condition. Using the Stouffer z meta-analytic method all receiver EEG results across all 60 subjects were combined by transforming the individual session p values into z scores. Data analyses showed overall significant results for EEG data recorded during the flickering condition (z =-3.28, p = 0.0005) as well as nonsignificant results for data recorded during the static condition (z = 0.35, p = 0.64). Four pairs participated in a replication experiment during which one pair replicated the effect. CONCLUSIONS: These results indicate that in some pairs of human subjects a signal may be detected in the brain of a distant member of the pair when the brain of the other member is visually stimulated. These data support the findings of similar studies performed in seven laboratories reported in the peer-reviewed literature since 1963. Research in this area should now proceed with investigation of its physical and biologic mechanism, its generalizability to varying populations and relationships, and its clinical application.

A survey of the use of complementary and alternative medicine in Illinois hospice and palliative care organizations.

This research assesses complementary and alternative medicine (CAM) use and administration for patients and family caregivers in Illinois hospice and palliative care organizations. An online survey was administered to a sample of 108 contacts of Illinois organizations listed in the National Hospice and Palliative Care Organization website, and 90.3% of the responding organizations offered some type of CAM. The top 5 most frequently offered CAM modalities to patients were pet therapy (64.5%), music therapy (61.3%), massage therapy (54.8%), art therapy (29.0%), and energy therapies (25.8%); these were the same top 5 offered to families but with different frequencies. Findings regarding utilization, administration, financing, and spiritual/cultural competency are discussed with policy recommendations for data collection, administrative improvements, and integration of CAM providers into service delivery.

A survey of complementary and alternative medicine (CAM) awareness among neurosurgeons in Washington State.

OBJECTIVES: Use of complementary and alternative medicine (CAM) by the U.S. population increased significantly in the past 2 decades. To maximize a patient's recovery from a neurosurgical procedure, it is critical that neurosurgeons be aware of the benefits and potential adverse complications of CAM therapies. The survey's purpose was to assess the current patterns of CAM utilization by neurosurgery patients and neurosurgeon knowledge of CAM therapies among Washington State Association of Neurological Surgeons (WSANS) members. METHODS: Members of the WSANS were surveyed in 2005. The survey was sent via e-mail and the data were anonymously collected using an online survey tool, Catalyst WebQ. RESULTS: The majority of responses (79%) stated that their neurosurgery practice was > or =75% adults. Acupuncture, herbs, massage therapy, prayer, and yoga were the most common CAM treatments patients used or discussed with their neurosurgeon. Fifty percent (50%) of neurosurgeons discussed the use of acupuncture among their colleagues. Concerning prayer and spirituality, 38% of the surveyed neurosurgeons stated that > or =25% of their patients have disclosed that they pray for their health; 42% stated that spirituality and prayer may affect neurosurgery outcome; and 38% stated that they pray for their patients. Overall, 63% of surveyed neurosurgeons stated that CAM treatments have a role in neurosurgery. CONCLUSIONS: The use of CAM may influence neurosurgical care; and the role of spirituality and prayer should be further explored. Because CAM utilization is ubiquitous, open discussion and familiarity with CAM treatments are becoming increasingly important in the field of neurosurgery.

Three lessons from a randomized trial of massage and meditation at end of life: patient benefit, outcome measure selection, and design of trials with terminally ill patients.

Improving end-of-life care is a priority in the United States, but assigning priorities for standard care services requires evaluations using appropriate study design and appropriate outcome indicators. A recent randomized controlled trial with terminally ill patients produced no evidence of benefit from massage or guided meditation, when evaluated with measures of global quality of life or pain distress over the course of patient participation. However, reanalysis using a more targeted outcome, surrogates' assessment of patients' benefit from the study intervention, suggested significant gains from massage-the treatment patients gave their highest preassignment preference ratings. The authors conclude that adding a menu of complementary therapies as part of standard end-of-life care may yield significant benefit, that patient preference is an important predictor of outcome, and that modifications in trial design may be appropriate for end-of-life studies.

Use of complementary and alternative medicine (CAM) by Washington State hospices.

PURPOSE: To assess the use of complementary and alternative medicine in hospice care in the state of Washington. METHODS: Hospices offering inpatient and outpatient care in Washington State were surveyed by phone interview. RESULTS: Response rate was 100%. Results indicated that 86% of Washington State hospices offered complementary and alternative services to their patients, most frequently massage (87%), music therapy (74%), energy healing (65%), aromatherapy (45%), guided imagery (45%), compassionate touch (42%), acupuncture (32%), pet therapy (32%), meditation (29%), art therapy (22%), reflexology (19%), and hypnotherapy (16%). Most hospices relied on volunteers with or without small donations to offer such services. CONCLUSIONS: Complementary and alternative therapies are widely used by Washington State hospices but not covered under hospice benefits. Extensive use of these therapies seems to warrant the inclusion of complementary and alternative providers as part of hospice staff, and reimbursement schedules need to be integrated into hospice care.