KORN KURATED RESEARCH

Integrative Medicine for End-of-Life Care

As the demand for integrative care grows, therapies like aromatherapy, yoga, and animal-assisted therapy offer comfort and peace to those nearing the end of life. These healing practices offer a compassionate way to ease symptoms and enhance well-being in the final stages of life.

There are many reasons why people seek treatment with natural medicines and desire an integrative approach to care at the end of life. Major symptoms at this stage include pain, depression, anxiety, insomnia, and digestive issues such as lack of appetite, gastroparesis, and nausea. Often, people seek alternatives to medications that cause side effects. Near the end of life, individuals may wish to balance comfort and consciousness.

The demand for integrative medicine in end-of-life and palliative care is growing, even though research and care delivery have been somewhat slow to keep pace. I am pleased to share the following research on end-of-life care that informs our work. 

Stay tuned—I’m about to launch a 3-hour course on this topic, which will eventually expand into a certification training.

Among the most common therapies used at the end of life are acupressure, acupuncture, aromatherapy, massage, breathing techniques, hypnotherapy, meditation, music therapy, reflexology, and reiki. The first article in this post is a slightly older review, offering an overview of CAM in hospice and palliative care. It found short-term benefits but questioned long-term effects. My response: We’re actually seeking short-term benefits!

One of the handouts I created for my upcoming End of Life course is an intake form that explores options with patients and their families, especially those who may not be familiar with CAM/integrative options, allowing for meaningful dialogue.

Find here a glossary of terms I developed to understand words and language in this emerging field.

One of the easiest ways to introduce CAM options is through aromatherapy. The second article explores the role of lemon aromatherapy, which has long been used to reduce nausea, improve digestion, and enhance mood. This study examines its efficacy in alleviating nausea.

The third article discusses the significant research supporting yoga in cancer treatment. A large meta-study found that yoga improved physical and psychological symptoms, quality of life, and immune markers in patients.

The fourth article is particularly close to my heart. Having worked with therapy dogs and dementia patients, I can attest to the well-being they bring to those nearing the end of life, especially those with dementia, for whom nonverbal, positive interactions are most meaningful. This qualitative study explores dog handlers' observations of the benefits of dog-assisted interventions with dementia patients. I always appreciate reading qualitative studies, as they offer real human experiences and highlight the importance of empirical narrative.

Tags: Complementary and alternative medicine, end-of-life care, aromatherapy, music therapy, animal-assisted therapy

Interested in Learning More?

• Course(s): Diabetes Type 2, Cognitive Decline, and Alzheimer’s
• Course(s): Mental Health Disorders
• Book(s): Rhythms of Recovery
• Book(s): The Brainbow Blueprint

Referenced Research Publications

Journal of pain and symptom management
2018, November 05
DOI: 10.1016/j.jpainsymman.2018.07.016

Complementary and Alternative Medicine in Hospice and Palliative Care: A Systematic Review

Abstract

Context: The aim of palliative care is to improve quality of life for patients with serious illnesses by treating their symptoms and adverse effects. Hospice care also aims for this for patients with a life expectancy of six months or less. When conventional therapies do not provide adequate symptom management or produce their own adverse effects, patients, families, and caregivers may prefer complementary or alternative approaches in their care.

Objectives: The objectives of this study were to evaluate the available evidence on the use of complementary or alternative medicine (CAM) in hospice and palliative care and to summarize their potential benefits.

Methods: A defined search strategy was used in reviewing literature from major databases. Searches were conducted using base terms and the symptom in question. Symptoms included anxiety, pain, dyspnea, cough, fatigue, insomnia, nausea, and vomiting. Studies were selected for further evaluation based on relevancy and study type. References of systematic reviews were also assessed. After evaluation using quality assessment tools, findings were summarized and the review was structured based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Out of 4682 studies, 17 were identified for further evaluation. Therapies included acupressure, acupuncture, aromatherapy massage, breathing, hypnotherapy, massage, meditation, music therapy, reflexology, and reiki. Many studies demonstrated a short-term benefit in symptom improvement from baseline with CAM, although a significant benefit was not found between groups.

Conclusion: CAM may provide a limited short-term benefit in patients with symptom burden. Additional studies are needed to clarify the potential value of CAM in the hospice or palliative setting.

Keywords: Complementary therapy; alternative therapy; hospice care; palliative care; review; symptom management.

Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Reference

Zeng, Y. S., Wang, C., Ward, K. E., & Hume, A. L. (2018). Complementary and Alternative Medicine in Hospice and Palliative Care: A Systematic Review. Journal of pain and symptom management, 56(5), 781–794.e4. https://doi.org/10.1016/j.jpainsymman.2018.07.016

Cancers
2022, April 24
DOI: 10.3390/cancers14092131

Aromatherapy in Palliative Care: A Single-Institute Retrospective Analysis Evaluating the Effect of Lemon Oil Pads against Nausea and Vomiting in Advanced Cancer Patients

Abstract

Aromatherapy is regularly used in the University Hospital Krems's palliative care unit. In a retrospective analysis, we investigated whether there were improvements in nausea and vomiting in patients with advanced cancers over a time span of 24 months. Data collection used the medical records of patients who were institutionally approved to receive routine aroma applications for alleviating nausea and vomiting. The efficacy of using lemon oil pads was tested with one-dimensional chi-squared tests. Sixty-six patients received 222 applications of lemon oil on cotton pads; no data were available for 17 applications. The adequate relief of nausea and vomiting was reported for 149 (73%) applications, whereas no symptom control was seen for 56 (27%) applications. For the 56 applications without symptom control, first- and second-line rescue medications were successful in 53 and 3 cases, respectively. The use of aromatherapy with lemon oil pads against nausea and vomiting was feasible for 73% of all applications. All patients who did not benefit from aromatherapy had effective symptom control with a rescue medication. Large randomized prospective trials are necessary to evaluate the benefit of the use of lemon oil pads against nausea and vomiting in patients with advanced cancer.

Keywords: antiemetic; aromatherapy; nausea; palliative care; vomiting.

Reference

Kreye, G., Wasl, M., Dietz, A., Klaffel, D., Groselji-Strele, A., Eberhard, K., & Glechner, A. (2022). Aromatherapy in Palliative Care: A Single-Institute Retrospective Analysis Evaluating the Effect of Lemon Oil Pads against Nausea and Vomiting in Advanced Cancer Patients. Cancers, 14(9), 2131. https://doi.org/10.3390/cancers14092131

International journal of yoga
Jan–Apr 2018
DOI: 10.4103/ijoy.IJOY_42_17

Yoga into Cancer Care: A Review of the Evidence-based Research

Abstract

To cope with cancer and its treatment-related side effects and toxicities, people are increasingly using complementary and alternative medicine (CAM). Consequently, integrative oncology, which combines conventional therapies and evidence-based CAM practices, is an emerging discipline in cancer care. The use of yoga as a CAM is proving to be beneficial and increasingly gaining popularity. An electronic database search (PubMed), through December 15, 2016, revealed 138 relevant clinical trials (single-armed, nonrandomized, and randomized controlled trials) on the use of yoga in cancer patients. A total of 10,660 cancer patients from 20 countries were recruited in these studies. Regardless of some methodological deficiencies, most of the studies reported that yoga improved the physical and psychological symptoms, quality of life, and markers of immunity of the patients, providing a strong support for yoga's integration into conventional cancer care. This review article presents the published clinical research on the prevalence of yoga's use in cancer patients so that oncologists, researchers, and the patients are aware of the evidence supporting the use of this relatively safe modality in cancer care.

Keywords: Cancer; complementary and alternative medicine; integrative medicine; meditation; mindfulness-based stress reduction; yoga.

Reference

Agarwal, R. P., & Maroko-Afek, A. (2018). Yoga into Cancer Care: A Review of the Evidence-based Research. International journal of yoga, 11(1), 3–29. https://doi.org/10.4103/ijoy.IJOY_42_17

International journal of palliative nursing
2019, February 02
DOI: 10.12968/ijpn.2019.25.2.65

Dog handlers' experiences of therapy dogs' impact on life near death for persons with dementia

Abstract

Background:: Persons with dementia may have severe physical and psychological symptoms at the end of life. A therapy dog used in their care can provide comfort and relieve their anxiety. The dog handler guides the dog during the interaction with the patient.

Aim:: To describe the impact of therapy dogs on people with dementia in the final stages of life from the perspective of the dog handler.

Methods:: Interviews were conducted and analysed using qualitative content analysis.

Findings:: The dog provides comfort and relief through its presence and by responding to the physical and emotional expressions of the dying person.

Conclusions:: Interactions with dogs were found to have a positive impact on persons with dementia and eased the symptoms associated with end of life according to the dog handlers.

Keywords: Animal-assisted therapy; Dementia; Palliative care; Therapy dog.

Reference

Swall, A., Craftman, Å., Grundberg, Å., Wiklund, E., Väliaho, N., & Hagelin, C. L. (2019). Dog handlers' experiences of therapy dogs' impact on life near death for persons with dementia. International journal of palliative nursing, 25(2), 65–71. https://doi.org/10.12968/ijpn.2019.25.2.65

Journal of hospice and palliative nursing : JHPN : the official journal of the Hospice and Palliative Nurses Association
2021, August 01
DOI: 10.1097/NJH.0000000000000747

Music Therapy and Nursing Cotreatment in Integrative Hospice and Palliative Care

Abstract

Integrative hospice and palliative care is a philosophy of treatment framing patients as whole persons composed of interrelated systems. The interdisciplinary treatment team is subsequently challenged to consider ethical and effective provision of holistic services that concomitantly address these systems at the end of life through cotreatment. Nurses and music therapists, as direct care professionals with consistent face-to-face contact with patients and caregivers, are well positioned to collaborate in providing holistic care. This article introduces processes of referral, assessment, and treatment that nurses and music therapists may engage in to address family support, spirituality, bereavement, and telehealth. Clinical vignettes are provided to illustrate how cotreatment may evolve and its potential benefits given diverse circumstances. As part of this framing, music therapy is positioned as a core-rather than alternative or complementary-service in hospice that satisfies the required counseling services detailed in Medicare's Conditions of Participation for hospice providers. The systematic and intentional partnering of nurses and music therapists can provide patients and caregivers access to quality comprehensive care that can cultivate healthy transitions through the dying process.

Copyright © 2021 by The Authors. Published by Wolters Kluwer Health, Inc.

Reference

Potvin, N., Hicks, M., & Kronk, R. (2021). Music Therapy and Nursing Cotreatment in Integrative Hospice and Palliative Care. Journal of hospice and palliative nursing : JHPN : the official journal of the Hospice and Palliative Nurses Association, 23(4), 309–315. https://doi.org/10.1097/NJH.0000000000000747

BMC primary care
2023, April 15
DOI: 10.1186/s12875-023-02049-x

Use of preventive medication and supplements in general practice in patients in their last year of life: a Retrospective cohort study

Abstract

Background: Several preventive medications and supplements become inappropriate in the last phase of life due to increased risk of adverse events caused by changed pharmacokinetics, drug-drug interactions, and changed care goals. Information on these preventive medication and supplements use in patients with a life-limiting illness in the home-care setting is limited. The primary aim of this study was to assess the use of four different groups of preventive drugs and supplements, which are inappropriate in adult patients with a life-limiting illness, living at home in the last year of life. The secondary aims were to assess reasons for discontinuing these drugs as documented in the general practitioners' patient file and whether these reasons affected the time between medication discontinuation and death.

Methods: We performed a retrospective cohort study using the routine primary care database of the Julius General Practitioners' Network of the University Medical Centre Utrecht, a database consisting of routine care data from GPs from the city of Utrecht and its vicinity. Patients in the homecare setting with a life-limiting illness, diagnosed at least one year before death, were included. Descriptive analyses were used to describe the study population and the frequency of starting, using, and discontinuing medication and supplements in the last year of life.

Results: A total of 458 of 666 included patients (69%) used at least one preventive drug in the last year of life. Vitamins were used by 36% of the patients, followed with 35% using cholesterol-lowering medication, 24% using calcium supplements and 9% using bisphosphonates. Bisphosphonates were discontinued by 70% of the users, calcium supplements by 61%, vitamins by 56% and cholesterol-lowering medication by 48% of the users, with a median interval between day of discontinuation and death of 119, 60, 110 and, 65 days, respectively. The median time between medication or supplement discontinuation and death was longest in patients with side effects and who had medication reviews.

Conclusion: Many patients in their last phase of life in the home-care setting use inappropriate medication and supplements. Timely medication review may contribute to optimise medication use in the last year of life.

Keywords: Discontinuing; Home-care setting; Inappropriate drugs; Life-limiting illness; Palliative care; Preventive medication use.

© 2023. The Author(s).

Reference

Antonisse, A., van der Baan, F. H., Grant, M., Uyttewaal, G., Verboeket, C., Smits-Pelser, H., Teunissen, S. C. C. M., & Geijteman, E. C. T. (2023). Use of preventive medication and supplements in general practice in patients in their last year of life: a Retrospective cohort study. BMC primary care, 24(1), 101. https://doi.org/10.1186/s12875-023-02049-x