Implementation and outcomes of complementary therapies in hospice care: an integrative review

Abstract

Complementary therapies are increasingly integrated into hospice care, emphasizing the need to examine the evidence regarding implementation and effects on end-of-life outcomes. This review synthesizes the evidence regarding the implementation of complementary therapies and effects on end-of-life outcomes in hospice care. Whittemore and Knafl’s five-step integrative review process was applied. Using predefined search terms, research-based articles between 2006 and 2020 were reviewed. Twenty-three quantitative/mixed method studies conducted across eight countries met the final review criteria. Most commonly used complementary therapies were music, biofield therapies (reiki, therapeutic touch), and massage therapy. Most studies reported significant findings on physical symptoms (pain, dyspnea, fatigue, gastrointestinal symptoms, agitation) and/or psychosocial/spiritual symptoms (anxiety, depression, spirituality, well-being, quality of life); 40% of studies had both significant and nonsignificant findings. Methodological limitations included study design (few randomized controlled trials), small sample size, high attrition rate, lack of racial/ethnic diversity, unstandardized intervention implementation, and multiple outcome measurement instruments. Complementary therapies are promising components of hospice care; however, rigorous studies are needed to validate the effect on end-of-life outcomes and determine the most efficacious implementation. Complementary therapy studies face challenges consistent with end-of-life research; however, efforts to design rigorous trials and address methodological issues are required to enhance the state of the science.

“Before I came to the hospice, I had nobody”. A qualitative exploration of what patients, family-caregivers, clinicians and volunteers valued most about home, day therapy or inpatient hospice services

“…Dingley et al . 18 in their integrative review reported that a number of studies revealed statistically significant improvements in symptoms such as pain and discomfort following patient access to biofield therapies such as massage and acupuncture. Subsequently, it is important that hospice care provision continues to offer access to non-traditional forms of treatments for both patients and family-caregivers.…”

Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory

“…A range of mind-body and other complementary therapies are also quite often used with people living with advanced cancers. This literature was summarized in a 2021 review, which synthesized the evidence regarding the implementation of complementary therapies on end-of-life outcomes in hospice care (Dingley et al 2021). Twenty-three quantitative or mixed-method studies across eight countries were included.…”

Effects of Music on the Quality of Life of Family Caregivers of Terminal Cancer Patients: A Randomised Controlled Trial

“…Focusing on caregivers of patients with advanced cancer, it has been previously shown that music has benefits on symptoms of anxiety, fatigue, depression, and blood volume pulse amplitude [28,29]. However, despite the importance of quality of life as a health indicator, to our knowledge, no previous clinical trials have been performed to evaluate the advantages of music for family caregivers of palliative-care patients in the home [30].…”