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Date received by Delegate: February 9th, 2009
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Name of Originator: Lisa Curran Parenteau
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AMTA ID#:148253 |
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Day phone: 617-797-7990
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Evening phone: 508-539-7099
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Fax: 508-539-7099
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Email: lisaparenteau@gmail.com
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Name of Originator: Mary White
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AMTA ID#:10631 |
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Day phone: 978-807-8245
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Evening phone: 978-807-8245
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Fax: N/A
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Email: mary@mmtcenter.com
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Name of Originator: Kelly Dalbec
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AMTA ID#:48333 |
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Day phone: 508-886-6242
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Evening phone: 508-886-6242
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Fax: N/A
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Email: dalbecs@peoplepc.com
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Name of Delegate: Lisa Curran Parenteau
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Day phone: 617-797-7990
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Evening phone: 508-539-7099
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Fax: 508-539-7099
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Email: lisaparenteau@gmail.com
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Background information
-
Recently published
studies confirm that massage therapy
is becoming the most frequently offered complementary
therapy in hospice and palliative care
1,2, and National Hospice and Palliative Care
(NHPCO) reveals that 38.8% of all U.S. deaths were in
hospice care in 20073 - a year in which an
estimated 1.4 million Americans received such care3.
The
quality of life for people in hospice and palliative
care is often compromised. Research has shown that
massage therapy can provide comfort6,12,13
and relaxation8,14,7 and help alleviate the
following symptoms and conditions commonly associated
with this population:
- pain
4,5,6,7
- anxiety
9,6,7,10
- loss of
sleep 7,11,9
- depression,
mood disorders 4,8,10
- stress
6,11
- nausea
6,7
- fatigue
7,8,10
Rationale
There is a strong and verifiable correlation between the effects of massage therapy and the well being of those in hospice and palliative care.
The position
statement supports the following AMTA Core Values:
- We are a diverse and nurturing community working with integrity,
honesty and dignity.
- We believe that massage benefits all.
- We embrace excellence in education, service, and leadership.
This position statement also supports the American Massage Therapy Association's 10 to 30 year vision:
- The public will view professional massage as an important contribution toward wellness, and will receive massage on a regular basis.
- People recognize the power of touch to affect the mind/body/spirit continuum.
- AMTA will be a trusted resource for information about massage therapy and current research.
- There will be significant information in scientific literature on the use, safety and effects of therapeutic massage.
- Massage therapy practice will be evidence-based.
- The role of massage therapy will be expanded in all practice settings
- AMTA will be instrumental in creating a climate conducive for members’ professional success.
- There will be international recognition for the value of massage.
All societies will be educated and accept massage
therapy and AMTA will be a global networking resource
for massage therapy and therapists.
This position statement is closely aligned with AMTA’s strategic plan directive of Industry Relationships.
Goal: AMTA members have the competencies, skills and professionalism to be successful.
Objective: Expand the understanding of the processes for building professional competency.
Finally, this position statement strengthens AMTA’s role as a collaborative partner with health care providers in traditional health care settings.
Position Statement
It is the position of the American Massage Therapy Association (AMTA) that
massage therapy can improve the quality of life for those in hospice and palliative care.
References
-
Kozak L.E., Kayes L., McCarty R., Walkinshaw C.,
Congdon S., Kleinberger J., Hartman V., Standish
L.J. (2008) Use of complementary and alternative
medicine (CAM) by Washington State hospices.
The American Journal of Hospice & Palliative
Care. Dec-2009 Jan;25(6):463-8.
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.
-
Oneschuk D., Balneaves L., Verhoef M., Boon H.,
Demmer C., Chiu L. (2007) The status of
complementary therapy services in Canadian
palliative care settings. Support Care
Cancer. Aug;15(8):939-47. Epub 2007 Jul 3.
GOAL OF WORK: Little is known about
complementary therapy services (CTs) available
in Canadian palliative care settings.
MATERIALS AND METHODS: An online survey was
e-mailed to multiple Canadian palliative care
settings to determine the types and frequency of
CTs provided and allowed, who are the CT
providers, funding of CT services, and barriers
to the provision of CTs.
MAIN RESULTS: The response rate was 54%
(74/136). Eleven percent of surveyed palliative
care settings provided CTs, and 45% allowed CTs
to be brought in or to be used by patients. The
three most commonly used CTs were music (57%),
massage therapy (57%), and therapeutic touch
(48%). Less than 25% of patients received CTs in
the settings that provided and/or allowed these
therapies. CTs were mostly provided by
volunteers, and at most settings, limited or no
funding was available. Barriers to the delivery
of CTs included lack of funding (67%),
insufficient knowledge of CTs by staff (49%),
and limited knowledge on how to successfully
operate a CT service (44%). For settings that
did not provide or allow CTs, 44% felt it was
important or very important for their patients
to have access to CTs. The most common reasons
not to provide or allow CTs were insufficient
staff knowledge of CTs (67%) and lack of CT
personnel (44%).
CONCLUSIONS: Overall, these findings were
similar to those reported in a US-based hospice
survey after which this survey was patterned.
Possible reasons for these shared findings and
important directions regarding the future of CT
service provision in Canadian palliative care
setting are discussed.
-
NHPCO Facts and Figures: Hospice Care in
America. Alexandria, VA: National Hospice and
Palliative Care Organization, October (2008).
-
Kutner J.S., Smith M.C., Corbin L., Hemphill L.,
Benton K., Mellis B.K., Beaty B., Felton S.,
Yamashita T.E., Bryant L.L., Fairclough D.L.
(2008) Massage therapy versus simple touch to
improve pain and mood in patients with advanced
cancer: a randomized trial. Annals of
Internal Medicine. Sep 16;149(6):369-79.
BACKGROUND: Small studies of variable quality
suggest that massage therapy may relieve pain
and other symptoms.
OBJECTIVE: To evaluate the efficacy of massage
for decreasing pain and symptom distress and
improving quality of life among persons with
advanced cancer. DESIGN: Multisite, randomized
clinical trial.
SETTING: Population-based Palliative Care
Research Network. PATIENTS: 380 adults with
advanced cancer who were experiencing
moderate-to-severe pain; 90% were enrolled in
hospice. INTERVENTION: Six 30-minute massage or
simple-touch sessions over 2 weeks.
MEASUREMENTS: Primary outcomes were immediate
(Memorial Pain Assessment Card, 0- to 10-point
scale) and sustained (Brief Pain Inventory
[BPI], 0- to 10-point scale) change in pain.
Secondary outcomes were immediate change in mood
(Memorial Pain Assessment Card) and 60-second
heart and respiratory rates and sustained change
in quality of life (McGill Quality of Life
Questionnaire, 0- to 10-point scale), symptom
distress (Memorial Symptom Assessment Scale, 0-
to 4-point scale), and analgesic medication use
(parenteral morphine equivalents [mg/d]).
Immediate outcomes were obtained just before and
after each treatment session. Sustained outcomes
were obtained at baseline and weekly for 3
weeks.
RESULTS: 298 persons were included in the
immediate outcome analysis and 348 in the
sustained outcome analysis. A total of 82
persons did not receive any allocated study
treatments (37 massage patients, 45 control
participants). Both groups demonstrated
immediate improvement in pain (massage, -1.87
points [95% CI, -2.07 to -1.67 points]; control,
-0.97 point [CI, -1.18 to -0.76 points]) and
mood (massage, 1.58 points [CI, 1.40 to 1.76
points]; control, 0.97 point [CI, 0.78 to 1.16
points]). Massage was superior for both
immediate pain and mood (mean difference, 0.90
and 0.61 points, respectively; P < 0.001). No
between-group mean differences occurred over
time in sustained pain (BPI mean pain, 0.07
point [CI, -0.23 to 0.37 points]; BPI worst
pain, -0.14 point [CI, -0.59 to 0.31 points]),
quality of life (McGill Quality of Life
Questionnaire overall, 0.08 point [CI, -0.37 to
0.53 points]), symptom distress (Memorial
Symptom Assessment Scale global distress index,
-0.002 point [CI, -0.12 to 0.12 points]), or
analgesic medication use (parenteral morphine
equivalents, -0.10 mg/d [CI, -0.25 to 0.05
mg/d]).
LIMITATIONS: The immediate outcome measures were
obtained by unblinded study therapists, possibly
leading to reporting bias and the overestimation
of a beneficial effect. The generalizability to
all patients with advanced cancer is uncertain.
The differential beneficial effect of massage
therapy over simple touch is not conclusive
without a usual care control group.
CONCLUSION: Massage may have immediately
beneficial effects on pain and mood among
patients with advanced cancer. Given the lack of
sustained effects and the observed improvements
in both study groups, the potential benefits of
attention and simple touch should also be
considered in this patient population.
-
Chang S.Y. (2008) Effects of aroma hand massage
on pain, state anxiety and depression in hospice
patients with terminal cancer. Taehan
Kanho Hakhoe Chi. Aug;38(4):493-502. Korean.
(Journal of Korean Academy of Nursing.)
PURPOSE: The purpose of this study was to
examine the effects of aroma hand massage on
pain, state anxiety and depression in hospice
patients with terminal cancer.
METHODS: This study was a nonequivalent control
group pretest-posttest design. The subjects were
58 hospice patients with terminal cancer who
were hospitalized. Twenty eight hospice patients
with terminal cancer were assigned to the
experimental group (aroma hand massage), and 30
hospice patients with terminal cancer were
assigned to the control group (general oil hand
massage). As for the experimental treatment, the
experimental group went through aroma hand
massage on each hand for 5 min for 7 days with
blended oil-a mixture of Bergamot, Lavender, and
Frankincense in the ratio of 1:1:1, which was
diluted 1.5% with sweet almond carrier oil 50
ml. The control group went through general oil
hand massage by only sweet almond carrier oil-on
each hand for 5 min for 7 days.
RESULTS: The aroma hand massage experimental
group showed more significant differences in the
changes of pain score (t=-3.52, p=.001) and
depression (t=-8.99, p=.000) than the control
group.
CONCLUSION: Aroma hand massage had a positive
effect on pain and depression in hospice
patients with terminal cancer.
-
Lafferty W.E., Downey L., McCarty R.L., Standish
L.J., Patrick D.L. (2006) Evaluating CAM
treatment at the end of life: a review of
clinical trials for massage and meditation.
Complementary Therapeutic Medicine.
Jun;14(2):100-12.
BACKGROUND: There is a pressing need for
improved end-of-life care. Use of complementary
and alternative medicine (CAM) may improve the
quality of care but few controlled trials have
evaluated CAM at the end of life.
OBJECTIVES: To determine the strength of
evidence for the benefits of touch and mind-body
therapies in seriously ill patients.
METHODS: Systematic review of randomized
controlled trials of massage and mind-body
therapies. A PubMed search of English language
articles was used to identify the relevant
studies.
RESULTS: Of 27 clinical trials testing massage
or mind-body interventions, 26 showed
significant improvements in symptoms such as
anxiety, emotional distress, comfort, nausea and
pain. However, results were often inconsistent
across studies and there were variations in
methodology, so it was difficult to judge the
clinical significance of the results.
CONCLUSIONS: Use of CAM at the end of life is
warranted on a case-by-case basis. Limitations
in study design and sample size of the trials
analyzed mean that routine use of CAM cannot be
supported. There are several challenges to be
addressed in future research into the use of CAM
in end-of-life patients.
-
Russell N.C., Sumler S.S., Beinhorn C.M.,
Frenkel M.A. (2008) Role of massage therapy in
cancer care. Journal of Alternative
and Complementary Medicine.
Mar;14(2):209-14.
The care of patients with cancer not only
involves dealing with its symptoms but also with
complicated information and uncertainty;
isolation; and fear of disease progression,
disease recurrence, and death. Patients whose
treatments require them to go without human
contact can find a lack of touch to be an
especially distressing factor. Massage therapy
is often used to address these patients' need
for human contact, and findings support the
positive value of massage in cancer care.
Several reviews of the scientific literature
have attributed numerous positive effects to
massage, including improvements in the quality
of patients' relaxation, sleep, and immune
system responses and in the relief of their
fatigue, pain, anxiety, and nausea. On the basis
of these reviews, some large cancer centers in
the United States have started to integrate
massage therapy into conventional settings. In
this paper, we recognize the importance of
touch, review findings regarding massage for
cancer patients, describe the massage therapy
program in one of these centers, and outline
future challenges and implications for the
effective integration of massage therapy in
large and small cancer centers.
-
Cheesman S., Christian R., Cresswell J. (2001)
Exploring the value of shiatsu in palliative
care day services. International
Journal of Palliative Nursing.
May;7(5):234-9.
This qualitative study sought to evaluate the
effects of shiatsu therapy on clients attending
hospice day services. Eleven clients with
advanced progressive disease received five
therapy sessions each at weekly intervals. Data
about the effects was collected through five
unstructured interviews with each client. Four
of these were conducted before, during, and
shortly after the therapy regime, and the fifth
was undertaken four weeks after treatment ended.
All the interviews were tape-recorded,
transcribed and subject to content analysis. The
results of the analysis revealed significant
improvements in energy levels, relaxation,
confidence, symptom control, clarity of thought
and mobility. These benefits were of variable
duration - in some instances lasting a few hours
but in others extending beyond the 5-week
treatment regime. Action to ensure research
trustworthiness included keeping research
journals to provide an audit trail, conducting
member checks and using peer debriefing. The
study involved three overlapping cohorts of
participants in a data collection period that
took approximately 6 months.
-
Meeks T.W., Wetherell J.L., Irwin M.R., Redwine
L.S., Jeste D.V. (2007) Complementary and
alternative treatments for late-life depression,
anxiety, and sleep disturbance: a review of
randomized controlled trials. Journal
of Clinical Psychiatry. Oct;68(10):1461-71.
OBJECTIVE: We reviewed randomized controlled
trials of complementary and alternative medicine
(CAM) treatments for depression, anxiety, and
sleep disturbance in nondemented older adults.
DATA SOURCES: We searched PubMed (1966-September
2006) and PsycINFO (1984-September 2006)
databases using combinations of terms including
depression, anxiety, and sleep; older
adult/elderly; randomized controlled trial; and
a list of 56 terms related to CAM.
STUDY SELECTION: Of the 855 studies identified
by database searches, 29 met our inclusion
criteria: sample size >or= 30, treatment
duration >or= 2 weeks, and publication in
English. Four additional articles from manual
bibliography searches met inclusion criteria,
totaling 33 studies. DATA EXTRACTION: We
reviewed identified articles for methodological
quality using a modified Scale for Assessing
Scientific Quality of Investigations (SASQI). We
categorized a study as positive if the CAM
therapy proved significantly more effective than
an inactive control (or as effective as active
control) on at least 1 primary psychological
outcome. Positive and negative studies were
compared on the following characteristics: CAM
treatment category, symptom(s) assessed, country
where the study was conducted, sample size,
treatment duration, and mean sample age.
DATA SYNTHESIS: 67% of the 33 studies reviewed
were positive. Positive studies had lower SASQI
scores for methodology than negative studies.
Mind-body and body-based therapies had somewhat
higher rates of positive results than energy- or
biologically-based therapies.
CONCLUSIONS: Most studies had substantial
methodological limitations. A few well-conducted
studies suggested therapeutic potential for
certain CAM interventions in older adults (e.g.,
mind-body interventions for sleep disturbances
and acupressure for sleep and anxiety). More
rigorous research is needed, and suggestions for
future research are summarized.
- Mansky P.J., Wallerstedt D.B. (2006)
Complementary medicine in palliative care and
cancer symptom management. Cancer Journal.
Sep-Oct;12(5):425-31.
Complementary and alternative medicine (CAM) use
among cancer patients varies according to
geographical area, gender, and disease
diagnosis. The prevalence of CAM use among
cancer patients in the United States has been
estimated to be between 7% and 54%. Most cancer
patients use CAM with the hope of boosting the
immune system, relieving pain, and controlling
side effects related to disease or treatment.
Only a minority of patients include CAM in the
treatment plan with curative intent. This review
article focuses on practices belonging to the
CAM domains of mind-body medicine, CAM
botanicals, manipulative practices, and energy
medicine, because they are widely used as
complementary approaches to palliative cancer
care and cancer symptom management. In the area
of cancer symptom management, auricular
acupuncture, therapeutic touch, and hypnosis may
help to manage cancer pain. Music therapy,
massage, and hypnosis may have an effect on
anxiety, and both acupuncture and massage may
have a therapeutic role in cancer fatigue.
Acupuncture and selected botanicals may reduce
chemotherapy-induced nausea and emesis, and
hypnosis and guided imagery may be beneficial in
anticipatory nausea and vomiting. Transcendental
meditation and the mindfulness-based stress
reduction can play a role in the management of
depressed mood and anxiety. Black cohosh and
phytoestrogen-rich foods may reduce vasomotor
symptoms in postmenopausal women. Most CAM
approaches to the treatment of cancer are safe
when used by a CAM practitioner experienced in
the treatment of cancer patients. The potential
for many commonly used botanical to interact
with prescription drugs continues to be a
concern. Botanicals should be used with caution
by cancer patients and only under the guidance
of an oncologist knowledgeable in their use.
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Soden K., Vincent K., Craske S., Lucas C.,
Ashley S. (2004) A randomized controlled trial
of aromatherapy massage in a hospice setting.
Palliative Medicine. Mar;18(2):87-92.
Research suggests that patients with cancer,
particularly in the palliative care setting, are
increasingly using aromatherapy and massage.
There is good evidence that these therapies may
be helpful for anxiety reduction for short
periods, but few studies have looked at the
longer-term effects. This study was designed to
compare the effects of four-week courses of
aromatherapy massage and massage alone on
physical and psychological symptoms in patients
with advanced cancer. Forty-two patients were
randomly allocated to receive weekly massages
with lavender essential oil and an inert carrier
oil (aromatherapy group), an inert carrier oil
only (massage group) or no intervention. Outcome
measures included a Visual Analogue Scale (VAS)
of pain intensity, the Verran and Snyder-Halpern
(VSH) sleep scale, the Hospital Anxiety and
Depression (HAD) scale and the Rotterdam Symptom
Checklist (RSCL). We were unable to demonstrate
any significant long-term benefits of
aromatherapy or massage in terms of improving
pain control, anxiety or quality of life.
However, sleep scores improved significantly in
both the massage and the combined massage
(aromatherapy and massage) groups. There were
also statistically significant reductions in
depression scores in the massage group. In this
study of patients with advanced cancer, the
addition of lavender essential oil did not
appear to increase the beneficial effects of
massage. Our results do suggest, however, that
patients with high levels of psychological
distress respond best to these therapies.
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Magill L., Berenson S. (2008) The conjoint use
of music therapy and reflexology with
hospitalized advanced stage cancer patients and
their families. Palliative & Supportive Care.
Sep;6(3):289-96.
Advanced stage cancer patients experience
debilitating physical symptoms as well as
profound emotional and spiritual struggles.
Advanced disease is accompanied by multiple
changes and losses for the patient and the
family. Palliative care focuses on the relief of
overall suffering of patients and families,
including symptom control, psychosocial support,
and the meeting of spiritual needs. Music
therapy and reflexology are complementary
therapies that can soothe and provide comfort.
When used conjointly, they provide a
multifaceted experience that can aid in the
reduction of anxiety, pain, and isolation;
facilitate communication between patients,
family members, and staff; and provide the
potential for a more peaceful dying experience
for all involved. This article addresses the
benefits of the combined use of music therapy
and reflexology. Two case studies are presented
to illustrate the application and benefits of
this dual approach for patients and their
families regarding adjustment to the end of life
in the presence of anxiety and cognitive
impairment.
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Bush E. (2001) The use of human touch to improve
the well-being of older adults. A holistic
nursing intervention. Journal of Holistic
Nursing. Sep;19(3):256-70.
Touch and massage are viable nursing modalities
that are both underutilized and understudied.
This underuse of touch is especially noted in
settings aimed at improving the well-being of
older adults. A number of studies suggest that
the appropriate use of touch by nurses has the
potential to significantly improve the health
status of older adults. In particular, touch can
be useful with cognitively impaired,
institutionalized, or hospitalized older adults.
Likewise, touch can be useful for improving
comfort and communication among terminally ill
older adults and their loved ones. This article
synthesizes some of the available literature on
the subject while suggesting avenues for nursing
practice and education aimed at using touch as a
viable and cost-effective holistic
gerontological nursing intervention.
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Meek S.S. (1993) Effects of slow stroke back
massage on relaxation in hospice clients.
Image—The Journal of Nursing Scholarship.
Spring;25(1):17-21.
This study was done to investigate a
nonpharmacological means of relaxation with 30
hospice clients. The purpose was to examine the
effects of slow stroke back massage (SSBM) on
systolic and diastolic blood pressure, heart
rate and skin temperature. SSBM was associated
with decreases in systolic BP, diastolic BP, and
heart rate and with an increase in skin
temperature. SSBM was shown to produce modest
clinical, but statistically significant changes
in vital signs which were indicative of
relaxation. It is a cost-effective treatment
which adds to the comfort of hospice clients.
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