Leila Kozak

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.

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.

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 patients recovery from a neurosurgical procedure, it is critical that neurosurgeons be aware of the benefits and potential adverse complications of CAM therapies. The surveys 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.

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.

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 describe the types of CAM therapies available and explore the influence of the nurse work environment on the availability of CAM therapies with multivariate regression analysis. This study shows that having an education environment where clinicians are trained, along with a highly educated registered nurse support staff, and a bachelor of science in nursing–educated staff was critical to the availability of CAM therapies. The clinical implications for hospice and palliative nurses caring for infants and their families are discussed.