Therapeutic alternatives to conventional Western medicine have long been a staple of many hospice programs due to their shared focus on comfort and quality of life. The wide array of complementary therapy (CT) modalities can be dizzying, however, and clinical evidence is often in short supply. In this article, we explore potential benefits and risks of five widely utilized CTs. Although wildly different in their approach, each of these therapies is an act of caring with the potential to improve patient and caregiver satisfaction. It’s up to hospices to decide which if any of these are appropriate for their practice, particularly when it comes to cultural factors among the populations they serve.
Acupuncture
Acupuncture is an ancient Chinese therapy based on the idea that small filaments inserted into the skin can help balance or redirect qi, or vital energy. Today there are a range of practices and philosophies, some of which depart from the spiritual elements and focus on functional elements. Theories on the mechanism of action center on the idea that the acupuncture needles cause a localized release of neurotransmitters, hormones or endorphins. Although the effectiveness of acupuncture is a subject of fraught debate in the scientific community, it has gained significant mainstream acceptance and is offered at many hospitals. Hospice-related indications include pain, nausea, depression, anxiety, drowsiness, well-being, and dyspnea. Risks associated with acupuncture are low, even in frail and elderly patients, but may include retained needles, dizziness, loss of consciousness, falls, bruising or soreness at needle site and, rarely, pneumothorax (collapsed lung).
Animal-Assisted Therapy
While skepticism around complementary therapies remains widespread, even the most hardened empiricists often make an exception for our furry friends. Animal-assisted therapy (AAT) takes many forms, from casual visits with well-behaved pets to highly structured programs with specific therapeutic goals. Many kinds of animals can be used in AAT, from hamsters to horses, but in practice dogs are best-suited to the work due to their coevolutionary relationship with humans.
Clinical evidence is mostly qualitative and anecdotal, but a controlled study of hospitalized heart failure patients demonstrated that visits with dogs and their humans improved anxiety and related biological markers more effectively than humans alone. Outcomes in hospice and palliative care settings include facilitated communication, positive emotional responses and enhanced physical relaxation. These benefits also extend to family caregivers and hospice staff. Additionally, pet visitation programs are a popular way for hospices to fulfill volunteer participation requirements.
There are some inevitable risks associated with having animals in a care setting so adherence to published guidelines is recommended as well as screening for allergies. Additionally, like any treatment, AAT requires informed consent – not everybody is a dog person.
Aromatherapy
The use of aromatic compounds has been intertwined with both medicine and spirituality throughout history. Aromatherapy builds on that legacy through the use of essential oils – volatile compounds extracted from plant sources. The vapors of these essential oils can be released into the air with various diffusers, either to the whole room or close to the patient’s nose.
There is moderate evidence supporting aromatherapy for relaxation, which can in turn reduce pain, anxiety, stress, depression, and insomnia. However, the value of one essential oil over another or for specific symptoms is considerably harder to determine. Lavender seems to be one of the more widely studied compounds, particularly for sleep. Other potentially beneficial essential oils include frankincense, rosemary, peppermint and various citrus varieties.
Apart from specific allergies (often to eucalyptus), aromatherapy is generally well-tolerated. Most risks stem from topical application or ingestion. Handling and storage of undiluted essential oils can also be dangerous due to potential toxicity and flammability.
Music Therapy
Music therapy is one of the most popular CTs in the hospice community, in part due to the ability of music to reach those whose physical or cognitive conditions diminish their ability to participate in other activities. While empirical data remains limited, qualitative studies do show promise for managing pain, dyspnea, depression and anxiety and provision of music therapy also is associated with patient and caregiver satisfaction.
While just about any use of music in a clinical context is sometimes referred to as music therapy, the officially recognized form is delivered by board-certified professionals with undergraduate and graduate degrees in the field. These MT-BC therapists use methods such as song writing, improvisation, guided imagery and music, singing, instrument playing and music therapy relaxation techniques to help alleviate symptoms and improve overall quality of life in patients.
In addition to MT-BC credentials, there are also a number of less formal certifications for therapeutic use of music, including several specific to harpists. Volunteer musician programs also remain popular, particularly as a way to fulfill hospice volunteer participation requirements. Regardless of modality, the additive value alone may account for some of the benefits observed. Nurses primarily treat physical needs and social workers are focused on case management, leaving the music therapist as the professional most focused on the emotional, spiritual, cognitive, and social needs of the patient.
Reiki
Reiki is one of several practices called “touch therapy,” but that can be a bit of a misnomer. In many cases no actual touch is involved. Instead, practitioners hold their palms an inch or two above the patient with no actual contact. The idea that practitioners can reduce pain and anxiety by channeling “biofield energy” from their hands to a subject is often held up as “exhibit A” in lessons about pseudoscience. Nevertheless, Reiki has won over many committed skeptics, a phenomenon summed up in the title of a 2021 article in The Atlantic: Reiki can’t possibly work. So why does it?
Despite limited high quality data supporting its use, Reiki is now offered at over 60 hospitals, including six of the top 15 academic hospitals in the country. Whether it’s due to forces science can’t explain, a classic placebo effect or just the biological response to an act of caring, many patients report a positive effect from Reiki and related practices. At the very least, with no touching or talking involved it presents little risk of harm.
