The use of complementary modalities for palliative care patients has increased. VanHyfte, et al. (2017) conducted an online survey of 108 contacts of Hospice and Palliative care organizations in Illinois about their use of complementary modalities. They found 90.3% of the organizations offered some type of CAM.
Here are modalities frequently used.
According to Satija and Bhatnagar (2017), there is some evidence supporting the use of hypnosis for managing pain, chemotherapy-induced nausea/vomiting, distress, and fatigue. Guided imagery and meditation can improve psychological functions. Yoga has some short-term benefits for anxiety, depression, and fatigue. Acupuncture is effective in reducing side effects, pain, and fatigue. While some modalities will help some patients more than others, and not all have strong evidence of effectiveness, they are thought to be relatively risk-free.
Use of hypnosis in palliative and supportive care
• Symptom control – pain, poor sleep, nausea
• Managing adverse effects or fears – needle phobia, MRI enclosure
• Reducing medication needs during procedures
• Stress reduction
• Support for healthy exercise, eating, and sleeping (Booth, 2020; Williamson, 2019).
A case study using hypnosis with a palliative care patient.
All identifying characteristics in this case study were altered to protect the identity of the client.
Ms. Stevenson was referred to a hypnotherapist by the palliative care team at the local hospital's cancer center. Ms. Stevenson was receiving chemotherapy for breast cancer but was intolerant of injections. The 2 to 3 mgs of Ativan was not sufficient to control her needle anxiety. Without more control of her fear, the chemotherapy would be curtailed.
After an intake assessment with the hypnotherapist, it was found this needle anxiety was present since childhood. At first, some desensitizing, relaxing hypnosis sessions were conducted to help Ms. Stevenson reduce her fear of needles. She was asked to list five situations that induced this fear of needles, from minor stress, such as making an appointment for bloodwork, to significant anxiety such as being injected in her arm. In hypnosis, she went through a relaxation process and then was asked to identify and go to a place in her mind where she felt safe and relaxed. She was then asked to picture herself making her appointment for blood work from her safe place, feeling calm and relaxed, knowing she was safe in hypnosis. Once Ms. Stevenson signaled, she was calm and relaxed making an appointment, and she was instructed to go back to her safe place. It took two sessions to address all five levels of needle stress.
Now that Ms. Stevenson had acquired some reduction in her needle anxiety and a safe place to which to retreat, the hypnotherapist used regression to identify the initial sensitizing event and the events that followed that reinforced the initial needle fear anxiety.
During the first hypnosis session, after relaxation and reinstituting her safe place, Ms. Stevenson recalled going to a dentist around the age of 10. The dentist was aware of her fear of needles. According to Ms. Stevenson, the dentist gave her injections, which caused her to be greatly agitated. That was identified as a reinforcing event.
In the second hypnosis session, an attempt was made to identify events before the age of 10. Ms. Stevenson remembered receiving some injections at a doctor's office who also knew Ms. Stevenson had a fear of needles. Ms. Stevenson was encouraged to ask her parents if they knew the earliest times she had been given injections. Ms. Stevenson reported being told she had been sick as a 2-year-old and received several injections in a short time to combat that illness.
In the final hypnosis session, Ms. Stevenson went through the relaxation experience and imagined herself feeling relaxed as she went for her chemotherapy session. She could imagine herself going to her safe place to reinforce that peaceful feeling. She was also given the post-hypnotic suggestion that when she rubbed her special pendant, she would have in her hand, the sense of relaxation would come over her.
Ms. Stevenson still had some needle anxiety, but it was lowered sufficiently to resume chemotherapy.
Which of the following complimentary modalities are used in the care of the patient receiving palliative care?
Booth, S. (2020). Hypnosis in a specialist palliative care setting – enhancing personalized care for difficult symptoms and situations. Palliative Care and Social Practice. 14 https://doi.org/10.1177/2632352420953436
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Satija, A. & Bhatnagar, S. (2017). Complementary Therapies for Symptom Management in Cancer Patients. Indian journal of palliative care, 23(4), 468–479.
Van Hyfte, G.J., Kozak, L.E. & Lepore, M. (2014). A survey of the use of complementary and alternative medicine in Illinois hospice and palliative care organizations. Am J Hosp Palliat Care. 31(5), 553-61.
Williamson, A. (2019). What is hypnosis, and how might it work? Palliat Care 12, 1–4.
Zeng, Y.S., Wang, C., Ward, K.E., et al. (2018). Alternative medicine in hospice and palliative care: a systematic review. J Pain Symptom Manage 56, 781–794