Caregiver delivered massage therapy options in inpatient palliative care: A mixed methods exploratory study

Palliative care aims to relieve suffering by identifying, assessing, and treating pain and other physical, psychosocial, and spiritual problems [1]. Individuals receiving palliative care increasingly use complementary therapies, including massage therapy [[2], [3], [4], [5]], which are evidence-based interventions used to control symptoms and optimize quality of life [[6], [7], [8]]. Complementary therapies are distinct from “alternative therapies”, which are offered as substitutes for mainstream treatment [6,7].

Surveys of adult patients in specialist palliative care units consistently show interest and highly favourable attitudes toward massage therapy [9,10]. A review on the use of massage therapy delivered by an accredited clinician by patients accessing oncological palliative care concluded that massage therapy is a non-invasive intervention which contributes to the reduction of pain, anxiety, depression and improvements in mood and relaxation [11]. Both multiple and single sessions of massage therapy provide mental and physical health benefits for palliative patients with cancer [[12], [13], [14], [15], [16]]. While massage therapy is considered safe in pain populations [17], therapists who provide therapeutic massage in oncology and palliative care require additional training and credentialing [18].

A lack of resources including limited access to suitably trained massage therapists, and concerns associated with intimacy [19] may limit the implementation of a massage therapy service within palliative care [20]. One approach to overcome this challenge is through engagement of a caregiver to provide massage therapy. A previous randomized, controlled trial of oncology patients and family caregivers demonstrated that simple, touch-based techniques delivered to patients by caregivers in the home environment improved self-efficacy and satisfaction in caregiving and reduced pain, nausea and other symptoms [20]. Similarly, caregiver-initiated massage therapy enabled a caregiver to develop their relationship with the patient through mutual physical contact, which strengthened mutual trust [11,21]. When provided in community cancer care or at home, caregiver-administered massage therapy has demonstrated feasibility [21] and is associated with high levels of patient satisfaction [22]. Despite these benefits, some healthcare professionals remain cautious towards the use of massage in inpatient palliative care [16], and it has been linked to increased caregiver burden when delivered at home [22].

Within an inpatient palliative care setting, the feasibility of caregiver massage therapy, and levels of satisfaction and burden associated with this approach have not been established. While there have been no reports of serious adverse events linked to massage therapy in patients with cancer [17], this has not been examined within an inpatient palliative care unit with massage therapy provided by caregivers. In addition, barriers or enablers for a caregiver massage therapy service within an inpatient palliative care unit from the perspective of healthcare professionals have not been identified.

The primary aim of this study was to determine feasibility and acceptability of caregiver massage therapy for patients in inpatient palliative care. The secondary aims were to establish the levels of patient and caregiver satisfaction with caregiver massage therapy following training, and to identify staff-perceived barriers and enablers to implementing a caregiver massage therapy service on an inpatient palliative care unit.

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