Complementary Therapies Services Evaluation

Transcription

1 Complementary Therapies Services Evaluation March 2016

2 CONTENTS Contents 1 Introduction Background and aims Results Patient Experiance Discussion Summary Appendix 1: Complementary Therapy Service Audit Questionnaire London Cancer Alliance

3 MARCH Introduction Complementary therapies are therapies or approaches that are safely used alongside medical treatment to support people affected by cancer. The NICE Supportive and Palliative Care Improving Outcomes Guidance (2004) states that Complementary therapies are used alongside orthodox treatments with the aim of providing psychological and emotional support through the relief of symptoms. Research has shown that, worldwide, around half of all people affected by cancer use some form of complementary and alternative medicine approach. People choose to use complementary therapies as a holistic approach to help them cope with various symptoms or side effects of their treatments. These therapies can: improve physical well-being support the body s ability to fight cancer improve emotional well-being and quality of life promote relaxation and reduce anxiety alleviate symptoms such as breathlessness, constipation, pain, nausea and fatigue improve sleep patterns People affected by cancer say that complementary therapies help them to feel better generally as well as helping them feel more in control and better able to cope with the cancer diagnosis and the demands of cancer treatment. Complementary therapies include: aromatherapy reflexology relaxation and stress management acupuncture craniosacral therapy herbal medicine meditation reiki tai chi yoga Complementary therapies can offer a holistic approach to help patients cope with various symptoms or side effects of their treatment. They can: promote relaxation and reduce anxiety alleviate symptoms such as breathlessness, constipation, pain, nausea and fatigue improve sleep patterns increase feelings of well-being and quality of life help people come to terms with an altered body image 3

4 2 Background and Aims BACKGROUND AND AIMS The LCA Complementary Therapies Community of Practice (CoP) was formed in 2013, and is formed of complementary therapy service managers from across the LCA. The services are diverse and are found in a variety of locations including hospitals, hospices, independent units, and in the voluntary sector. The Community of Practice (CoP) developed guidelines for practice in 2013, and audited compliance against these is This showed that all services were either already fully compliant with the LCA standards, or had clear action plans in place in order to become compliant. Subsequent to that, the CoP wanted to look in more depth at the quality of the services they were providing. They developed a patient feedback form, which aimed to explore the impact of complementary therapy on the person s symptom(s) and their quality of life. The form was based on a questionnaire used in a published study from 2014, which examined the experience of complementary therapy on people with a cancer diagnosis. The questionnaire can be found in Appendix 1. The form asked people to identify which symptoms they were hoping complementary therapy would help with, and to underline the symptom that was most significant to them. The survey ran for one month, from 11 January to 11 February 2016 and included all services represented within the CoP. A paper copy of the survey was given to every person who had been treated at least once as an outpatient. People were asked to complete the form after their appointment, reflecting on their previous therapy session when answering their questions. All the forms were anonymised. The completed forms were put in a box at the centres, with the data subsequently collated onto a spread sheet at each centre before being sent to the LCA for full analysis. 4

5 3 Results MARCH 2016 Results were received from: Epsom and St Helier University Hospitals NHS Trust The Lynda Jackson Centre at East and North Hertfordshire NHS Trust Kingston Hospital NHS Foundation Trust Mulberry Centre Paul s Cancer Support Centre Princess Alice Hospice The Royal Marsden NHS Foundation Trust St Christopher s Hospice Royal Trinity Hospice The Haven The Dimbleby Cancer Centre at Guy s and St Thomas Hospital NHS Foundation Trust Results were received for 322 people affected by cancer 282 patients and 40 carers 3.1 Demographics Figures 1 and 2 shows the split by gender and primary cancer diagnosis. Figure 1 100% 80% 60% 40% 20% 0% Figure 2 Female Male Breast Colon Lung Ovarian Prostate Brain Significantly more people affected by breast cancer accessed complementary therapies, which meant more woman than men accessed services. As The Haven only provided complementary therapies to those affected by breast cancer, analysis was also completed without The Haven s results (not shown here). However, the bias towards people affected by breast cancer remained. 5

6 RESULTS 3.2 Reason for accessing services Figure 3 shows all symptoms that people reported seeking help with. Figure 3 25% 20% 15% 10% 5% 0% Figure 4 shows the symptoms deemed most important by people accessing complementary therapy services. Figure 4 25% 20% 15% 10% 5% 0% Figure 5 shows that people attending hospice services presented with slightly different symptoms than those attending other services. Figure 5 30% 25% 20% 15% 10% 5% 0% Hospices % (n=83) Non Hospice % (n=163) 6

7 MARCH 2016 These results are comparable with the results seen in holistic needs assessment (HNA) data across the LCA, which shows that the most common issues people report are worry, fear or anxiety, fatigue, sleep problems and pain. 3.3 Complementary therapies offered A wide range of complementary therapies are offered across the LCA, as shown in Figure 6. This supports the previous audit results. Figure Complementary therapies and quality of life Figure 7 shows the impact that complementary therapy had on people s quality of life. Almost every person said it improved their quality of life, either slightly or significantly. Only 11 people said it made no difference. No one reported that it made their symptoms worse. Figure Aromatherapy Reiki It greatly improved it It made no difference It slightly improved it The duration of improvements in quality of life can be seen in figure 8. Please note, in the interests of consistency the CoP decided to merge results for aromatherapy and massage. 7

8 Aromatherapy Reiki Aromatherapy Aromatherapy Aromatherapy Aromatherapy Aromathera Reiki yoga Aromathera Aromathera yoga Aromathera yoga Aromathera RESULTS Figure 8 50% 40% 30% 20% 10% 0% (n=28) Aromatherapy (n=158) (n=70) Reiki (n=11) Not applicable % A few hours % Until the next day % Several days % A week % More than a week % 3.5 Complementary therapies and symptom management Figure 9 shows the impact that complementary therapy had on people s symptoms. Almost every person said it improved their symptoms, either slightly or significantly. Only 10 people said it made no difference. One person reported that aromatherapy made their symptom worse, but this fits within published evidence on the effect of aromatherapy, specifically massage, on pain. Figure It made it much worse It made no difference It slightly improved it It greatly improved it Figure 10 shows how long the improvements lasted dependent on the reported symptoms and therapy given. Figure Anxiety Fatigue Pain Relaxation Stress More than a week 10 A week 5 Several days 0 Until the next day A few hours Anxiety Fatigue Pain Relaxation Stress 8

9 MARCH 2016 Figure 11 shows the difference in duration of effect in hospices and in other settings Figure 11 50% 40% 30% 20% 10% Not applicable A few hours Until the next day Several days A week 0% Hospices % (n=92) Non Hospice % (n=226) More than a week 9

10 4 Patient experience PATIENT EXPERIENCE The word cloud (Figure 12) shows the single words people used to describe their experience of complementary therapy. The larger the size of the word, the more often it was used. Figure 12 10

11 5 Discussion MARCH 2016 The aim of this service evaluation questionnaire was to demonstrate the impact of complementary therapy on both people s self-reported symptom(s) and their quality of life. The results show that there are a wide range of complementary therapies available across the LCA in a variety of settings. Almost 300 people a month are accessing these services and a huge majority report an improvement in both their symptoms and quality of life following the therapy. More women than men access complementary therapy, as do significantly more people affected by breast cancer than any other cancer. This will be something that the CoP and/or individual services seek to address in coming months. There was a difference in the symptoms profile reported by hospice based teams and non-hospice based teams. The length of improvement following treatment was also different depending on setting. This may be something that needs further investigation. The pathway point e.g. end of treatment, recurrence, or life limiting disease, was not recorded this time, and this may be a useful additional data item for future work to help understand the differences. Feedback from the services using the questionnaires indicated that some respondents failed to underline the symptom that they felt was most important. This may be because no single symptom was the more important than another, but it was felt in future audits the instructions and their explanation needs to be clearer. In some cases, people were treated with more than one therapy on a single day, and this meant it was difficult to attribute a change in symptoms to a specific therapy. In addition to the reported changes in quality of life and symptom experience, people were asked to use one word to summarise their experience of complementary therapies. These words are without exception positive, suggesting that not only objectively, but subjectively, complementary therapies are a positive experience for people. 11

12 6 Summary SUMMARY The LCA Complementary Therapy CoP completed a one month service evaluation which investigated the impact of complementary therapies on symptom management and quality of life. The results show that it is feasible to evaluate impact on quality of life and symptom burden using a question in the form of a Likert scale a significant number of people access complementary therapies within the LCA complementary therapies have a positive impact on self-reported quality of life the improvement in quality of life lasts several days or longer in a majority of cases complementary therapies have a positive impact on self-reported symptom control in a majority of cases the improvement in symptoms lasts for several days or longer in a majority of cases 12

13 Appendix 1: Complementary Therapy Service Audit Questionnaire MARCH 2016 Complementary Therapy Service Audit In order to ensure that our complementary therapy services are the best they can possibly be, we need feedback from people who have had a complementary therapy treatment, about whether or not the treatment was effective. This is known as an audit, and we are asking everyone who has more than one complementary therapy treatment to complete this feedback questionnaire. Please answer every question as fully as possible to allow us to get a good idea about our service. Your thoughts and comments are welcomed. Please be assured that your confidentiality will be respected and maintained at all times. When you have completed this questionnaire, please place it in the envelope provided and put it in the box marked: LCA Complementary Therapy Audit located at reception. 1. Date: 2. Are you a (tick one): Person affected by cancer (please specify e.g. breast) Carer for person affected by cancer (please specify e.g. lung) Person with other diagnosis (please specify e.g. MND) Carer for person with other diagnosis (please specify) 3. What is your gender? Male Female Transgender 4. What year were you born (e.g. 1951)? 5. What symptoms did you hope the complementary therapy would help with? (Please tick all that apply and underline the one which is most important to you) Anxiety Breathlessness Constipation Depression Fatigue Insomnia Mobility Nausea & Vomiting Pain Relaxation Stress Other (please specify) 6. Which complementary therapy did you receive? 7. Think back to the previous time you received this complementary therapy. What impact did this therapy have on your quality of life? It made it much worse It made it slightly worse It made no difference It slightly improved it It greatly improved it 13

14 APPENDIX 1: COMPLEMENTARY THERAPY SERVICE AUDIT QUESTIONNAIRE If you felt any better, did this last: Not Applicable A few hours Until the next day Several days A week More than a week If you felt any worse, did this last: Not Applicable A few hours Until the next day Several days A week More than a week 8. Once again, think back to the previous time you received this complementary therapy. What impact did this therapy have on the most important symptom to you (the one you underlines in Q5) with which you were looking for help? It made it much worse It made it slightly worse It made no difference It slightly improved it It greatly improved it If the symptom improved, did this last: Not Applicable A few hours Until the next day Several days A week More than a week If the symptom got worse, did this last: Not Applicable A few hours Until the next day Several days A week More than a week 9. Which one word sums up your experience of Complementary Therapy? If you would like to add any further comment about your Complementary Therapy experience, please do so in the box below. Thank you for taking part in this survey Please put your completed form in the envelope provided and leave it in the box marked: LCA Complementary Therapy Audit at reception. 14