Integrative Bodywork in Hospice & Palliative Care
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1 Integrative Bodywork in Hospice & Palliative Care drreliaz.org John Chamness, LMT, BCTMB Leslie Mendoza Temple, MD, ABOIM NorthShore University HealthSystem Integrative Medicine Program Integrative Medicine for the Underserved August 26, 2017 Feinberg Pavilion Breakout session #33 2:00-3:00 pm
2 Beginnings Palliative Care Division, Department of Medicine, Medical Director Mike Marschke, MD University of Illinois studies - decline in pain and in pain medicine with massage therapy. Funding by general Palliative Care and Hospice donations.
3 Beginnings 2012, Home Health Services approached the NorthShore Integrative Medicine Program. Integrative Medicine put out invitation to staff. Started service on the 5 th floor Glenbrook Hospital in November 2012.
4 Growth Started with one 3-hour shift on the 5 th floor of Glenbrook Hospital. NorthShore Hospice inpatients only and their families. Worked on staff if there was time.
5 Growth Added another 3-hour shift at the Palliative Care unit at Evanston Hospital. NorthShore Hospice and Palliative Care consult patients and their families. Worked on staff at Evanston Hospital if there was time.
6 Growth Added another 3-hour shift for NorthShore Hospice residents at the Lieberman Center for Health & Rehabilitation. And when time, for NorthShore Hospice and Palliative Care consults and their families at Skokie Hospital. Worked on staff if there was time.
7 Growth Added another 3-hour shift at Highland Park Hospital. Inpatient Hospice and Palliative Care consults, and their families. Worked on staff, if there was time.
8 Growth Added a second massage therapist to the team. Currently serve approximately 90 people per month.
9 Funding Stream NorthShore Foundation funds were designated for Palliative Care and/or for Hospice use. Greatest number of individual donations to the Foundation are for Palliative Care Integrative Medicine Services.
10 Program Administration Administered through NorthShore Home and Hospice Services.
11 Challenges in getting started Identifying who was a Hospice patient at the Lieberman- solved with a new list in EPIC. Staff resistance Administrative resistance Family resistance
12 Typical Day Supplies, massage chair. Spend first minutes reviewing 5 patient charts from a list of inpatients enrolled in NorthShore Hospice or who have had Palliative Care consults ordered.
13 Chart Work Up First team encounter Last team encounter Last nurse encounter Modifications do no harm Symptoms/conditions where I can make a difference Things to know for patient/family confidence
14 Chart: conditions / modifications Cancer location, metastases, ascites, small bowel obstruction, radiation therapy, chemotherapy, fractures, low platelets Cardiac: Hypertension, CAD, atrial fibrillation / blood thinners, congestive heart failure, peripheral arterial disease, deep vein thrombosis, edema
15 Chart: modifications Stroke, subdural hematoma, intracranial bleed Altered mental status, Alzheimers, dementia, Parkinsonism Brain shunt Non-responsive, minimally responsive, nonverbal Fibromyalgia syndrome
16 Chart: modifications Acute and chronic kidney disease Reflux Diabetes mellitus Gout Osteoarthritis Inflammatory arthritis
17 Chart: modifications Pacemakers Ports Catheters Cellulitis Sepsis
18 Make a difference Pain Anxiety Agitation Nausea Mithchinson A, Fletcher CE, Kim HM, et al. Integrating massage therapy within the palliative care of veterans with advanced illness: an outcome study. Am J Palliat Care. Feb Russell NC, Sumler SS, Beinhorn CM et al. Role of massage therapy in cancer care. J Altern Complement Med Mar;14(2):
19 Make a difference Sleep Pinar R, Afsar F. Back massage to decrease state anxiety, cortisol level, blood pressure, heart rate and increase sleep quality in family caregivers of patients with cancer: a randomized controlled trial. Asian Pac J Cancer Prev. 2015;16(18): Toth M, Marcantonio ER, Davis RB, et al. Massage therapy for patients with metastatic cancer: a pilot randomized controlled trial. J Altern Complement Med Jul;19(7):
20 Make a difference Shortness of breath Peripheral neuropathy Russell NC, Sumler SS, Beinhorn CM., Frankel MA. Role of massage therapy in cancer care. J Altern Complement Med Mar;14(2): Lopez G, Liu w, Milbury K, et al. The effects of oncology massage on symptom selfreport for cancer patients and their caregivers. Support Care Cancer, June 28, 2017.
21 Things to know Chronic obstructive pulmonary disease Pneumonia Irritable bowel syndrome, colitis Open wounds Clostridium difficile infection
22 Things to know Family involved? Conflicts with pt/family/staff? What is the atmosphere? Special requests eg, request that the word hospice not be used. Language barriers Behavior: agitation, hostility Bed Personal alarms and restraints
23 Find a Patient No appointments Room to room Busy with docs, nurse, Getting physical therapy, radiation therapy, procedures, Toileting, bathing Waiting to go home Already passed
24 In the room Introduce self, what I can offer, what that looks like. Address patient, even if non-responsive Wash hands. Use lotion, no oil. No repositioning. Adjust bed height, bed rails, move stuff out of the way.
25 In the room Be mindful of: Tubing, oxygen, ventilator IV's, catheters Chairs, walkers, wheelchairs Bed alarms, personal alarms Restraints Heel cushions, bandages, skin condition Ketchup packs
26 Be the deep stillness The calm state o-en achieved during integra5ve medicine treatments is similar to that seen during deep prayer or medita5on. In so doing, pa5ents may gain greater insight and find inner peace through simple, non-verbal approaches. Steinhorn DM, Din J, Johnson A. Healing spirituality and integra9ve medicine. Ann Palliat Med May 22.
27 In the room Warm lotion in hands. Make contact before contact. Check in, How does that feel? Listen within the stillness. Observe changes, be curious. Maintain eye contact.
28 In the room - observations Breath slows, deepens, quiets, evens out. Moans Sigh sign Face relaxes Smiles Eyes close or make connection Affect softens Body softens
29 After treatment Check in (if awake) How do you feel? How is your pain? Feeling better. Made my day. When will you be back? What a wonderful service. This is the best hospital ever.
30 Patient Cases 98 year old woman gets first massage ever. Young woman with intractable pain settles with craniosacral therapy. Older man skeptical, I can t believe I waited so long. Family incredulous; deep, emotional gratitude.
31 After treatment Clean lotion bottle. Wash hands. Put every thing back the way it was. Offer to family. Chart.
32 Thank you!
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