In complementary therapy, the more info, the better

Patients making informed decisions improve care

Look at the headlines of consumer publications, and it becomes obvious that Americans are interested in complementary therapies. Therefore, many health care administrators are developing policy on complementary therapies realizing that a "don’t-ask-don’t-tell" strategy won’t meet the needs of their patients.

M.D. Anderson Cancer Center in Houston is diligently working to provide patients with facts about complementary therapy so they can make informed decisions, reports Laura Baynham-Fletcher, MA, LPC, director of the Place of Wellness at the facility.

The Place of Wellness offers cancer patients opportunities to participate in various therapies; but before they make a selection, they attend a class to learn more about the therapy so that they can determine if it will complement their cancer treatment. Classes on such modalities as self-hypnosis, relaxation, or guided imagery include a short history of the modality, a little about how it may be used within the cancer context, what qualifications are needed by a practitioner, and then participants experience the technique so they understand what it’s all about.

Informational classes on modalities not offered at the Place of Wellness also are provided. For example, educational sessions on healing touch and reiki are offered because people are using the services in the community. However, in these classes, participants see a demonstration of the modality rather than participate in an exercise using it.

Therapies are not endorsed, nor are patients advised against the therapy. "We are of the inclination to help you get all the information that is available on that modality rather than just putting our foot down," says Baynham-Fletcher.

Many complementary therapies are offered to patients and consumers through the Collaborative Medicine Program at South Miami (FL) Hospital, but they must be evidence-based. "We are always looking at what is evidence-based, and we follow the literature and good medical research," reports Kathryn Bishopric, LCSW, RN, BSN, manager of Counseling Services. Good research is being conducted at the National Institutes of Health, National Center for Complementary and Alternative Medi-cine in Bethesda, MD, she adds. (The web address is www.nccam.nih.gov.)

Massage therapy is offered to the patients and the community at large. Meditation, stress management programs, and support groups are available to the community and specific patient groups such as those on the oncology unit, in radiation therapy, and in cardiac rehab. Also open to patients are the expressive therapies such as art therapy, journaling, poetry therapy, music therapy, and dance and movement therapy. Patients can participate in hypnotherapy and biofeedback available in the psychology department by physician referral. Community outreach classes include tai chi and yoga. "People who come from the community into the programs pay, but people who are part of inpatient care like cardiac rehab or radiation therapy receive the therapies for free," says Bishopric.

The dietary and pharmacy departments at South Miami Hospital worked together to create a packet of evidence based information about herbals and dietary supplements. It provides general warnings and contraindications and is given to patients at the nurse’s discretion, says Bishopric.

While it is important to educate consumers about complementary therapy, equally important is the education of health care professionals. The medical director for the Collaborative Medicine Program and a member of the Complementary Medicine Committee at South Miami Hospital teaches staff about nonpharmacological pain management covering such modalities as acupuncture and the expressive therapies. Information on evidence-based modalities is provided, but also included in the classes is discussion of interventions consumers might be using that have not been studied properly, says Bishopric. The classes are scheduled monthly.

Providers need education, too

At M.D. Anderson, work on an Internet site is in progress, which is known as the CIMER (complementary integrative medicine educational research). It is designed to educate faculty and staff about various modalities by providing an analysis of the research that has been done on them. "Many times, the consumer is more savvy about these things than the practitioner, says Baynham-Fletcher. (The CIMER web address is www.mdanderson.org/cimer.)

An educated provider not only would be able to have an educated discussion with patients about a complementary therapy, he or she would be able to refer patients to practitioners when appropriate. Referrals are not a common practice now at M.D. Anderson because there are no clinical pathways for particular cancers such as leukemia that include complementary therapy. Currently, not enough research has been done to develop such pathways either, says Baynham-Fletcher. "When a physician makes a recommendation or referral, it becomes a therapeutic intervention, and is very different from saying, We have some support groups you might check out,’" she says.

At South Miami Hospital, a few physicians will refer patients to complementary therapies for specific conditions. For example, a pulmonary specialist refers asthma patients to the mindfulness-based stress-reduction program, which is an in-depth meditation-training course that also integrates some yoga movement exercise, says Bishopric.

Patients with chronic fatigue syndrome, fibro-myalgia, and irritable bowel syndrome also are being referred to the mindfulness-based stress-reduction program. "It is really a small percentage of doctors who are making those kinds of referrals, and they usually are a last resort," says Bishopric. A few other physicians refer patients to alternative therapies as a preventative measure.

Cardiothoracic surgery patients at New York-Presbyterian Hospital in New York City are offered a massage session and cardiac appropriate yoga classes, which are held on the unit one day a week. In addition, they are told about guided imagery audiotapes when they come in for their consultation prior to surgery. (The tapes are developed by Belleruth Naparstek — www.healthjourneys.com.) Those patients who are interested are put in touch with the clinical services coordinator at the Colum-bia Integrative Medicine Program.

The complementary therapies are offered to cardiothoracic surgery patients because the Integrative Medicine Program only provides services and referrals to patients if conducting research in that area. "It is our ultimate goal to provide more information and services for all types of patients, their family members, and hospital staff. We also plan to expand our research efforts to include other patient populations," says Traci R. Stein, MPH, CHES, director, Columbia Integrative Medicine Program, College of Physicians & Surgeons of Columbia University in New York City.

Should patients scheduled for cardiothoracic surgery request services that are not offered by this health care facility, such as healing touch or acupuncture; they are referred to outside, per diem practitioners. Stein and her colleagues recommend practitioners whose credentials have been reviewed and whom they have met. "We typically only refer to practitioners whose services we have witnessed or experienced directly or who come referred by other professionals in the medical center/university," she says.

Familiarity with the therapy also is a must. They typically not only want to know that the research that has been done, but they also want to have experienced that type of therapy before making a referral. They also look at the risks to the patient vs. the benefits and modify the therapy for the patient population.

While patients may ask about the use of complementary therapies during their treatment, they don’t always volunteer information about the various therapies they are using when they enter treatment. Often they don’t see the necessity of it. That is why M.D. Anderson is in the process of working on a new inpatient nursing assessment that will be part of the electronic medical records that solicits information about the patient’s use of complementary therapy. "That question of use of complementary therapy is going to be asked of every inpatient and that model will be used for outpatient areas eventually so that we do consistently ask," says Baynham-Fletcher.

For more information about addressing complementary policy in hospital policy and procedures, contact:

  • Laura Baynham-Fletcher, MA, LPC, Director, Place of Wellness, M.D. Anderson Cancer Center, 1515 Holcomb Blvd., Unit 16, Houston, TX 77030-4009. Telephone: (713) 794-4700.
  • Kathryn Bishopric, LCSW, RN, BSN, Manager, Counseling Services, South Miami Hospital, 6200 S.W. 73rd St., Miami, FL 33143. Telephone: (786) 662-400, ext. 24141. E-mail: kathrynb@bhssf.org.
  • Traci R. Stein, MPH, CHES, Director, Columbia Inte-grative Medicine Program, College of Physicians & Surgeons of Columbia University, 177 Fort Washington Ave., MHB 7-435, New York, NY 10032. Telephone: (212) 305-9598. E-mail: ts2007@columbia.edu.