Massage/Aromatherapy Massage

Massage/Aromatherapy Massage

PEP Topic 
Caregiver Strain and Burden
Description 

Aromatherapy is the use of fragrant essential oils distilled from plants to alter mood or improve health. Aromatherapy has been used along with massage in some studies. Aromatherapy massage is massage therapy that is delivered by a therapist simultaneously as aromatherapy oils are administered by inhalation. Massage with or without aromatherapy has been studied in patients with cancer for management of anxiety, caregiver strain and burden, constipation, chemotherapy-induced nausea and vomiting, depression, lymphedema, pain, sleep-wake disturbances, and fatigue.

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Effectiveness Not Established

Research Evidence Summaries

Collinge, W., Kahn, J., Walton, T., Kozak, L., Bauer-Wu, S., Fletcher, K., . . . Soltysik, R. (2013). Touch, caring, and cancer: Randomized controlled trial of a multimedia caregiver education program. Supportive Care in Cancer, 21, 1405–1414.

doi: 10.1007/s00520-012-1682-6
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Study Purpose:

To evaluate the effect of family caregiver–provided massage, as instructed through a multimedia home-based training program, on patient symptom ratings, caregiver attitudes (confidence, self-esteem), and perceived stress

Intervention Characteristics/Basic Study Process:

The experimental group received a DVD and written manual instructing caregivers on how to prepare for and safely practice providing massage and acupressure to patients with cancer in the home setting. Dyads were requested to practice at least three times per week for four weeks. Control group caregivers were asked to read to patients for the same frequency and duration. Caregiver/patient dyads were randomized to the intervention or control (reading) group for a four-week period, after which controls could opt to receive the intervention. An additional 16-week observation period followed.

Sample Characteristics:

  • The sample included 97 caregiver/patient dyads.
  • Age range of participants was 18–82 years.
  • The caregiver sample was 56% male and 44% female; the patient sample was 76% male and 24% female.
  • Patients with any type or stage of cancer were eligible.
  • Participants had to be at least 18 years old and able to read and write English, Spanish, or Chinese.

Setting:

  • Multisite  
  • Home setting
  • Three U.S. cities: Boston, MA, Portland, ME, and Portland, OR

Phase of Care and Clinical Applications:

  • Mutliple phases of care
  • Palliative care

Study Design:

A randomized controlled trial design was used.

Measurement Instruments/Methods:

  • Using a 1–10 scale, patients rated their level of pain, stress/anxiety, depression, fatigue, nausea, and patient-specified “other” symptoms prior to and 15 minutes after one of the weekly massage or reading sessions.
  • Caregivers completed weekly reports on the number, content, and duration of the sessions.
  • At baseline and four weeks, caregivers completed a seven-question investigator-designed survey on attitudes toward caregiving and the seven-item caregiver esteem subscale of the Caregiver Reaction Assessment; dyads completed the Perceived Stress Scale; and patients completed the Functional Assessment of Cancer Therapy–General.

Results:

Both control and intervention caregivers had good compliance with the protocol, and both experienced significant improvements in caregiver attitudes (ability to help patient feel better and worry about causing distress through touch). Intervention group caregivers reported increased self-efficacy in providing massage.

Patients in both groups reported significantly improved symptoms after each session. Over the four-week period, patients in the intervention group had significant mean decreases in symptom ratings for pain (p = 0.04), nausea (p = 0.02), and patient-specified symptoms (p = 0.02; these symptoms were not listed by the authors). There were some significant pre-/postsession symptom ratings improvements in the massage group when scores by week were compared, but no linear association of time and symptom trajectory was noted.

Conclusions:

Both massage and reading interactions within patient/caregiver dyads appear to have a positive effect on caregiver attitudes and patient symptom ratings. Dyads utilizing massage based on the home instruction materials may receive more benefit regarding caregiver self-efficacy specific to that skill and greater symptom relief over time.

Limitations:

  • The study had risk of bias (no control group).
  • Given the improvements noted in both groups, it is possible that control group dyads intentionally (as a result of learning about the potential benefits of massage during the consent process) or unintentionally engaged in forms of touch that provided some benefits over the four-week observation period.

Nursing Implications:

This study measured the benefits of massage on caregiver and patient outcomes as compared to a control (reading) and found both activities were potentially beneficial. The method by which the intervention group was instructed was innovative, multilingual, and widely reproducible, as it is offered through a DVD recording and written manual, and was tested in a sample that was very inclusive (open to all cancers and stages of adult patients who spoke three common languages, from three geographic sites in the United States). However, despite the study title, which leads the reader to believe that an aim of the study was to examine the effectiveness of the instruction method itself, this is not the case. A prior feasibility study was noted to pilot the included content, and a patient convenience sample (n = 18)  was noted to have tested the multimedia program for usability, but no report of testing the effectiveness of teaching the content in this manner versus any other method was reported. There were no implementation challenges or adverse events reported in the study (these were assessed by biweekly phone calls), and an oncology massage therapist made one home visit to the dyads to ensure the intervention was delivered safely. It is implied that the multimedia tool was an effective instruction method, but this was not explicitly studied. Study findings suggest that providing carers with any specific concrete way to intervene to help patients may be what is actually beneficial.

Cronfalk, B.S., Ternestedt, B., & Strang, P. (2010). Soft tissue massage: Early intervention for relatives whose family members died in palliative cancer care. Journal of Clinical Nursing, 19, 1040–1048.

doi:10.1111/j.1365-2702.2009.02985.x
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Study Purpose:

To explore how bereaved relatives experienced early intervention with soft tissue massage during the first four months since the death of a family member who received palliative cancer care

Intervention Characteristics/Basic Study Process:

Study data resulted from two interactions with Swedish-speaking relatives of deceased patients with cancer who had received care in a large palliative care unit. Demographic and baseline data were collected in an initial 60-minute visit to the relative. Hand or foot soft tissue massage, which is defined as a gentle but firm movement of the skin that activates touch receptors, was done in slow strokes, light pressure, and circling movement using lightly scented vegetable oil.

One week after an eight-week intervention involving either protocol-driven or relative election of either hand or foot soft tissue massage, the first author audiotaped hour-long interviews with the 18 study participants. Open-ended interviews focused on the experience of receiving the massages via a dialectical validation approach to ensure understanding of relatives’ experience. The authors supported trustworthiness and qualitative credibility factors during interviews and data analysis processes based on interview transcriptions and close attention text. An additional follow-up telephone call six to eight months after the interview was intended to encourage participants to reflect on their current life situation in relation to the grieving process.

Sample Characteristics:

  • The sample (N = 18) was comprised of 14 females (78%) and 4 males (22%) who were bereaved relatives of deceased patients with cancer.
  • The age range of participants was 34–78 years (mean age = 56.2 years).
  • Diagnoses of the deceased patients were not noted.
  • The relationship to the patient was widow (9), widower (4), daughter (3), and sister (2).
  • The type of massage chosen was foot (9), hand (8), and hand and foot (1).
  • The working status of participants was sick leave (7), retired (6), and working full- or part-time (5).
  • Three relatives had previous experience with deep body massage.
  • The study authors provided no other information, such as educational status, about the sample. This status may help to interpret the rich textual findings presented by the authors.
  • Of the sample, 14 expressed interest in participating the first few weeks of their relative’s death, although the authors planned to contact relatives within three to six weeks of the relative’s death.
  • Seven relatives chose not to participate due to living too far away or a lack of interest in study participation.
  • Most chose to receive massages in their home, and most massages occurred in a silent environment.

Setting:

  • Single site
  • Home or palliative care center
  • Stockholm, Sweden

Study Design:

A prospective, descriptive, qualitative design was used.

Measurement Instruments/Methods:

  • Private interviews were audiotaped in which bereaved relatives narrated freely about their experience of receiving soft tissue massage over eight weeks.
  • Follow-up telephone conversations were initiated six to eight months postinterview “to see how the relative was doing.”

Results:

A qualitative content analysis allowed various levels of interpretation and abstraction to support one predominant theme: Bereaved relatives felt “feelings of consolation and help in learning to restructure everyday life.” The theme derived from four categories: (a) a helping hand at the right time, (b) something to rely on, (c) moments of rest, and (d) moments of retaining energy. Overall, soft tissue massage supported relatives’ need for comfort, as well as hope during a difficult transition time for relatives who sought a balance of grieving and moving on with their lives after the death of a loved one. No analysis of the follow-up telephone conversations appeared in the article.

Conclusions:

Early interventions for relatives who grieve the loss of a family member’s death, including sequential soft tissue hand or foot massage, may facilitate relatives’ feelings of belonging, human connection to healthcare staff who cared for their family member before death, sense of self, and energy to structure life after a family member’s death. Too often, delayed interventions cause unnecessary worry and suffering of bereaving relatives. The offering of soft tissue massage to those relatives at a desired time may constitute a cost-effective way to support bereaved relatives early in their grieving process.

Limitations:

  • The sample was small, with less than 30 participants.
  • Although the sample size appears adequate for qualitative studies, further replication of the study across cultures and healthcare units would expand application of the findings to multiple relatives who experience the death of a family member. For example, in some cultures, there may be limited acceptance of personal touching by a person that is not family.
  • Recruitment for this qualitative study occurred in one specialized palliative care unit, thus limiting generalizability of the study findings. The study also occurred in Sweden, and this may influence access and acceptance of soft tissue massage as a culturally-sensitive intervention in the United States. Scope of practice issues in the United States and other countries may influence nurses’ use of massage therapy with population groups, as well as nurses’ continued contact with families following a family member’s death. In this study, it appeared that at least one of the study authors served as a massage therapist, a behavior that may “cross the line” in the United States of inappropriately meshing two distinct healthcare provider roles.
  • The authors did not address “member checking,” a common process in qualitative research in which data findings gain support from a person experiencing the topic under study. The input of a grieving caregiver once the study data resulted would have addressed validation of the findings and expanded interpretation of those.

Nursing Implications:

Early support, including that inherent in the delivery of soft tissue massage, to grieving relatives of a family member who died from cancer or other chronic illnesses, offers a cost-effective intervention that may improve the health of those relatives. This intervention needs further testing to determine its efficacy but does highlight the importance of grieving relatives reconnecting with the healthcare professional, physical touch, and getting needed support. Further research with diverse populations in other global communities may extend understanding and acceptance of this potentially future intervention to add quality-of-life care to relatives and other family members. Testing of a soft tissue massage intervention could support evidence for the effectiveness of this intervention and nurses’ referral of caregivers to this intervention for improved quality of life.

Rexilius, S.J., Mundt, C., Erickson Megel, M., & Agrawal, S. (2002). Therapeutic effects of massage therapy and healing touch on caregivers of patients undergoing autologous hematopoietic stem cell transplant. Oncology Nursing Forum, 29, E35–E44.

doi: 10.1188/02.ONF.E35-E44
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Intervention Characteristics/Basic Study Process:

In the control group, one of the researchers visited caregivers for about 10 minutes twice a week for three weeks and asked, “How are you doing?”

In the massage therapy and Healing Touch groups, caregivers were provided with six 30-minute sessions. A certified massage therapist administered massage therapy, and a certified therapist provided Healing Touch treatments.

Sample Characteristics:

  • The sample (N = 36) was comprised of family caregivers of patients undergoing hematopoietic stem cell transplantation.
  • Caregivers did not have an acute health problem.

Setting:

Outpatient oncology clinic

Study Design:

  • The study was a well-designed quasi-experimental trial without randomization (control group [n = 13], massage therapy group [n = 13], Healing Touch group [n = 10]).
  • The sample size was determined by power analysis.

Measurement Instruments/Methods:

  • Subjective Burden Scale
  • Beck Anxiety Inventory
  • Center for Epidemiologic Studies–Depression
  • Multidimensional Fatigue Inventory–20

Results:

  • No significant difference was found in burden.
  • Anxiety scores declined significantly for the massage therapy group only.
  • Although depression scores declined for both treatment groups, only the massage therapy group achieved significance on post-hoc analysis.
  • Significant differences in general fatigue, reduced motivation fatigue, and emotional fatigue were found between the control and massage therapy groups, but no differences were found in physical fatigue and activity.

Limitations:

  • The study had a small sample and no randomization.
  • Special training was needed for the intervention.

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