Danhauer, S. C., Tooze, J. A., Holder, P., Miller, C., & Jesse, M. T. (2008). Healing touch as a supportive intervention for adult acute leukemia patients: a pilot investigation of effects on distress and symptoms. Journal of the Society for Integrative Oncology, 6, 89–97.

To determine the feasibility of conducting a randomized, clinical trial testing the effectiveness of healing touch (HT) for patients undergoing induction for acute leukemia and to obtain preliminary data to determine the effect size.

A prospective cohort of patients was selected to participate in the intervention trial. They completed self-report questionnaires and rated fatigue, nausea, pain, and distress at baseline, within seven days of hospital admission. Follow-up data collection was performed during the fifth week of hospitalization or prior to discharge. The HT intervention consisted of nine 30-minute sessions during weeks 2, 3, and 4. Family members were allowed to stay or leave during the session, depending on patient preference. All who provided the sessions were certified and had at least two years of experience with HT. All sessions were provided to the patient by the same practitioner. Sessions were standardized and included (1) the practitioner setting an intention for the patients’ highest good and (2) a standardized sequence of hand positions progressing from the ankles upward to the top of the head, with the hands placed either touching the patient or several inches above the body for one minute.

• The sample was comprised of 12 patients (33.3% male, 66.7% female).    
• Mean age was 59.8 years (standard deviation = 10.7 years).
• Of the patients, 91.7% had acute myeloid leukemia (AML), 8.3% had acute lymphoblastic leukemia (ALL), and 66.7% were in relapse.
• Of the patients, 75% had at least some college level education, 50% were employed, and 100% were white.

• Single site  
• Inpatient 

Patients were undergoing the active treatment phase of care.

The study was a prospective trial.

• MD Anderson Symptom Inventory (MDASI):  13 symptoms rated from 0 (not present) to 10 (as bad as you can imagine) for severity; six items rate the degree to which symptoms interfered with functioning on the same type of 11-point scale
• Women’s Health Initiative Insomnia Rating Scale (WHIIRS):  five-item measure of sleep quality
• Profile of Mood States Short Form (POMS-SF):  37 items on a five-point Likert scale
• Distress Thermometer
• Self-rating of symptoms on a 0- to 10-point scale
• Questionnaire to obtain general feedback on the HT intervention
   

Of the individuals approached for study participation, 48% declined (66% due to lack of interest and 34% due to medical issues or feeling too ill). Three patients who initially entered withdrew, one due to family request and concerns about interference with medical treatment, one due to medical complications, and one after speaking with his minister who had religious objections to participation.

There were no significant changes from baseline to the five-week follow-up measurement on the MDASI, sleep quality measures, or POMS.

There were significant improvements on the patient self-report scale for fatigue (–1.8 change; p < 0.01) and nausea (–0.5 change; p < 0.01). Changes in distress were not significant. There were no changes in pain, and baseline values for pain were low (median = 1), although patient feedback suggested short-term pain reduction and improved sleep.

Of the patients, 91% liked HT “very much,” and most stated they felt more calm and relaxed during and after the sessions. All said they would recommend HT to others, and eight patients (73%) wanted to continue using HT.

Patients suggested improvements of providing a better explanation of HT, offering longer and more frequent sessions, and offering 30 minutes of protected quiet time for patients in addition to HT sessions.

The study demonstrated that use of HT in the acute setting is feasible and may benefit patients.

• The study had a very small sample size. 
• No comparison group was included. 
• Because patients suggested protected quiet time, it is not clear if the benefits seen were from the HT or from the fact that the sessions provided such uninterrupted time.

The study findings suggest that a simple intervention of providing protected, uninterrupted quiet time to patients can be helpful to patients. This is something that could be readily incorporated into nursing care. Findings suggest that further research in this area is feasible in acutely ill patients. Findings suggest that provision of quiet time control in further research would be a viable approach, as well as comparison to other strategies to elicit a relaxation response. Information regarding drop-out reasons suggest that more extensive explanation of HT and mechanisms of effects is warranted with use of HT.