Emerson, K., Murphy, M., Quinlin, L., O'Malley, P., & Hayes, K. (2017). Evaluation of a low-light intervention—starlight therapy—for agitation, anxiety, restlessness, sleep disturbances, dyspnea, and pain at end of life. Journal of Hospice and Palliative Nursing, 19, 214–220.

DOI Link

Study Purpose

To evaluate the effectiveness of low light therapy (starlight therapy) on symptoms at end of life, including anxiety, agitation, dyspnea, restlessness, insomnia, and pain.

Intervention Characteristics/Basic Study Process

Patients observed or reporting symptoms were enrolled in the study and low light therapy (starlight therapy) was applied for two hours with observations at baseline, 30 minutes, and at two hours.

Sample Characteristics

  • N: 40
  • AGE:  Average age = 82.25 years
  • MALES: 65%
  • FEMALES: 35%
  • CURRENT TREATMENT: Not applicable
  • KEY DISEASE CHARACTERISTICS: Various terminal illnesses (cancer, dementia, neurologic disease, lung disease, heart disease) with prognosis of six months or less enrolled in hospice

Setting

  • SITE: Multi-site   
  • SETTING TYPE: Two inpatient hospice facilities, one community and one VA
  • LOCATION: Southwest Ohio

Phase of Care and Clinical Applications

  • PHASE OF CARE: End-of-Life 
  • APPLICATIONS: Palliative care

Study Design

Prospective trial of use of low light therapy in patients observed or self-reporting symptoms

Measurement Instruments/Methods

Lux meter (measuring light levels), vital signs, adapted Assessing Distressing Symptoms STAR Symptom Scale and Questionnaire, outcome measurement tools (physiological symptoms)

Results

Respiratory rate significantly reduced from a rate of 23.91 at baseline to a mean rate of 18.63 (p < 0.01) at 30 minutes and a mean rate of 17.88 (p < 0.0001) at two hours. Heart rate also significantly reduced from a mean of 98.45 at baseline to a mean of 84.9 at 30 minutes (p < 0.01) and 84.55 at two hours (p < 0.0001). End-of-life symptoms as measured on the STAR symptom scale were noted and presence of moderate or severe symptoms were totaled with significantly fewer patients with presence of moderate or severe symptoms at both 30 minutes and two hours for agitation (p = 0.003 for 30 minutes, p < 0.0001 for two hours), anxiety (p < 0.0001 for 30 minutes, p < 0.0001 for two hours), restlessness (p < 0.001 for 30 minutes, p < 0.0001 for two hours), and sleep (p = 0.002 for 30 minutes, p < 0.0001 for two hours), with no significant reduction in numbers of patients with moderate or severe pain or dyspnea seen at any other time point.

Conclusions

Low light therapy shows some promise symptoms of agitation/anxiety/restless/sleep in patients with terminal illness in hospice, but further research needed given the small sample size, prospective design, limited patient population, and specific setting. 

Limitations

  • Small sample (< 100)
  • Risk of bias (no control group)
  • Risk of bias (sample characteristics)
  • Measurement/methods not well described
  • Findings not generalizable
  • Other limitations/explanation: There seems a risk of selection bias and it was not clearly outlined how patients were chosen and there is a possibility that patients who were most likely to show benefit were disproportionately included. Tools used for measurement of symptoms were not provided, so evaluation was difficult. The impact of other interventions was difficult to evaluate, and it is noted that 7 of 40 patients received scheduled pain or sedation medication during therapy, but the medications are unknown and those patients were not broken out and analyzed separately.

Nursing Implications

An oncology nurse should be aware that noninvasive interventions such as low light therapy show promise for reductions in certain symptoms at end of life, but more research is warranted for recommendation for wider populations/settings.