Effectiveness Not Established

Zen Initiative

for Fatigue

An urban “Zen initiative” was examined in patients with cancer for its impact on symptoms of depression and fatigue. The initiative involved remodeling of the physical space with attention to lighting and color use, incorporation of holistic interventions such as relaxation therapies, images, provision of yoga therapy, and related patient education materials.

Research Evidence Summaries

Kligler, B., Homel, P., Harrison, L. B., Sackett, E., Levenson, H., Kenney, J., . . . Merrell, W. (2011). Impact of the Urban Zen Initiative on patients' experience of admission to an inpatient oncology floor: a mixed-methods analysis. Journal of Alternative and Complementary Medicine, 17, 729–734.

Study Purpose

To evaluate the impact of the Urban Zen Initiative (UZI) on quantitative and qualitative measures of the experiences of patients admitted for inpatient oncology care.

Intervention Characteristics/Basic Study Process

The UZI model consists of five focus points:  the physical space surrounding patients, holistic nursing techniques, yoga with trained therapists, a navigator for patients, and audiovisual yoga materials at the bedside. All patients received the intervention; therefore, the investigators collected preintervention information about patients who were receiving standard care prior to the UZI intervention. Preintervention data were the basis of the control comparison. The investigators measured the outcomes immediately after admission and immediately before discharge. 

Sample Characteristics

  • The sample was comprised of 163 patients.
  • Mean age preintervention was 52.9 years (standard deviation [SD] = 17.3 years). Mean age in the UZI group was 54.4 years (SD = 14.6 years).
  • The preintervention group was comprised of 55% males and 45% females. The UZI group was comprised of 49% males and 51% females.
  • The investigators did not specify the key disease characteristics.
  • Patients were included if they
    • Were admitted to a specific inpatient oncology unit
    • Had a Karnofsky Performance Status (KPS) score greater than 60
    • Had a life expectancy longer than six months
    • Were able to speak English.

Setting

  • Single site
  • Inpatient
  • Beth Israel Deaconess Medical Center, New York City

Phase of Care and Clinical Applications

Patients were undergoing the active treatment phase of care.

Study Design

The study used a quasiexperimental design with historical control groups.

Measurement Instruments/Methods

  • Profile of Mood States–Brief Form (POMS-BF)    
  • EuroQol EQ-5D
  • Semistructured qualitative interview
     

Results

  • The investigators noted no significant admission or discharge changes based on POMS scores.
  • The investigators reported significant changes between groups in regard to tension (p = 0.009), depression (p = 0.03), vigor (p = 0.001), fatigue (p = 0.03), and total mood disturbance (p = 0.008). The scores indicated positive associations with UZI.
  • Mobility was significantly different (p = 0.03) between the groups, according to the EQ-5D scores. The EQ-5D demonstrated no significant group-based changes in pain, anxiety, or health state.
  • Thirty-three patients participated in qualitative data collection and indicated that the experience included fear and the need for information, caring, and connection. Responses also described the impact of the physical environment on patients' experiences, as well as the impact of yoga on patients' experiences of symptoms. Some patients stated they believed that what they had learned from the UZI could be useful in the future.

Conclusions

UZI may improve components of mood in an inpatient oncology setting. More work is needed to assess the real impact.

Limitations

  • The study had a risk of bias due to lacking an appropriate historical control group.
  • Knowing which part of the intervention had the greatest effect was difficult because the UZI has many components.
  • Whether the finding of significant pre- and post-UZI differences was based on initial POMS scores or \"change scores\" is unclear. Based on change scores, no intergroup differences existed.  

Nursing Implications

Providing a multifaceted healing environment, such as the UZI, within inpatient oncology settings could improve mood and perceived health status in patients with cancer. To facilitate the care process, nurses should assess patients' physical spaces; promote relaxation techniques, such as yoga breathing; and support patients.

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