Does aromatherapy massage benefit patients with cancer attending a specialist palliative care day centre? Challenges in palliative care research; recruitment, attrition and compliance: experience from a randomized controlled trial A pilot study to evaluate the effect of reflexology on mood and symptom rating of advanced cancer patients Effectiveness of palliative day care in improving pain, symptom control, and quality of life. Yoga for patients and carers in a palliative day care setting. Exploring the value of shiatsu in palliative care day services.
A r and omised controlled pilot study was carried out to examine the effects of adjunctive aromatherapy massage on mood , quality of life and physical symptoms in patients with cancer attending a specialist unit . Participants were r and omised  to conventional day care alone or day care plus weekly aromatherapy massage using a st and ardised blend of oils for four weeks . At baseline and at weekly intervals , patients rated their mood , quality of life and the intensity and bother of two symptoms most important to them . Forty-six patients were recruited to the study . Due to a large number of withdrawals , only 11 of 23 ( 48 % ) patients in the aromatherapy group and 18 of 23 ( 78 % ) in the control group completed all four weeks . Mood , physical symptoms and quality of life improved in both groups . There was no statistically significant difference between groups in any of the outcome measures . Despite a lack of measurable benefit , all patients were satisfied with the aromatherapy and wished to continue . Whilst this pilot study has shown that a r and omised controlled trial of complementary therapy is feasible , it has also identified several areas that would require further consideration when design ing future studies , e.g. , the recruitment and retention of appropriate numbers of patients and the outcome measures used R and omized controlled trials ( RCTs ) in palliative cancer care often experience method ological problems . In this paper we discuss issues of major concern , including recruitment , patient attrition and compliance , arising from an RCT that compared comprehensive palliative care to conventional care .  The main criteria for trial entry were incurable malignant disease and a survival expectancy of between 2 and 9 months . Patients '  health-related quality of life ( HRQL ) , self-assessed by multi-item question naires , was a defined endpoint . The planned number of patients was successfully recruited , although the patients were referred late in the course of their disease so that follow-up tended to be short . Compliance in completing HRQL question naires was good up to 1 month before the patient 's death ; but in the final weeks it was found to drop substantially . Based on our experience , recommendations are given for those planning similar research . Procedures for improving patient recruitment are suggested , stressing the need for local data management , repeated information to referral sources , extensive screening for potentially eligible patients and simple referral routines . Precise inclusion criteria , including prognostic factors other than physicians ' estimates of life expectancy , should be used to ensure a sufficient follow-up period . For HRQL assessment , multi-item question naires can achieve excellent compliance up to 1 month before patients ' death , but in order to evaluate the very final weeks of life we recommend the use of simpler methods Many specialist palliative care services are under pressure to provide therapies such as aromatherapy , acupuncture or reflexology either by paid staff or volunteers . The evidence to justify the provision of such treatment , however , remains largely anecdotal as controlled clinical trials are difficult to design . Reflexology involves the application of pressure to ` reflex ’ areas of the h and s or feet with the intention of producing specific effects elsewhere in the body . The reflexologist palpates tender or painful areas that , it is suggested , indicate functional imbalance . As well as treatment of specific conditions , it is suggested that reflexology can relax the patient , which may aid selfhealing and prevention of disease . We have therefore conducted a pilot study with a r and omized controlled design to compare reflexology with simple foot massage To evaluate the effectiveness of palliative day care in improving pain , symptom control , and quality of life ( QOL ) , 120 consecutive new referrals to five specialist palliative day care centers were recruited into a prospect i ve comparative study . Fifty-three comparison patients were identified as those patients receiving usual palliative care services ( home care , inpatient care ) , but did not attend day care .  Patients were assessed at 3 interviews ( baseline , 6 - 8 weeks , and 12 - 15 weeks ) using measures of health-related quality of life : McGill Quality of Life Question naire ( MQOL ) and Palliative Care Outcome Scale ( POS ) . There were two main analyses : 1 ) patient demographic data were analyzed using chi-square ( chi(2 ) ) , and 2 ) QOL data were compared , based on distribution of scores , using the Mann-Whitney test ( MQOL and POS ) , and Wilcoxon Signed Rank for within group differences ( POS data only ) ; P < 0.05 was taken as significant . The patients were representative of those attending palliative day care in the UK . At baseline , the day care group were ( non-significantly ) worse than the comparison group in the MQOL support domain ( P = 0.065 ) . The comparison group had marginally more severe pain at baseline ( P = 0.053 ) and more severe symptoms at second assessment ( P = 0.025 ) . Both patient groups maintained overall health-related quality of life during the three months of the study . Palliative day care was not found to improve overall health-related quality of life . The limitations of the QOL measures in identifying the effects ( patient outcomes ) of palliative day care and the differences between the two patient groups ( age , employment , unequal sample sizes ) were limitations of the study and indicate the need for further research in this area This study suggests that yoga can be of benefit to patients ( and carers ) in palliative care setting s.  Complementary therapies have been employed in our day care unit for several years -- aromatherapy , reflexology and massage-- and have grown in popularity , enabling relaxation and a feeling of well-being . For patients striving to remain physically fit and , in consultation with our physiotherapist , we felt there may be a role for a gentle form of yoga . A study of the literature yielded information on yoga and cancer but little evidence of its use in palliative care . Having identified a form of yoga that could be adapted for those with physical frailties--  Dru yoga -- a 12-week pilot project was introduced into the day care unit . This proved to be highly successful and has now been incorporated as part of our therapeutic service This qualitative study sought to evaluate the effects of shiatsu therapy on clients attending hospice day services . Eleven clients with advanced progressive disease received five therapy sessions each at weekly intervals . Data about the effects was collected through five unstructured interviews with each client . Four of these were conducted before , during , and shortly after the therapy regime , and the fifth was undertaken four weeks after treatment ended . All the interviews were tape-recorded , transcribed and subject to content analysis . The results of the analysis revealed significant improvements in energy levels , relaxation , confidence , symptom control , clarity of thought and mobility . These benefits were of variable duration - in some instances lasting a few hours but in others extending beyond the 5-week treatment regime . Action to ensure research trustworthiness included keeping research journals to provide an audit trail , conducting member checks and using peer debriefing . The study involved three overlapping cohorts of participants in a data collection period that took approximately 6 months
This systematic review evaluates the evidence underpinning the provision of  palliative day care services ( PDS )  to determine whether such services have a measurable effect on attendees ’ wellbeing .