How best to capture the impact of complementary therapies in palliative care: A systematic review to identify and assess the appropriateness and validity of multi-domain tools

Authors: Mitchinson Lucy, Chu Christina, Bruun Andrea, Sisk Ali-Rose, Armstrong Megan, Vindrola-Padros Cecilia, Kupeli Nuriye, Candy Bridget, Stone PatrickJournal: Palliative medicinePublished: October 1, 2022DOI: 10.1177/02692163221122955

Q1 JournalSJR: 1.5h-index: 112SCImago

Strong EvidenceSystematic Review

Cancer Pain Management

In Plain Language: cancer pain, explained

Complementary therapies are widely used in palliative care settings. Qualitative research found that people with advanced disease report a range of physical and psychological benefits from complementary therapies, however evidence of their effectiveness from clinical trials is inconclusive. This may be because trials are limited by use of inappropriate outcome measures. To identify tools which capture the impact of massage, reflexology and aromatherapy in people with advanced disease. We (1) identified multi-domain tools used to evaluate these therapies in populations with any chronic health condition and (2) assessed whether tools were valid and psychometrically robust in populations with advanced disease. A two-stage systematic review was conducted using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines (PROSPERO: CRD42020161199). Six databases were searched (August 2021). Study methodological quality, tool psychometric properties and evidence quality were assessed. A global comparison score was generated. Stage 1: 66 trials using 40 different multi-domain tools were identified. Stage 2: Of these tools, we identified papers for seven tools regarding development or validation in advanced disease populations. The majority of psychometric data were inconsistent or inconclusive. Data were mostly of low quality due to methodological issues. Of the tools identified, 'Functional Assessment of Cancer Therapy - General' appears to be the most suitable alternative tool against COMSIN criteria, for trials of massage, reflexology and aromatherapy in palliative care. Further tool validation is required before firm recommendations can be made. Co-development of a core outcome set could ensure relevant domains are assessed.

Key Findings: what this systematic review found about cancer pain

✓Qualitative research demonstrates that people with advanced disease report multiple physical and psychological benefits from complementary therapies, but clinical trial evidence of their effectiveness remains inconclusive.
✓The gap between reported patient benefits and inconclusive clinical trial evidence may be attributable to the use of inappropriate outcome measures in existing trials.
✓A systematic review using COSMIN guidelines identified and assessed multi-domain tools to determine which measurement instruments are valid and psychometrically robust for evaluating massage, reflexology, and aromatherapy in populations with advanced disease.

What This Means for You

While complementary therapies like reflexology are commonly used in palliative care and patients report feeling better, current research hasn't settled on the best way to properly measure their benefits, so more rigorous testing is needed.

What This Means for Practitioners

When documenting reflexology outcomes for palliative clients, be aware that standardized measurement tools for advanced disease are underdeveloped; consider using validated tools like FACT-G or supplementing with detailed client-reported outcomes to strengthen evidence of your practice's impact.

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Cancer pain: common questions

What does this study say about cancer pain?

What did this study find?

Qualitative research demonstrates that people with advanced disease report multiple physical and psychological benefits from complementary therapies, but clinical trial evidence of their effectiveness remains inconclusive. The gap between reported patient benefits and inconclusive clinical trial evidence may be attributable to the use of inappropriate outcome measures in existing trials. A systematic review using COSMIN guidelines identified and assessed multi-domain tools to determine which measurement instruments are valid and psychometrically robust for evaluating massage, reflexology, and aromatherapy in populations with advanced disease.

How strong is this evidence?

This is a systematic review and we rate its evidence strong. It was published in Palliative medicine, a Q1 journal. This study is indexed here for context; it did not test reflexology itself.