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一份关于改善癌症相关结局的肿瘤多站点按摩和针刺治疗项目的质量简报。

A Quality Brief of an Oncological Multisite Massage and Acupuncture Therapy Program to Improve Cancer-Related Outcomes.

机构信息

Department of Health Informatics and Administration, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.

Department of Integrative Medicine, Aurora Health Care, Aurora Sinai Medical Center, Milwaukee, WI, USA.

出版信息

J Altern Complement Med. 2020 Sep;26(9):820-824. doi: 10.1089/acm.2019.0371.


DOI:10.1089/acm.2019.0371
PMID:32924553
Abstract

Cancer treatment can present its own physical and mental challenges resulting in symptoms such as fatigue, stress, pain, nausea, and vomiting. Aurora Health Care is a large health system with 19 cancer centers. Integrative therapies such as acupuncture and massage have demonstrated success in reducing cancer-related symptoms and side effects to conventional cancer treatment and improving patient outcomes. In 2018, 15 of the 19 Aurora Cancer Clinics embedded a replicable Integrative Cancer Care closed model to provide adjuvant therapies for the best patient outcomes. This quality improvement study aimed to explore if the replicable integrative care model could demonstrate consistent outcomes for massage and acupuncture therapies aimed at symptom reduction across multiple oncology clinics. Aurora Cancer Care and Aurora Integrative Medicine designed a reproducible integrative therapy service model to be embedded into the Aurora Cancer Centers. Integrative therapies within the cancer centers allow patients easy access to care before, during, or after their cancer treatment. In 2018, 15 of the 19 cancer clinics had integrative therapies available to patients with cancer. This model required unified operations, onboarding, training, competency, and clinical oversight to achieve consistent processes for consistent outcomes. Furthermore, these innovative models prioritized the following: patient access (easy and affordable); service delivery (consistent and operationalized); clinical outcomes (effective and meaningful); and caliber of clinician (competent and confident). Aurora Health Care employs massage therapists (Mts) and acupuncturists (Ats). This employment model allows for standards and program model adherence. To achieve competent and confident clinician's, MT or AT must complete a cancer treatment-focused competency training program relative to their respective profession and adherence to practice standards outlined. The training program is built on evidence-based practice, observation, direct demonstration, return demonstration, mentorship, and ongoing quality review by clinical leaders. Aurora's Integrative Cancer Care closed model of care is accessible to patients through philanthropic funds secured to underwrite the free service of MT provided during infusion treatments. Funds also provided three free AT sessions. Ongoing acupuncture therapies were provided at a low-cost group acupuncture fee at $25.00 per treatment. Acupuncture is available in group format and provided either before or after chemotherapy treatment. The free services were intended to introduce the concept of integrative therapies as a viable adjuvant option with conventional cancer care. As this model incorporates a mix of philanthropic funding and low-cost fees to offset the cost of the therapy provider, it is referred to as a "closed model" or accessible only to those patients under the care of an Aurora Cancer specialist. In 2018, 15 Aurora Cancer Clinics offered massage and 11 Aurora Cancer Clinics offered acupuncture. Patients who self-selected integrative therapies via system-employed Mts and Ats were surveyed pre/post acupuncture and MT treatments using a visual analog scale about their perceived levels of pain, stress, nausea, and neuropathy. The staff integrative clinicians collected data from patients, and post-treatment data were compiled by the Department of Integrative Medicine. Aurora Cancer Centers are embedded within Aurora hospitals or free-standing clinics located throughout Wisconsin. In 2018, 15 cancer clinic locations embedded Mts, and 11 cancer clinic locations embedded Ats. Oncology patients. Clinical competencies were developed and applied to address indications, contraindications, and oncology-specific procedures to ensure that consistent quality of therapies was provided across sites. In 2018, Ats delivered 4367 Ats across 11 locations and Mts delivered 4197 Mts across 15 locations. During this study, the number of treatments provided was tracked versus episodic care. Pre/post AT and MT pain, stress, nausea, and neuropathy scores were recorded (0 [least] to 10 [worst]) and compared using paired -tests. Pre/post AT scores for pain, neuropathy, stress, and nausea were all significantly different ( < 0.001). For AT, there was a reported decrease in pain, stress, and neuropathy of 61.7%, 68.8%, and 47.9%, respectively. Pre/post MT scores for pain, neuropathy, nausea, and stress were also significantly different ( < 0.001). MT was greater at reducing stress and pain, 42.5% and 34.4%, respectively. Across 15 cancer clinics, both AT and MT treatments consistently and significantly reduced cancer-related side effects. These findings highlight the value of conducting a larger randomized-controlled trial to further assess the impact of Oncological Multisite Massage and Acupuncture Therapy on cancer-related symptoms across multiple oncologic clinics.

摘要

癌症治疗可能会带来身体和精神上的挑战,导致疲劳、压力、疼痛、恶心和呕吐等症状。奥罗拉医疗保健是一个拥有 19 个癌症中心的大型医疗系统。针灸和按摩等综合疗法已被证明可以成功减轻癌症相关症状和副作用,改善患者的治疗效果。2018 年,19 个奥罗拉癌症诊所中的 15 个诊所采用了可复制的综合癌症护理封闭模式,为患者提供辅助治疗,以获得最佳的治疗效果。这项质量改进研究旨在探索可复制的综合护理模式是否可以为减轻症状和副作用提供一致的结果,这些治疗方法适用于多个肿瘤学诊所的按摩和针灸治疗。奥罗拉癌症护理和奥罗拉综合医学设计了一种可复制的综合治疗服务模式,以融入奥罗拉癌症中心。癌症中心内的综合疗法使患者在癌症治疗前后能够方便地获得治疗。2018 年,19 个癌症诊所中有 15 个为癌症患者提供了综合疗法。该模式需要统一的运营、入职、培训、能力和临床监督,以实现一致的流程,获得一致的结果。此外,这些创新模式还优先考虑以下方面:患者的可及性(方便且负担得起);服务提供(一致且可操作);临床结果(有效且有意义);以及临床医生的素质(有能力且有信心)。奥罗拉医疗保健雇佣按摩治疗师(Mts)和针灸师(Ats)。这种雇佣模式允许遵守标准和项目模式。为了实现有能力和有信心的临床医生,MT 或 AT 必须完成针对其各自专业的癌症治疗重点能力培训计划,并遵守概述的实践标准。该培训计划基于循证实践、观察、直接演示、返回演示、指导和临床领导者的持续质量审查。奥罗拉的综合癌症护理封闭模式的护理对患者开放,通过慈善基金为在输液治疗期间提供的免费 MT 服务提供资金。资金还提供了三次免费的 AT 疗程。持续的针灸治疗以每次 25.00 美元的低费用团体针灸费用提供。针灸可在团体形式下进行,在化疗治疗前后均可进行。这些免费服务旨在将综合疗法作为一种可行的辅助选择引入常规癌症护理。由于这种模式结合了慈善资金和低费用费用来抵消治疗师的费用,因此被称为“封闭模式”,只能为接受奥罗拉癌症专家治疗的患者提供。2018 年,15 个奥罗拉癌症诊所提供按摩,11 个奥罗拉癌症诊所提供针灸。通过系统雇佣的 Mts 和 Ats 自行选择综合疗法的患者在接受针灸和 MT 治疗前后使用视觉模拟量表对他们的疼痛、压力、恶心和神经病变感知水平进行了调查。工作人员综合临床医生从患者那里收集数据,综合医学部门对治疗后的数据进行了汇编。奥罗拉癌症中心嵌入在奥罗拉医院或位于威斯康星州各地的独立诊所中。2018 年,15 个癌症诊所地点嵌入了 Mts,11 个癌症诊所地点嵌入了 Ats。肿瘤患者。制定并应用临床能力以解决适应症、禁忌症和肿瘤学特定程序,以确保在各个地点提供一致的治疗质量。2018 年,Ats 在 11 个地点提供了 4367 次 Ats,Mts 在 15 个地点提供了 4197 次 Mts。在这项研究中,跟踪了治疗次数与发作性护理的关系。记录了治疗前后 AT 和 MT 的疼痛、压力、恶心和神经病变评分(0[最低]至 10[最高]),并使用配对检验进行了比较。治疗前后 AT 的疼痛、神经病变、压力和恶心评分均有显著差异(<0.001)。对于 AT,疼痛、压力和神经病变分别降低了 61.7%、68.8%和 47.9%。治疗前后 MT 的疼痛、神经病变、恶心和压力评分也有显著差异(<0.001)。MT 对压力和疼痛的缓解作用更大,分别为 42.5%和 34.4%。在 15 个癌症诊所中,AT 和 MT 治疗均一致且显著减轻了癌症相关的副作用。这些发现强调了进行更大规模的随机对照试验的重要性,以进一步评估肿瘤学多站点按摩和针灸治疗对多个肿瘤学诊所癌症相关症状的影响。

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