TERAPI KOMPLEMENTER

DALAM PERAWATAN
PALIATIF
YOSI OKTARINA
Introduction

 The use of complementary therapies in palliative care has a very long history.
 Many ‘natural therapies‘ have traditionally been used in nursing and have
been understood as normal nursing care. These have included touch,
massage, listening, prayer, the use of scents (now called ‘aromatherapy’),
energy therapies (therapeutic touch, reiki), diet, music, relaxation
techniques, foot massage (reflexology), the therapeutic use of water
(hydrotherapy), meditation, visualisation, and the provision of a healing or
sacred environment. In a sense, the inclusion of what are now called
‘complementary therapies’ is really no more than a development of
traditional nursing practices.
The use of complementary therapies can be understood as an empowerment
strategy that can be used by palliative-care patients and their families to regain
a sense of control over their illness and its management(Turton & Cook 2000),
and it has been argued that one of the major benefits of complementary
therapies in palliative care is that they encourage self-reliance (Shenton 1996).
EVIDENCE BASED PRACTICE

One of the greatest challenges for nurses who choose to incorporate

complementary therapies into clinical practice is the lack of substantive research that validates
these therapies. However, developing research into complementary therapies is not without its
problems. It is sometimes difficult to provide rigorous, validated evidence as
to why some things seem to work.
Research must be directed at highlighting the practical application of these therapies and their
value as a complement to conventional medicine, particularly in the palliation of symptoms.
More than 60% of palliative-care patients have a primary diagnosis of cancer, and
many of these are suffering from pain, dyspnoea, narcotic-induced constipation,
nausea and vomiting, and sleep problems. Other illnesses encountered in
palliative care are end-stage cardiac disease, HIV/AIDS, and end-stage
respiratory disease. All of these conditions have many severe physical symptoms.
ACUPUNTURE
There is good evidence to suggest that acupuncture can be of benefit in pain
control. Various studies have found statistically significant increases in pain
threshold when acupuncture is used for pain relief (Vickers 1996a). Another study
showed that acupuncture can produce a significant decrease in pain scores and
morphine requirements (Hidderley & Weinel 1997).
REFLEXOLOGY

The use of foot reflexology on patients with breast and lung cancer can result in
significantly decreased pain and anxiety (Stephenson et al. 2000).
Relaxation techniques

The scope of non-pharmacological strategies to manage pain has broadened

considerably over the past decade or so. The most popular non-pharmacological
strategies are breathing, imagery, music, and meditation (Kwekkeboom 2001).
Patients with advanced cancer using relaxation techniques have reported
reductions in pain and have been found to have a significant reduction in
nonopiate analgesics, indicating Better control and less need for breakthrough
pain relief (Sloman et al. 1994). Nurses should be encouraged to explore
relaxation techniques that are effective in managing pain (Kanji
2000).
Music Therapy

There have been numerous studies supporting the use of music therapy in the
alleviation of pain in palliative care (for example, O’Callaghan 1996). One of the
biggest challenges for nurses in palliative care is the amelioration of pain from
bone metastases. Bone is a common metastatic site for cancers of
the breast, prostate, and lung. Approaches to the management of this difficult
problem should be multifaceted and can include such things as relaxation
therapy, guided imagery, music, meditation, and therapeutic touch (Maxwell,
Givant & Kowalski 2001).
Nausea

Acupuncture and acupressure

Acupuncture is a potentially beneficial therapy for palliative-care patients experiencing
nausea and vomiting (Vickers 1996a).
Acupressure is a technique that involves manipulating the same acupoints as acupuncture
(Harris 1997). It can easily be incorporated into nursing practice, and can be taught to
patients and their carers. Acupressure has been shown to decrease nausea among women
undergoing chemotherapy for breast cancer (Dibble et al. 2000). In particular, acupressure on
acupoint pericardium 6
(PC6)—located on the anterior surface of the forearm proximal to the wrist— can reduce
nausea and vomiting in patients undergoing chemotherapy (Price,
Lewith & Williams 1991) and has been used to treat nausea and vomiting in children with
aggressive cancers (Keller 1995). It has also been suggested that acupressure wristbands worn
by palliative-care patients might decrease the incidence of nausea and vomiting (Brown et al.
1992).
Other therapies in nausea

Self-hypnosis, music therapy with guided imagery, and relaxation exercises have
been shown to decrease the severity of paediatric nausea and vomiting (Keller
1995). Clinical relaxation programs that include massage, guided
imageryprogressive muscle relaxation appear to shorten the emetic period
following chemotherapy (Fessele 1996).
It has also been suggested that aromatherapy can be beneficial. There are
indications that the use of peppermint oil in electric burners can reduce the
incidence of nausea in cancer patients receiving high-dose chemotherapy
(Hudson 1998).
ANXIETY

Massage can contribute to feelings of relaxation, calmness and wellbeing, but

few studies have been conducted in palliative care (Vickers 1996b). However,
aromatherapy massage is increasingly being used in palliative care to induce
relaxation—offering support and improved quality of life to people with limited
treatment options and a poor prognosis (Hadfield 2001).
Aromatherapy massage with 1% roman chamomile essential oil in palliativecare
patients has produced immediate positive improvement in anxiety, with a
persistent effect on physical symptoms and a consistent fall in anxiety scores
Over time (Wilkinson 1995).
Art Therapy

Creative arts such as music can reduce anxiety and depression when used as
part of a philosophy of healing the whole person (Hirsch & Meckes 2000;
Biley 2000).
Art therapy can assist dying people to face pain and depression, lead a more
meaningful life, and be creative in the ‘art of living’ (Deane, Carman & Fitch
2000). Terminally ill people with advanced cancer who were given an opportunity
to participate in the making of a sculpture found it to be an empowering
experience in which they went ‘beyond’ their illness and invested energy in
something worthwhile (Shaw & Wilkinson 1996).