Hospital-Based Massage Therapy at Boston Medical Center

Hospital-Based Massage Therapy at Boston Medical Center with Paula Gardiner, MD, MPH Part 1 of the webinar series, Hospital-Based Massage Therapy: Successes, Challenges, and Sound Advice with Tracy Walton Hospital-Based Massage Therapy: Successes, Challenges, and Sound Advice Tracy Walton MS, LMT Researcher Writer Educator Oncology massage specialist 1

Hospital-Based Massage Therapy: Successes, Challenges, and Sound Advice Speakers will: Answer questions and provide guidance in hospital-based massage therapy Share hard data that have helped move massage therapy toward the standard of care Tell inspiring patient stories from in-hospital massage services Describe strategies for communicating and collaborating with medical staff Featured Hospitals Beaumont Health Systems Royal Oak, MI Dartmouth-Hitchcock Medical Center Lebanon, NH California Pacific Medical Center San Francisco, CA Boston Medical Center Boston, MA MD Anderson Cancer Center Houston, TX 2

Karen Armstrong Beaumont Health Systems Royal Oak, MI Briane Pinkson Dartmouth-Hitchcock Medical Center Lebanon, NH Carolyn Tague California Pacific Medical Center San Francisco, CA Sat Siri Sumler MD Anderson Cancer Center Houston, TX Paula Gardiner Boston Medical Center Boston, MA Roadmap for Webinar Featured Presenter/Program: Dr. Paula Gardiner, Boston Medical Center Dr. Gardiner s background BMC and Integrative Medicine Massage Therapy Program Vision of the Future Questions from Participants (If time) General Hospital-Based Massage Therapy Resources 3

In this Webinar Boston Medical Center Boston, MA Paula Gardiner, MD, MPH Paula Gardiner, MD, MPH Physician in family medicine, BMC, since 2008 Trained at Tufts University School of Medicine Tufts University Residency Program Research Fellowship at Harvard Medical School (Children s Hospital, Osher Institute) 4

Boston Medical Center Boston Medical Center Boston, Massachusetts 496 bed academic medical center Teaching hospital for BU School of Medicine Community-based care Largest provider of trauma/er services in New England Largest safety-net hospital in New England Boston Medical Center Serves 1/3 of Boston residents More than half of patients at annual income below 200% of Federal Poverty Level ($44,200/family of 4) 5

BMC Patients Less than 1/4 have employer-based health insurance 70% of patients from social and ethnic minority populations 30% do not speak English as primary language 110 languages spoken Health care for people who are homeless 6

From www.bmc.org Integrative Medicine at BMC Safe, effective integrative therapies should be available to everyone without regard to ability to pay 7

Integrative Medicine Services Community Garden Food Pantry Nutrition Education 8

Integrative Medicine at BMC Vision Build a center of excellence, a national model for how integrative medicine can positively impact the health of the urban underserved Clinical Services Research Education 30 25 20 15 10 5 0 multivitamins chiropractor herbal tea cod liver oil acupuncture healers Chinese supplements prayer garlic aloe 9

What Does it Take to do Massage in a Hospital? Space Money Job descriptions Legal Language Champions (more later on that) History of Massage at BMC 10

History of Massage at BMC Physical Space 11

How are MTs Credentialed? State License Certificate of Malpractice Insurance Immunizations Annual TB test HIPAA Training Hospital Orientation Internship Training for Professional MTs Oncology Massage Working in a medical setting HIPAA, hospital practices Appropriate application of massage Cross-cultural considerations Charting skills 12

Internship Training for Professional MTs Infant Massage at BMC 13

Where is Massage Offered Now? Radiation Oncology Hematology/Oncology (Chemotherapy Infusion bays) Postpartum (Infant Massage) Palliative care Ambulatory care Staff table massage Staff on-site massage Why Massage Evolved at BMC (How do we keep these wonderful MTs?) Grads of internship program or equivalent Wanted to keep them around Wanted them to be paid Think outside the box how to pay Hired Palliative care (grant funded) ACC (fee for service, sliding scale) Staff table massage (fee for service, $50/session)) Staff chair massage (free, paid by philanthropic funds) Included in research projects 14

Research/Data Collection on Massage Oncology Massage Training Program in an Inner City Cancer Center P. Gardiner, L. Mullen, T. Walton, R. Saper, J. Rosen Dept. of Family Medicine, Dept. of Surgery, Boston University Medical School, Boston, MA Background Few massage training programs provide hospital-based massage to underserved patients Few oncology massage training programs exist Little is known about the feasibility of providing massage to underserved patients Aims Our primary aim is to create a sustainable oncology massage training program to provide free massage to underserved patients at a busy inner city hospital in Boston, Massachusetts, USA Materials and Methods After obtaining IRB approval, we developed oncology massage admission materials, patient documentation tools, and an oncology massage curriculum. We established safe hospital practice guidelines for our massage trainees in working with patients. We collected demographic information on our trainees and administered pre and post knowledge, behavior, and confidence questionnaires to each massage trainee. We used descriptive statistics to report on the previous number of years of experience with massage, age, race, occupation, and type of pre-requisite training in oncology massage. We used T tests to compare the pre and post knowledge, behavior and confidence questionnaires for each massage trainee Results Table 1. Demographics and Experience of Massage Therapist Participants (N=19) Frequency (percent) Previous massage experience Less than 1 year 4 (21) 1-2 years 11 (58) 5-6 years 3 (16) 18 years 1 (5) Age 20-30 1 (5) 30-40 6 (32) 40-50 7 (37) 50-60 3 (16) >60 2 (11) Race Non-Hispanic White 16 (85) Hispanic 1 (5) Asian 1 (5) Other 1 (5) Occupation Massage therapist (MT) 18 (95) MT and grants manager 1 (5) Pre-requisite training oncology massage Cancer hospice and HIV training 1 (5) CME course at a massage school 3 (16) CME course and Walton Oncology 4 (21) Massage training Walton Oncology Massage training only 8 (42) No formal training 2 (11) Not specified 1 (5) Table 2. Difference Summary Scores for Behavior, Knowledge, and Confidence (N=19) Standard Mean Deviation P-Value Behavior Score Difference -3.37 3.32 0.003 Knowledge Score Difference -1.5 4.15 0.12 Confidence Score Difference -5.4 3.12 0.001 Table 3. Pre- and Post-Test Behavior Questions (N=19) Mean Standard P-Value Difference Deviation Can warn patients about side effects -1.83 2.14 0.126 Can provide correct information on scientific evidence -1.16 0.83 0.001 Can easily record information in patient record -1.32 1.70 0.003 Table 4. Pre-and Post-Test Confidence Questions (N=19) Mean Standard P-Value Difference Deviation Confident in tailoring Limitations Small sample size Massage therapists were already interested in and had previous educational training in oncology massage. This may explain why we did not see a change in knowledge score Survey questions were not previously validated Conclusions It is feasible to have an oncology massage training program at a busy inner city hospital Training in a oncology clinical setting increased both confidence and clinical skills working with cancer patients Clinical skills such as patient documentation and providing massage to patients with IVs increased in trainees. Massage therapists are interested in working with underserved patients We had over 60 massage therapists inquire about the training. Of those who inquired, 19 massage therapists were selected to participate in four training internship courses. We provided over 400 free massages to cancer patients. Seventy percent (70%) of massage clients were breast cancer patients. massage protocol -1.26 1.37 < 0.001 Confident in providing massage to cancer patients -1.27 1.05 < 0.001 Confident talking with colleagues about cancer massage -1.37 1.46 < 0.001 Confident working with PIC lines and IVs -1.52 1.26 < 0.001 Future Directions To collect additional survey data on further graduates Provide continuing education credits Research mechanisms and benefits of massage for our cancer patients Evaluations from patients and providers demonstrate that our oncology patients are benefiting from the massage services and curb chemotherapy side effects. Contact information: Paula.Gardiner@BMC.org 15

Research on Massage in the Hospital Setting Effects of Massage Therapy on Preoperative Anxiety and Postoperative Pain in Cancer Patients Undergoing Port Implantation Principal Investigator Dr. Jennifer Rosen Port for IV chemo administration 32 Source: http://commons.wikimedia.org/wiki/file%3aport-catheter.jpg 16

Where does Support Come From? Nurses Physicians Administrative Staff Massage Therapists Patients Nursing Support Earliest adopters of massage program Nurses feel less burnt out LMTs bring holistic, patientcentered perspective 17

Building Physician Support In-house data about patients experience of massage Published research about benefits Prior positive experiences of integrative medicine Administrative Support Human Resources Hospital orientation Room scheduling Appointment scheduling Program coordination 18

Building Capacity through Interdisciplinary Education Program Sustainability How do we make CAM necessary, not just nice? Needs Assessment Administration, Providers, Researchers, Patients Align Program to Needs (Example Staff Massage Program) Role of Champions Advocate for Synergy Research Funding is Key (creative options) 19

Benefits of CAM Internship Partnerships with Schools Patients get services at low or no cost Hospital can provide CAM services for free Partner schools get training opportunities Training CAM professionals in certain aspects of medical field Familiarizing medical staff with CAM BMC Massage Therapy Internship Program Contact information: BMC Family Medicine 617 414 6267 familymedicine@bmc.org Saskia Cote, Director Saskiacote@gmail.com Cindy Gillan Instructor 20

What worked? Sliding scale for fee for service Educational partnerships! Cultivating champions in all departments Collecting data in-house research Grant-writing skills Do Differently? Would have partnered earlier with a massage school to implement massage therapy training program. Would have charged tuition for the program earlier, not offered for free Would have provided low cost massage to staff earlier 21

The Future? Massage Therapy, CAM, Health Care, Health Care Reform Two things in health care reform Accountable care organization Patient-centered medical home Role of massage therapy? Resources in Hospital-Based Massage Therapy Associations/Organizations Publications Research 22

Resources in Hospital-Based Massage Therapy ACCAHC Academic Consortium for Complementary and Alternative Health Care Clinical Care Working Group (CWG) Hospital-Based Massage Therapy (HBMT) Subgroup Contact MK Brennan, MS, RN, LMBT, with info on your program to share brennanmk@aol.com ACCAHC Info, Conferences at www.accahc.org Resources in Hospital-Based Massage Therapy Society for Oncology Massage Sets standards for oncology massage education Lists hospitals providing oncology massage www.s4om.org 23

Resources in Hospital-Based Massage Therapy Massage Therapy Foundation Funds research Funds community service Education Research literacy (online and face to face courses) www.massagetherapyfoundation.org www.educationtrainingsolutions.com AMTA Career Success Series Working in a Health Care Environment A guide from the AMTA Free download Available at: http://www.amtamassage.org/uploads/cms/docu ments/amta_health_care_guide.pdf www.amtamassage.org 24

Hospital-Based Massage Network Association of hospitals/individuals sharing information about programs Directed by Laura Koch Extensive resources Data collected Sample HBMT proposals in Exploring Hospital-Based Massage Available at Natural Touch Marketing: http://www.naturaltouchmarketing.com/hbmn-hospitalmassage/hbmnhome.php www.hbmn.com Resources in Hospital-Based Massage Therapy Books MacDonald, G. Massage for the Hospital Patient and Medically Frail Client 25

Resources in Hospital-Based Massage Therapy Books MacDonald, G. Medicine Hands: Massage Therapy for People with Cancer Wible, J. Drug Handbook for Massage Therapists Walton, T. Medical Conditions and Massage Therapy Tips for Using Research to Promote HBMT www.pubmed.gov (published research) www.clinicaltrials.gov (research in progress) When searching at these sites: Avoid massage therapy hospital-based Instead, search by condition or treatment Massage therapy cancer Massage therapy stroke Massage therapy migraine Massage therapy back pain 26

Research (some favorites) Mitchinson AR, Hyungjin MK, Rosenberg JM, Geisser M, Kirsch M, Cikrit D, Hinshaw DB. Acute postoperative pain management using massage as an adjuvant therapy: a randomized trial. Arch Surg 2007;142(12):1158-1167 Grealish L, Lomasney A, Whiteman B. Foot massage. A nursing intervention to modify the distressing symptoms of pain and nausea in patients hospitalized with cancer. Cancer Nurs. 2000 Jun;23(3):237-43. Post-White J, Kinney ME, Wavik K, Gau JB, Wilcox C, Lerner I. Therapeutic massage and healing touch improve symptoms in cancer. Integrative Cancer Therapies 2003;2(4):332-44. Jane SW, Chen SL, Wilkie DJ, Lin YC, Foreman SW, Beaton RD, Fan JY, Lu MY, Want YY, Lin YH, Liao MN. Effects of massage on pain, mood status, relaxation, and sleep in Taiwanese patients with metastatic bone pain: a randomized clinical trial. Pain 152(2011) 2432-2442. Cassileth BR, Vickers AJ. Massage therapy for symptom control: outcome study at a major cancer center. Journal of Pain and Symptom Management Sep 2004;28(3):244-9. Mitchinson et al. (2007) Sample size: 605 veterans undergoing major surgery Procedure: up to five 20-min back massages Controls: Individual attention, routine care Findings. Compared to controls, massage associated with: Pain Short-term anxiety 27

Grealish L et al. (2000) Sample size: 87 inpatients Procedure: 10-min foot massage Control: Quiet time Findings. Compared to control, massage associated with: Pain Nausea Relaxa on Post-White et al., 2003 Sample size: 164 outpatients in chemotherapy Control/Comparisons: Standard care, Healing Touch, Caring presence Findings. Compared to control, massage associated with: Anxiety Pain Analgesic use Mood Relaxation No change in nausea (!) 28

Cassileth and Vickers, 2004 Sample size: 1290 in- and outpatients Control: None Procedure: 20-60 min. massage Findings. Compared to pre-massage values, post-massage values suggested: Pain 40% Nausea 21.2% Fa gue 40.7% Anxiety 52.2% Depression 30.6% Jane et al, 2011 Sample size: 84 inpatients Control: attention Procedure: 45 min. massage (3 sessions) Findings. Compared to control, massage associated with: Pain Mood status improved Muscle relaxa on 29

Research References Cassileth BR, Vickers AJ. Massage therapy for symptom control: outcome study at a major cancer center. Journal of Pain and Symptom Management Sep 2004;28(3):244-9. Corbin L. Safety and efficacy of massage therapy for patients with cancer. Cancer Control Jul 2005;12(3):158-164. Ernst E. Massage therapy for cancer palliation and supportive care: a systematic review of randomised clinical trials. Support Care Cancer. 2009 Jan 13. Grealish L, Lomasney A, Whiteman B. Foot massage. A nursing intervention to modify the distressing symptoms of pain and nausea in patients hospitalized with cancer. Cancer Nurs. 2000 Jun;23(3):237-43. Jane SW, Chen SL, Wilkie DJ, Lin YC, Foreman SW, Beaton RD, Fan JY, Lu MY, Want YY, Lin YH, Liao MN. Effects of massage on pain, mood status, relaxation, and sleep in Taiwanese patients with metastatic bone pain: a randomized clinical trial. Pain 152(2011) 2432-2442. Jane SW, Wilkie DJ, Gallucci BB, Beaton RD. Systematic review of massage intervention for adult patients with cancer: a methodological perspective. Cancer Nurs. 2008 Nov-Dec;31(6):E24-35. Review. Kutner J, et al. Methodological challenges in conducting a multi-site randomized clinical trial of massage therapy in hospice. Journal of Palliative Medicine 2010: 13:6;739:744. Click here for an abstract. Kutner J, et al. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer. Annals of Internal Medicine: September 16, 2008; 149:6;369-380. Lu W, Ott MJ, Kennedy S, Mathay MB, Doherty-Gilman AM, Dean-Clower E, Hayes CM, Rosenthal DS. Integrative Tumor Board: a case report and discussion from Dana-Farber Cancer Institute. Integr Cancer Ther. 2009 Sep;8(3):235-41. Research References, continued Menard MB. Making Sense of Research (2nd ed). Toronto: Curties-Overzet Publications, 2010. Moyer, C, et al. Does massage therapy reduce cortisol? A comprehensive quantitative review. Journal of Bodywork & Movement Therapies (2011)15:3-14. Moyer C, et al. A meta-analysis of massage therapy research. American Psychological Association, Inc. 2004;130(1):1,3-18. Myers C, Walton T, Small B. The value of massage therapy in cancer care. Hematology/Oncology Clinics of North America 2008;22:649-660. Phipps S, Barrera M, Vannatta K, Xiong X et al. Complementary therapies for children undergoing stem cell transplantation: report of a multisite trial. Cancer 2010 Jul 12. (Epub ahead of print) Phipps S, Dunavant M, Gray E, Rai SN. Massage therapy in children undergoing hematopoietic stem cell transplantation: results of a pilot trial. Journal of Cancer Integrative Medicine 2005;3(2):62-70. Phipps, S. Reduction of distress associated with paediatric bone marrow transplant: complementary health promotion interventions. Pediatric Rehabilitation 2002;5(4):223-34. Post-White J, Kinney ME, Wavik K, Gau JB, Wilcox C, Lerner I. Therapeutic massage and healing touch improve symptoms in cancer. Integrative Cancer Therapies 2003;2(4):332-44. Walton T. "Massage Research in Massage Practice," in Medical Conditions and Massage Therapy: A Decision Tree Approach. Philadelphia: Lippincott Williams & Wilkins, 2011. 30

THANK YOU! Questions? Karen Armstrong Beaumont Health Systems Royal Oak, MI Briane Pinkson Dartmouth-Hitchcock Medical Center Lebanon, NH Carolyn Tague California Pacific Medical Center San Francisco, CA Sat Siri Sumler MD Anderson Cancer Center Houston, TX Paula Gardiner Boston Medical Center Boston, MA 31

How to enter: Contest Write a review of a Hospital-Based Massage webinar on Dr. Benjamin s Facebook Wall at Facebook.com/BenjaminInstitute. You re eligible for one entry per webinar What you can win: A free copy of Massage for the Hospital Patient and Medically Frail Client by Gayle MacDonald A complete set of the Hospital-Based Massage Therapy webinar series to give to a friend or colleague Webinars Available On Demand Other Webinars with Tracy Walton Massage in Cancer Care More About Cancer & Massage Cardiovascular Conditions & Massage All Webinars Available at www.benbenjamin.com 32

Webinars Available On Demand Dr. Ben Benjamin Unraveling the Mystery Series: Low Back Pain Cervical Pain Shoulder Pain Knee Pain Ankle Pain Hip & Thigh Pain Tom Myers Anatomy Trains: Clinical Applications of Myofascial Meridians Beyond Good Posture And Many More Whitney Lowe Orthopedic Approaches to Upper Body Disorders Orthopedic Approaches to Lumbo-Pelvic Pain Carole Osborne Pregnancy Massage 101 Tracy Walton Massage in Cancer Care More About Cancer & Massage Cardiovascular Conditions & Massage All Webinars Available at www.benbenjamin.com JOIN The Benjamin Institute E-Mailing List & Receive a FREE Ebook on the Low Back 33