TERMINAL ILLNESS AND PALLIATIVE MASSAGE
The World Health Organization defines palliative care as that which focuses on the comfort of terminally ill patients. Palliative massage is reflective of our culture’s growing acceptance of alternative methods to treat the body and mind, since it is focused not on a “cure” but purely on comforting and easing the whole person as they make the transition from life into death. Palliative care attempts to minimize or eliminate emotional and physical pain or distress, emphasize the individual’s dignity and quality of life, and provide bereavement care for families. On a purely physical level, palliative massage is critical in preventing pressure sores, ulcerations that are likely to occur in people who are unable to leave their beds or wheelchairs for long periods of time. They commonly occur on bony areas like the tailbone, buttocks, ankles, heels, elbows and shoulders, areas that are in direct contact with the mattress or the wheelchair. More than other types of massage, palliative massage demands sensitive, perceptive, and gentle interpersonal skills as well as a personal assessment of one’s own attitudes regarding death and dying. Denial regarding the diagnosis, fear of illness and death, frustration with the state of medical care, mood swings, depression, and suicidal tendencies — all are commonly associated with the powerful emotions experienced by individuals with terminal illness. Palliative massage can help a person come to terms with these feelings, and even to find acceptance and peace. Palliative massage can assist the client in dealing with the tumultuous feelings experienced with a diagnosis of terminal
illness, helping them to cope with the physical or mental limitations imposed by the disease or level of disability, and confront or manage their anxiety regarding loved ones who must cope with the illness and death of a person close to them. Case studies show that palliative massage provides a nurturing environment, beneficial to stabilizing moods, easing depression, and allowing people to live the rest of their lives more fully, as it allows clients to confront their deepest fears about death and dying, leaving them with a sense of peace and comfort. Palliative massage can ease depression, anger, anxiety, and loneliness for those with terminal illness, as well as their family members and dear friends who are caregivers. Palliative massage has been shown to be especially beneficial to those with no family or few visitors, easing the client’s loneliness, fear, and anxiety, and extending warmth, affection, and care through the power of touch. Clients may have lost friends and other important people from their lives over the years; they may be unable to speak frankly with the individuals who currently surround them. Palliative massage can help bridge that gap, providing a human connection, easing stress and comforting the individual as he or she approaches death. Palliative massage uses a lighter touch than most massage. Its purpose is to encourage relaxation and ease tension, so light, soothing strokes, and a comforting touch is required. The relaxation response elicited from this type of massage enables the client to approach death with less fear and anxiety, feelings that often accompany a diagnosis of terminal illness. be identified as the individual moves through different stages on the scale. At higher points on the scale, for example, the client still has a significant amount of function, and may need increased circulation and pain management in specific areas of the body. In these stages, muscle manipulation and working the body as a whole increases circulation and promotes relaxation. The increased blood flow to the brain also helps ease anxiety and depression that often accompanies the diagnosis of terminal illness. At later stages on the scale, the palliative massage becomes more emotional and spiritual. For these clients, slow, light massage and rhythmic breathing exercises can be very helpful. Patients at ratings above 50 on the Karnofsky scale tend to have qualitatively different needs and expectations from massage than patients at ratings below 50. Patients scoring high on the scale need increased circulation and pain management in specific parts of the body, as postural distortion and bad body mechanics when walking, sitting and standing can cause muscles and blood vessels to tighten. The massage practitioner, after referral, must assess the plan of care to determine if there are any contraindications to the individual receiving massage. Once it is determined that there are no contraindications, the practitioner must obtain consent from the hospice staff nurse or team, if one exists. The assessment should follow these steps: 1. The attending physician provides the medical information. 2. The hospice team conducts a biological, psychosocial and spiritual assessment. 3. A referral is made for palliative massage. 4. The massage practitioner assesses for contraindications. 5. The practitioner obtains consent from the hospice staff nurse. 6. Informed consent is obtained from the client or caregiver. Hospice Palliative massage may or may not be part of an entire hospice care program for an individual. Hospice care is appropriate when the individual can no longer benefit from or decides not to participate in active treatment for his or her disease
Patient assessment and contraindications for palliative massage The palliative massage practitioner usually works closely with other health professionals, but each member of the health team is responsible for properly assessing the client’s condition, including the identification of any potential contraindications to massage. A thorough understanding of the client’s diagnosis and the risks and benefits of massage for that individual are essential to client safety and well-being. Contraindications for palliative massage include: ● History of recent deep vein thrombosis (within last three months). ● Thrombocytopenia with a platelet count of less than 50,000. ● Multiple myeloma. ● Therapeutic coumadin treatment. ● Recent surgery, injury, radiation, or invasive medical treatments. Karnofsky Performance Status Scale 4 100 Normal, no complaints, no evidence of disease.
90 Able to carry on normal activity: minor symptoms of disease. 80 Normal activity with effort: some symptoms of disease. 70 Cares for self: unable to carry on normal activity or active work. 60 Requires occasional assistance but is able to care for needs. 50 Requires considerable assistance and frequent medical care. 40 Disabled: requires special care and assistance. 30 Severely disabled: hospitalization is indicated, death not imminent. 20 Very sick, hospitalization necessary: active treatment necessary. 10 Moribund: fatal processes progressing rapidly. 0 Death. The Karnofsky Performance Status Scale is used to trace the client’s decline in function until the point of death, and is a useful tool in assessing the client on an ongoing basis. This is essential in palliative massage because different types of massage or forms of touch are more appropriate at certain times, and can
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