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

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

1 Featured Hospitals Dartmouth-Hitchcock Beaumont Health Systems Medical Center Royal Oak, MI Lebanon, NH

California Pacific Medical Center San Francisco, CA

Boston Medical Center Boston, MA MD Anderson Cancer Center Houston, TX

Briane Pinkson Karen Armstrong Dartmouth-Hitchcock Beaumont Health Systems Medical Center Royal Oak, MI Lebanon, NH

Carolyn Tague California Pacific Medical Center San Francisco, CA

Paula Gardiner Boston Medical Center Sat Siri Sumler Boston, MA MD Anderson Cancer Center Houston, TX

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

2 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)

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

3 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)

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

4 From www.bmc.org

Integrative Medicine at BMC

Safe, effective integrative therapies should be available to everyone without regard to ability to pay

Integrative Medicine Services

5 Community Garden Food Pantry Nutrition Education

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

6 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

7 Physical Space

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

8 Internship Training for Professional MTs

Infant Massage at BMC

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

9 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

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

10 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

Where does Support Come From?

• Nurses • Physicians • Administrative Staff • Massage Therapists • Patients

11 Nursing Support Earliest adopters of massage program Nurses feel less burnt out LMTs bring holistic, patient- centered perspective

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

12 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)

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

13 BMC Massage Therapy Internship Program

Contact information: BMC Family Medicine 617 414 6267 [email protected]

Saskia Cote, Director Cindy Gillan [email protected] Instructor

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

14 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

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 [email protected] – ACCAHC Info, Conferences at www.accahc.org

15 Resources in Hospital-Based Massage Therapy

• Society for Oncology Massage – Sets standards for oncology massage education – Lists hospitals providing oncology massage

www.s4om.org

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

16 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-hospital- massage/HBMNHome.php

www.hbmn.com

Resources in Hospital-Based Massage Therapy Books

MacDonald, G. Massage for the Hospital Patient and Medically Frail Client

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

17 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

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

18 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 ↑ Relaxaon

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 (!)

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% Fague ↓ 40.7% Anxiety ↓ 52.2% Depression ↓ 30.6%

19 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 relaxaon ↑

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, 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.

20 THANK YOU! Questions?

Briane Pinkson Karen Armstrong Dartmouth-Hitchcock Beaumont Health Systems Medical Center Royal Oak, MI Lebanon, NH

Carolyn Tague California Pacific Medical Center San Francisco, CA

Paula Gardiner Boston Medical Center Sat Siri Sumler Boston, MA MD Anderson Cancer Center Houston, TX

Contest

How to enter: • 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

21 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

Webinars Available On Demand

Dr. Ben Benjamin Whitney Lowe Unraveling the Mystery Series: • Orthopedic Approaches to Upper • Low Back Pain Body Disorders • Cervical Pain • Orthopedic Approaches to • Shoulder Pain Lumbo-Pelvic Pain • Knee Pain • Ankle Pain • Hip & Thigh Pain Carole Osborne • Pregnancy Massage 101 Tom Myers • Anatomy Trains: Clinical Applications of Myofascial Meridians Tracy Walton • Massage in Cancer Care • Beyond Good Posture • More About Cancer & Massage • Cardiovascular And Many More… Conditions & Massage

All Webinars Available at www.BenBenjamin.com

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