Evidence Synthesis Program Aromatherapy and Essential Oils: A Map of the Evidence September 2019 Prepared for: Authors: Department of Veterans Affairs Michele Freeman, MPH Veterans Health Administration Chelsea Ayers, MPH Health Services Research & Development Service Carolyn Peterson, PhD Washington, DC 20420 Devan Kansagara, MD, MCR Prepared by: Evidence Synthesis Program (ESP) Center Portland VA Medical Center Portland, OR Devan Kansagara, MD, MCR, Director PREFACE The VA Evidence Synthesis Program (ESP) was established in 2007 to provide timely and accurate syntheses of targeted healthcare topics of importance to clinicians, managers, and policymakers as they work to improve the health and healthcare of Veterans. These reports help: • Develop clinical policies informed by evidence; • Implement effective services to improve patient outcomes and to support VA clinical practice guidelines and performance measures; and • Set the direction for future research to address gaps in clinical knowledge. The program is comprised of four ESP Centers across the US and a Coordinating Center located in Portland, Oregon. Center Directors are VA clinicians and recognized leaders in the field of evidence synthesis with close ties to the AHRQ Evidence-based Practice Center Program and Cochrane Collaboration. The Coordinating Center was created to manage program operations, ensure methodological consistency and quality of products, and interface with stakeholders. To ensure responsiveness to the needs of decision-makers, the program is governed by a Steering Committee comprised of health system leadership and researchers. The program solicits nominations for review topics several times a year via the program website. Comments on this evidence report are welcome and can be sent to Nicole Floyd, Deputy Director, ESP Coordinating Center at [email protected]. Recommended citation: Freeman M, Ayers CK, Peterson C, and Kansagara D. Aromatherapy and Essential Oils: A Map of the Evidence. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #05-225; 2019. Available at: https://www.hsrd.research.va.gov/publications/esp/reports.cfm. This report is based on research conducted by the Evidence Synthesis Program (ESP) Center located at the VA Portland Healthcare System, Portland, OR, funded by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report. i Aromatherapy and Essential Oils Evidence Synthesis Program ACKNOWLEDGMENTS This topic was developed in response to a nomination by the Office of Patient Centered Care and Cultural Transformation (OPCC&CT) to guide the use of aromatherapy and essential oils in the VHA. The scope was further developed with input from the topic nominators (ie, Operational Partners), the ESP Coordinating Center, the review team, and the technical expert panel (TEP). In designing the study questions and methodology at the outset of this report, the ESP consulted several technical and content experts. Broad expertise and perspectives were sought. Divergent and conflicting opinions are common and perceived as healthy scientific discourse that results in a thoughtful, relevant systematic review. Therefore, in the end, study questions, design, methodologic approaches, and/or conclusions do not necessarily represent the views of individual technical and content experts. The authors gratefully acknowledge Robin Paynter, MLIS, and the following individuals for their contributions to this project: Operational Partners Operational partners are system-level stakeholders who have requested the report to inform decision-making. They recommend Technical Expert Panel (TEP) participants; assure VA relevance; help develop and approve final project scope and timeframe for completion; provide feedback on draft report; and provide consultation on strategies for dissemination of the report to field and relevant groups. Ben Kligler, MD, MPH National Director, Integrative Health Coordinating Center VA Central Office, Washington, DC Peter A. Glassman, MBBS, MSc Chair, Medical Advisory Panel, Pharmacy Benefits Management Services VA Greater Los Angeles Healthcare System Technical Expert Panel (TEP) To ensure robust, scientifically relevant work, the TEP guides topic refinement; provides input on key questions and eligibility criteria, advising on substantive issues or possibly overlooked areas of research; assures VA relevance; and provides feedback on work in progress. TEP members are listed below: Leila Kozak, PhD Whole Health National Champion, OPCC&CT – IHCC, VA Puget Sound HCS Director, Integrative Palliative Care Institute (IPCI) Angie Lillehei, PhD MPH RN Chief Integrator, Minnesota Personalized Medicine Owner and Principal, Noctilessence LLC ii Aromatherapy and Essential Oils Evidence Synthesis Program Linda L. Halcon, PhD, MPH, RN Associate Professor Emerita, University of Minnesota School of Nursing Margo A. Halm, RN, PhD, ACNS-BC Associate Chief Nurse Executive, Nursing Research/ EBP & Magnet Director, Portland VAHCS Peer Reviewers The Coordinating Center sought input from external peer reviewers to review the draft report and provide feedback on the objectives, scope, methods used, perception of bias, and omitted evidence. Peer reviewers must disclose any relevant financial or non-financial conflicts of interest. Because of their unique clinical or content expertise, individuals with potential conflicts may be retained. The Coordinating Center and the ESP Center work to balance, manage, or mitigate any potential nonfinancial conflicts of interest identified. iii Aromatherapy and Essential Oils Evidence Synthesis Program TABLE OF CONTENTS ACKNOWLEDGMENTS ........................................................................................................... II ABSTRACT ................................................................................................................................... 1 EXECUTIVE SUMMARY .......................................................................................................... 2 Introduction ................................................................................................................................. 2 Methods....................................................................................................................................... 2 Results ......................................................................................................................................... 4 Figure. Map of the evidence from systematic reviews of inhaled and topical essential oils for targeted health conditions/populations ....................................................................................... 5 Discussion ................................................................................................................................... 6 Conclusions ................................................................................................................................. 6 Abbreviations Table .................................................................................................................... 7 INTRODUCTION......................................................................................................................... 9 METHODS .................................................................................................................................. 10 Topic Development ................................................................................................................... 10 Search Strategy ......................................................................................................................... 10 Study Selection ......................................................................................................................... 11 Data Abstraction ....................................................................................................................... 12 Quality Assessment ................................................................................................................... 12 Data Synthesis ........................................................................................................................... 13 Rating the Body of Evidence .................................................................................................... 14 RESULTS .................................................................................................................................... 15 Literature Flow.......................................................................................................................... 15 Key Question: What evidence is available that examines the effectiveness of aromatherapy or essential oils for health-related indications? ............................................................................