Role of Nurse Healer in Integrated Cancer Care Explored

ARLINGTON, Va—Nurses often take an active role in integrating complementary and alternative medicine (CAM) with conventional care in the hospital setting, said a panel of nurses at a session of the Comprehensive Cancer Care 2000 conference.

“Patients want more than they are getting now from the medical system,” said Janice Post-White, RN, PhD, associate professor, School of Nursing and Center for Spirituality and Healing, University of Minnesota.

Drugs, diagnostics, treatments, and cure are essential components of cancer care, she said, “but patients want more. They want care. They want you to spend time with them. They want you to communicate hope. They want a compassionate presence from the beginning of life to the end.” That presence, she said, is precisely what nurses can provide.

Susan Bauer, RN, DNSc, assistant professor of nursing and medicine, University of Massachusetts at Worcester, agreed. “Patients often feel abandoned by health care professionals. Nurses step in when other conventional therapies are no longer effective or available,” she said.

Stepping in and providing that compassionate presence means overcoming barriers to change not only within the institution but also within oneself, one’s patients, and among one’s colleagues, the panelists said.

“Find key people within your institution who are interested in working with you on CAM,” Dr. Post-White advised, adding that not all colleagues will offer support in the early stages of a CAM program. “Selectively introduce CAM to patient populations who already use CAM. Ask them what they are doing. Choose one unit to start with, not the entire institution, and integrate CAM into existing programs there.”

Integrating CAM into other interventions means documenting outcomes, she added. “Not documenting what we have done and what outcomes resulted would put us back decades, when evidence about CAM was only anecdotal,” she said.

Dr. Post-White cited a survey of patients indicating that meditation led the choices of CAM therapies, followed by herbal remedies, humor, massage, therapeutic touch, progressive muscle relaxation, and prayer. An American Cancer Society study of breast cancer patients, she said, concluded that CAM allowed patients to feel more hopeful, participate in their own care, and better cope with the emotional aspects of their cancer.

The use of CAM in children also is increasing. In a survey of children with cancer, Dr. Post-White and her colleagues found that parents sought out CAM to manage side effects of chemotherapies, to cope with emotional aspects of the disease, or simply to feel more hopeful. For childhood cancers, the top CAM intervention was prayer, she said, followed by nutritional supplements, megavitamins, and massage therapy.

At Minnesota, she said, massage therapists are giving massage to parents of children with cancer. In one research study, the children watch and then they too receive a massage. The primary outcome proved to be lessening of the parents’ anxiety.

Dr. Post-White also pointed out that only 57% of patients told their health care team that they were using CAM. “You have to know if patients are using CAM to check on any interactions with chemotherapy,” she warned. “Herbals are often impure or contain high levels of calcium or phosphorous.”

Providers should inquire about CAM use by asking direct, nonjudgmental questions, she said. Conceivably, the institution could be held liable for not knowing what patients are using or for not informing patients about any risks associated with CAM use. So a knowledge base on potential interactions had to be developed within the institution.

“Close cooperation with the pharmacy department is indicated when patients bring in their own herbals and other supplements,” Dr. Post-White said.

Dr. Bauer said the nursing profession needs to takes steps to change policy regarding CAM. She urged greater participation at conferences and expert panels for nurses as a starting point.

She also said that establishing standards of practice in CAM is an ethical and legal responsibility for the profession. Consistency of training is needed, integrated into formal nursing training and as continuing education for working nurses.

She urged combining strengths and resources with other disciplines—pharmacy, medicine, massage—to bring students together and teach them in the same classroom when content overlaps.