Mitchinson, Lucy; (2023) Understanding the impact of touch-based complementary therapies in palliative care: Development of a Core Outcome Set. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: Complementary therapies, such as massage, reflexology and aromatherapy-massage, are widely used in palliative care settings yet clinical trials evidence of effectiveness is inconclusive. A Core Outcome Set (COS) is a list of outcomes deemed most important to key stakeholders. Using a COS, as a minimum, in future trials would ensure that meaningful outcomes are consistently evaluated and improve the evidence on their impact in palliative care. / Aim: To develop a COS for touch-based complementary therapies used in palliative care. / Design: A four-phase approach was used; 1) A systematic literature review to identify outcomes used to assess the effects of complementary therapies and the quality of psychometric tools, 2) Interviews with patients and complementary therapists to explore their experiences and identify further relevant outcomes, 3) A modified Delphi process to reduce the list of outcomes through group consensus, and 4) A single patient consultation and a professional consensus meeting to determine which of the shortlisted outcomes should be included in the COS. / Results: No tools were sufficiently validated for populations with life-limiting illness, however the FACT-G demonstrated promise. Holistic benefits of touch-based complementary therapies were identified from 12 interviews. 59 unique outcomes were identified from the literature and interviews. Following two rounds of Delphi process, 17 outcomes met inclusion criteria and were shortlisted. In the consensus meeting, five outcomes met criteria for inclusion. These were augmented by an additional four outcomes which were identified as important. The final COS comprised; anxiety, sleep quality, overall mental wellbeing, pain, muscle relaxation, receiving supportive and empathetic care, mental resilience, enjoyment and patient satisfaction. / Conclusion: A COS which reflects the priorities of key stakeholders was developed. Use of the COS in future trials will standardise trial outcomes, allow for data syntheses, and improve the evidence on the impact of complementary therapies in palliative care.

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