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Why aren’t policy makers listening to palliative care patients?

Massage & Myotherapy Australia has today called upon all political parties contesting seats in the NSW state election to listen and respond to what the palliative care patients, community and researchers are telling them about the needs of patients.

Mrs Hughes, Massage & Myotherapy Australia CEO, said that ‘User choice, anecdotal evidence, and a growing body of scientific evidence provide a solid basis on which to formulate appropriate policies around palliative care.

‘Unfortunately, in the absence of adequate policies and funding that recognise their role, many professional therapists are asked to provide their services for free. In the long-term this is untenable.’

‘Among the palliative care community, massage is well known for its benefits in improving the quality of life of patients.

‘Often, massage fills the gap when patients seek alternatives to medications and other therapies because patients feel that massage is more appropriate to their needs.

‘However, leaving it up to patients or their carers to find a qualified professional when they are desperate is no longer a responsible government response, when there is now a large pool of qualified professionals in NSW,’ Mrs Hughes said.

The CSIRO’s Futures Report, ‘Future of Health’, found that:

Consumers can be empowered to better prevent illness and manage their health by improving health literacy, reducing information asymmetry, expanding telehealth services and developing consumer focussed health solutions.

The report also found that:

Consumers are demanding more from their healthcare experiences and embracing new technology for low-risk decision making relating to their health.

Massage and myotherapy are well within these criteria,’ Mrs Hughes said.

A recent Australian study found that the complementary medicine workforce provides substantial levels of clinical care in many important areas of health (Steel, A. et al. 2017). The most frequently reported specialities used in a clinical environment involving massage and myotherapy included: Pain management—59.6%, Complex chronic disease—44.9% and Oncology—32.9%.

The 2017 Steel et al, study also found that the skills and training of many qualified therapists are underutilised with a sizeable proportion of this workforce also engaged in other non-clinical roles.

‘Despite these reports informed user choice, access to private health insurance coverage and publicly-funded services are restricted, Mrs Hughes said.

‘Consequently, the presence of massage in palliative and end-of-life care, in private and public settings, has occurred largely on an ad-hoc basis as organisations respond to consumer demand

‘Additionally massage is often championed by key personnel within the organisation who are motivated by the effectiveness of massage therapy as evidenced in the scientific literature or anecdotal and personal experiences related by patients’.

However, limited access is available to therapists who are accredited individually and who provide fee-for-service therapy.

While this is expanding, with some large metropolitan hospitals actively establishing massage services in a hospice setting, involving contractors or employed staff, the number of well-trained palliative or end-of-life care massage therapists is small, with demand often outstripping supply.

‘Providing funding to augment training and education for the speciality through professional development providers in various training settings would have a direct impact on user choice and availability,’ Mrs Hughes said.

‘A more formally funded and integrated approach, overseen at a NSW state level is needed.’

‘This does not mean that massage therapists or myotherapists should depose the role of Allied Health services, but it does provide another known and recognised end-of-life care option that is underutilised and underfunded, in comparison.’

‘Medical science is yet to fully understand how massage works, but the evidence coming out of clinical settings is clear. Massage is a useful tool for improving symptom management and reducing suffering in palliative care patients,’ Mrs Hughes said.

Studies have found that:

  • many palliative care services now offer massage as a complementary therapy—most often with the aim of improving the wellbeing of patients and their carers (Falkensteiner, M. et al.)
  • following massage, patients note short-term changes in symptoms, a decrease in pain intensity and anxiety, and an improvement in patients’ sense of relaxation and feelings of inner peace (Mitchinson, A. et al.)
  • massage therapy has been shown to reduce the subjectively-perceived symptom of pain in oncological patients receiving palliative care and remission of the symptoms of anxiety and depression (Falkensteiner, M. et al.).
  • the overall safety and the acceptability of massage to palliative care patients has been demonstrated by the uptake of these therapies within services (Palliative Care Knowledge Network)
  • in their 2008 review of published literature to determine the prevalence of under-treatment in cancer pain, Deandrea A et al. found that people with cancer-related pain have their own particular needs which are often not well met, despite effective techniques being known to relieve their burden
  • the median number of massage sessions provided for Cancer Treatment Issues and Other Chronic Conditions is five (AAMT Practitioners' Survey).

Remedial massage therapists and myotherapists hold qualifications ranging from Cert IV, Degrees, and post-graduate qualifications, and offer a qualified and skilled workforce that can be accessed locally and in the home.

Funding to extend massage services in palliative care settings will have a direct positive impact on the quality of life of palliative care patients and it is time that policy-makers at the state level recognise this important and vital role.

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