Home hospice acupuncture: a preliminary report of treatment delivery and outcomes

In recent years, complementary and alternative medicine modalities, including acupuncture, have been incorporated intohospice careboth to address symptom distress and to enhance quality of life. Beginning in 1997, Kaiser Permanente Northwest Hospice began offering limited acupuncture services to hospice patients and, in some cases, their caregivers. Data collection-comprising a chart review (n = 71) and in-depth interviews with the two program acupuncturists-was initiated to explore in a preliminary fashion both the processes involved in acupuncture delivery and outcomes associated with this intervention. Information culled from the patient charts (representing the year 2003) revealed a median age of 68.5 years, a cancer diagnosis in 63% of cases, and a median hospice length of stay of 102 days. The most commonly cited chief complaints presented to the acupuncturists included pain (70%), anxiety (45%), shortness of breath (27%), and nausea/vomiting (14%). Patients received a median of three acupuncture treatments; excellent or good results were noted in the charts of 34% of patients whose chief complaint was pain, in 31% of anxiety chief complaints, in 22% of shortness-of-breath chief complaints, and in 29% for nausea/vomiting chief complaints. The program acupuncturists described their practice with this group of patients as a departure from how they treat patients in a typical practice context. They described a greater focus on providing comfort through ameliorating symptoms and a diminished focus on more holistic goals, which often are typical elements in an acupuncture intervention. Nonetheless, acupuncturists also observed instances of outcomes in psychologic, social, and spiritual domains, regardless of whether these outcomes were the principal focus of treatment. These data add to the accumulating anecdotal reports suggesting that acupuncture is a promising adjunctive therapy for those nearing the end of life in the home hospice setting. More in-depth and precise assessment is warranted to comprehensively evaluate acupuncture as a viable adjunct to current usual and customary hospice care.