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    Complimentary therapy policy_for_centre-final_version-july_2010 Complimentary therapy policy_for_centre-final_version-july_2010 Document Transcript

    • COMPLEMENTARY THERAPY POLICY FOR THE LODGE CANCER SUPPORT & INFORMATION CENTRE Torbay Hospital Annexe, Newton Road, Torquay TQ2 7BA Tel: 01803 617521This policy is in agreement with the Peninsula Cancer Network criteria and has been agreedby David Sinclair, Clinical Director of Cancer Services, Torbay Hospital on 7th July 2010 andthe Chair of the Network Board 1
    • SOUTH DEVON HEALTHCARE NHS FOUNDATION TRUST POLICY FOR THE DELIVERY OF A COMPLEMENTARY THERAPY SERVICE WITHIN THE LODGE CANCER SUPPORT CENTRE.DEFINITIONSThe term ‘complementary therapy’ used within this policy refers only to the therapies providedwithin the Cancer Support Centre. Those are massage, aromatherapy and reflexology.The terms ‘practitioners’ and ‘therapists’ used within this policy only refer to those personsproviding therapy services within the cancer support centre.BACKGROUND:Although the scientific evidence base for complementary therapies is small, anecdotalevidence suggests that many people find complementary therapies help them cope with theexperience of cancer.The NICE Guidance on Improving Supportive and Palliative Care for Adults with Cancer(2004) states that recent reports show that between 9% - 30% of patients with cancer haveused complementary/alternative therapies for their condition. One Cochrane review (2003)suggests that massage can confer short-term benefits for patients with cancer in terms ofpsychological well-being and, probably, a reduction in anxiety and some physical symptoms.The National Guidelines for the use of Complimentary Therapies in Supportive and PalliativeCare (National Council for Hospice and Specialist Palliative Care Services 2003) cites severalstudies showing the benefit of massage on quality of life issues. These include: Meek 1993,Corner et al 1995, Wilkinson et al 1999 and Wilkie et al 2000.Macmillan Cancer Support (Directory of complementary therapy services 2002) states thatpatients and their carers frequently report reduced anxiety, less depression, greaterrelaxation, better sleep, better symptom control and an improved sense of well-being aftercomplementary treatment.AIM:To ensure the effective and safe provision of a Complementary Therapy Service to peoplewith cancer and their carers attending the centre. The therapies offered will be used alongsideorthodox treatments with the aim of providing psychological and emotional support. They willnot be offered as an alternative to conventional therapies (surgery, radiotherapy,chemotherapy etc.)OBJECTIVES:  To enhance the range of services offered by The Lodge, Cancer Support Centre, to reflect its holistic philosophy of care 2
    •  That the complementary therapies are provided safely by trained practitioners who are aware of the clinical and psychological issues that people with cancer may have  To promote a sense of relaxation and well being for patients and carers  To ensure that the complementary therapists work within safe guidelinesRECRUITMENT and SELECTIONAll complementary therapists will have to provide evidence that the following standards havebeen met before any interviews can be undertaken:Recruitment and selection will be as per Trust protocols.ReflexologyPractitioners must hold a recognised qualification in reflexology to the minimum Level 2 orNVQ 4 standard, be at least one year post qualification and have a minimum 100 hourssupervised clinical practise.Practitioners should have an in-depth knowledge of physiology and anatomy, holding aqualification in the subject to a minimum Level 2 or NVQ 4 standard.Holistic massagePractitioners must hold a recognised qualification in massage to the minimum Level 2 orNVQ4 standard, be at least one year post qualification and have a minimum 100 hourssupervised clinical practise.Practitioners undertaking aromatherapy massage should also have a recognised qualificationin aromatherapy.Practitioners should have an in-depth knowledge of physiology and anatomy, holding aqualification in the subject to a minimum Level 2 or NVQ 4 standard.AromatherapyPractitioners must have undertaken a recognised training leading to competency in acomplementary therapy recognised by the Trust to a standard that entitles the practitioner tofull membership of the relevant professional association. The practitioner should be at leastone year post qualification.All practitioners will hold full membership of a recognised professional body. Some of therecognised qualifications include:The International Federation of Aromatherapists (IFA)International Institute of Health and Holistic Therapy (IIHHT)Association of Reflexologists (AOR)British Massage Therapy Council (BMTC) 3
    • British Complementary Medicines Association (BCMA)International Therapy Examination Council (ITEC)REGISTRATION OF PRACTITIONERSThe centre manager will be responsible for producing an annual list of the therapists workingwithin the centre. This will contain their qualifications, therapies offered and employmentstatus. This list will be available within the centre and also on the Trust’s intranet.The centre manager will also be responsible for each practitioner’s individual staff file. Thefiles should contain copies of the practitioner’s certificates (qualifications, membership of anappropriate regulatory body and insurance). A signed Trust honorary contract (to include CRBcheck and Occupational Health Clearance), evidence of continuing CPD and theirprofessional body’s Code of Practice and Ethics.  All practitioners will have access to informal supervision and support from the centre manager and peer group meetings will be held at least twice a year * The Trust’s Clinical Governance Lead has agreed that this level of supervision and support is acceptable as the practitioners only work a few hours each month  All practitioners will undertake the Trust’s mandatory training, this to include fire safety, manual handling, basic life support and level 2 Vulnerable Adults training  All practitioners must undertake at least 2 days (appropriate)additional training, arranged by the centre manager  All practitioners must be responsible for their own personal CPD (evidence of this will be required by the centre manager)  All practitioners must demonstrate their understanding of the need to care for themselves, to maintain their own effectiveness, to monitor their limits of competence and to know if their own resources are depleted  All practitioners need to be personally able to deal with the emotional self-disclosures that their clients may share ALL PRACTITIONERS MUST HOLD A CURRENT PROFESSIONAL INDEMNITY INSURANCE RECOGNISED BY THEIR PROFESSIONAL BODY AND SOUTH DEVON HEALTHCARE NHS FOUNDATIONTRUST(Practitioners, having signed an honorary contract, will also be regarded as staff of SouthDevon Healthcare NHS Trust and will therefore also be covered by the Trust’s insurance.) GUIDELINES FOR PRACTISE: 1.) The practitioner will have read and signed a South Devon Healthcare NHS Trust Honorary Contract. 4
    • 2.) Written notification of all treatments being offered to the patient must be sent to their Consultant, allowing at least two weeks notice of any appointment, to enable them to contact The Lodge if there are any concerns about their patient receiving a particular therapy. The doctors of carers who access the service (providing they themselves do not have a cancer diagnosis or other illness) do not need to be sent written notification 3.) The patient must be given written and verbal information about the therapy they will be receiving and will be asked to sign a consent to treatment form. These will be confidentially stored within the centre and shredded after one year. 4.) Each practitioner will keep clear written records of each therapy given, these will be kept only within the cancer support centre 5.) The centre manager will be responsible for the safety maintenance of all equipmentused within the therapy treatment room (this to include the oils used by the therapists) PRIOR TO COMMENCEMENT OF TREATMENT: 1) Each client will have an individual, holistic assessment of their needs, encompassing the physical, mental and emotional. 2) Any contra-indications will be noted and treatment not commenced. If, during the course of a complementary therapy a contra-indication/s occurs, treatment will be discontinued and the client advised to contact their doctor. 3) The proposed treatment plan to be offered will be shared with the patient and only if accepted by them can treatment proceed. 4.) Treatments will be given with regard to the client’s dignity at all times. Any part of the body not being treated must be covered.CONFIDENTIALITY:Complementary therapists will respect the confidentiality of all patients and carers accessingthe service and of staff working in the Centre.Complementary therapists must have read and signed a South Devon Healthcare NHS Trusthonorary contract which contains a staff code of conduct with regard to confidentiality.ACCOUNTABILITYWhilst working within The Lodge, all therapists will be accountable to the Centre Manager.REFERRALS:These may be either: Self referral Referral from a healthcare professional 5
    •  The service is offered free of charge to patients and carers. A maximum of 4 sessions can be offered to patients, or they may decide to have only 2 and give the other 2 to carers/friends All appointments will be kept within the room bookings folder held within The Lodge 6
    • PRECAUTIONS TO BE TAKEN WHILST PROVIDING AROMATHERAPY AND MASSAGE  Avoid using any pressure directly over the area of the cancer  Avoid pressure work with patients who are taking anti-coagulation medication or who have a low platelet count (less than 50,000)  Avoid massaging clients with petechiae (pinprick bruising which is an indicator of a low platelet count). Use gentle stroking or light, holding touch only. Radiotherapy:  Be aware of possible side effects, such as fatigue, soreness of skin and digestive disturbance  Avoid the entry and exit sites of those people undergoing radiotherapy and for 3 - 6 weeks after completion of treatment. Check with the client to assess if the skin is still sore, tender or sensitive. Encourage the patient to seek advice from the radiotherapy department regarding the use of gels and creams. Chemotherapy  Be aware of possible side-effects of those people undergoing chemotherapy. These can include:Extreme fatigueNauseaLowered immune functionIncreased risk of bruisingIncreased risk of infectionHair lossAltered sensation in extremitiesAltered behaviour or personalityAltered smell preferencesDryness or peeling of skinSkin sensitive to touchParticularly for this group of patients consider using gentle massage only. Modify pressure,approach and duration of session to take into account the patient’s preferences and theirphysical and emotional condition. Be guided by their body language and consider massagingpart of the body only and in shorter sessions.  Avoid a limb with suspected or recently diagnosed deep vein thrombosis  Be aware that patients with advanced cancer or severely impaired mobility are more susceptible to low grade, undiagnosed and asymptomatic deep vein thrombosis: use gentle massage only.  Avoid sites of recent surgery / scar tissue  Avoid stoma sites, dressings, catheters and TENS machines 7
    •  Avoid areas of bony metastases and use gentle stroking or light, holding touch only. Avoid massaging over ascites (fluid retention in the abdomen) and use gentle stroking or light, holding touch only. Only treat lymphoedematous limbs or areas if working in conjunction with a lyphoedema specialist or physiotherapist Be aware that patients have a lowered immune function and are more susceptible to infection Be aware that the skin can be sensitive and / or paper thin due to medication and treatments, especially in the elderly. Only carrier oil should be used initially on anyone who suffers from allergies. Patch- testing should be undertaken prior to their second appointment to determine what, if any additional oils can be used. 8
    • PRECAUTIONS TO BE TAKEN WHILST PROVIDING REFLEXOLOGY Avoid a limb or foot with suspected deep vein thrombosis and avoid varicose veins. Be aware of any tender areas on the foot or hand that relate to new surgical wounds. Only treat lymphoedematous limbs or areas if working in conjunction with a lymphoedema specialist. Avoid areas corresponding to colonic stimulation if there are any symptoms or risk of intestinal obstruction due to causes other than constipation. Adjust pressure for patients with a low platelet count, taking note of any existing bruising and skin viability. (N.B. haematologists advise that patients with a platelet count of 50,000 or less should not be treated with reflexology. Be aware that peripheral sensation may be affected by a person’s psychological state, or medication, such as steroids, opioids or chemotherapy. Be aware that peripheral neuropathy may be a symptom of diseases such as multiple sclerosis and certain tumours, although diabetes is the most common cause of peripheral neuropathy. Palpate gently and sensitively over the reflexes relating to tumour site(s). Assess the condition of the reflexes and adapt treatment accordingly so that the feet are not over stimulated in any way, especially in patients with altered peripheral sensation or peripheral neuropathy. Establish a working pressure that is comfortable for the patient at all times, and tailor treatment to avoid strong reactions. Use fragrance free talcum powder or appropriate cream if the skin is very dry. 9
    • *Please complete and bring with you on your first appointment* MEDICAL HISTORY / CONTRA-INDICATIONS CHECK LIST (PLEASE NOTE: ALL INFORMATION IS STRICTLY CONFIDENTIAL)NAME: DATE OF BIRTH: TEL NO:ADDRESS:TYPE OF CANCER (if applicable)ARE YOU ON ANY TREATMENT?(E.g. chemotherapy/radiotherapy)If yes DATE OF LAST/NEXT TREATMENTCURRENT MEDICATION DO YOU HAVE PROBLEMS WITH ANY OF THE FOLLOWING?OPEN WOUNDSMRSA/CDIFFHIGH FEVERSKIN PROBLEMS (e.g. allergies, eczema, dermatitis or skin sensitivity)URINARY PROBLEMS (e.g. cystitis, thrush)BREATHING PROBLEMS (e.g. asthma, bronchitis, breathlessness)CIRCULATORY PROBLEMS (e.g. varicose veins, deep vein thrombosis, pulmonaryembolism or history of clotting problems)DIGESTIVE PROBLEMS (e.g. constipation, nausea, indigestion, diarrhoea)NERVE PROBLEMS (e.g. sciatica, pain)BONE / JOINT PROBLEMS (e.g. arthritis, rheumatism, fractures, osteoporosis)MOBILITY PROBLEMSLYMPHOEDEMA 10
    • PROSTHESIS / IMPLANTSLOSS OR ALTERED SENSATION IN HANDS OR FEETSTRESS PROBLEMS (e.g. anxiety, insomnia, depression, headaches)FEMALE PROBLEMS (e.g. pregnancy, miscarriage, PMT, period problems, menopause)ANY OTHER PROBLEMS (e.g. epilepsy, diabetes, unstable/high/low blood pressure)ANY ALLERGIES (APART FROM SKIN ALLERGIES)HAVE YOU RECENTLY CONSUMED ALCOHOL/TAKEN UNPRESCRIBED DRUGS* To the best of my knowledge the information I have given is correctSIGNATURE:DATE:TO BE COMPLETED BY THE THERAPISTAssessment undertaken by PRINT NAME SIGNATURE1.)2.)3.)4.)Therapy prescribed Consent Aftercare advice1.)2.)3.)4.) Please note: Any complementary therapies taking place within the centre are not offered as an alternative method of tumour reduction to conventional therapies such as surgery, radiotherapy, chemotherapy, endocrine or biological therapies. 11
    • CODE OF PRACTICE FOR COMPLEMENTARY THERAPISTSTherapists must hold an appropriate qualification recognised by South DevonHealthcare NHS Foundation Trust and registered with a regulatory body.Therapists will adhere to the code of ethics laid down by the professionalorganisation(s) of which they are a member.Therapists must have signed a South Devon Healthcare NHS Trust Honorary Contract.Therapists must hold a current insurance indemnity recognised by their professionalbody.Therapists will respond to client’s needs, irrespective of gender, age, race, disability,sexuality, culture or religious beliefs.Therapists will ensure that working conditions and equipment are suitable and safe foruse.A case history should be taken prior to the commencement of treatment.Any contra-indications should be clearly documented and treatment not commenced.If contra-indications occur during the course of the complementary therapy, treatmentwill be discontinued.Therapists will protect all confidential information concerning clients and will makedisclosures only with consent.Therapists will maintain accurate records of all treatments.All client records will be kept confidentially in a secure place within the centre.Only those oils allowed by The Trust (see separate sheet) are to be used within thecentreTherapists should not diagnose, prescribe or claim to cure.Therapists should make no claims for their treatment which are not wholly true andjustifiable.Therapists will not be paid by the client, nor accept gifts from them. 12
    • FLOW CHART FOR COMPLEMENTARY THERAPY REFERRALS CLIENT (Patient or carer) ↓ MACMILLAN CANCER SUPPORT MANAGER/MACMILLAN ASSISTANT (Will give/send client medical history form and ask for it to be completed and brought withthem on their first appointment. These forms will be stored confidentially within The Lodge.) ↓ CLIENT(will be given written information on the therapy they would like to receive, a complementary therapy appointment and the date/time will be written in the room booking folder held within the office.) ↓ MACMILLAN CANCER SUPPORT MANAGER/MACMILLAN ASSISTANT(will write to the patients Consultant informing them of the particular therapy their patient hasbeen offered and giving at least two weeks notice of the therapy appointment they have been given, to enable the consultant time to contact The Lodge with any concerns they may have regarding their patient having that particular complementary therapy. The doctors of carers (providing they have not had a cancer diagnosis) accessing the complementary therapy service do not need to be sent written notification.) ↓ COMPLEMENTARY THERAPIST(Initial appointment and assessment of patient: completion, if necessary of medical history / contra-indications form and if treatment can go ahead safely, the patient / carer to sign consent form, which will be stored confidentially within The Lodge.) 13
    • Cancer Support & Information Centre Torbay Hospital Annexe, Newton Road, Torquay TQ2 7BA Tel: 01803 617521Date:DearYour patient--------------------------------------------Hospital number------------------Address ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Has been given an appointment to attend The Lodge for reflexology/massagearomatherapy on:If you have any concerns about this being undertaken could you please telephoneThe Lodge prior to the appointment.Yours sincerelyGail SmithCentre Co-ordinator Please note: Any complementary therapies taking place within the centre are not offered as an alternative method of tumour reduction to conventional therapies such as surgery, radiotherapy, chemotherapy, endocrine or biological therapies. 14
    • Cancer Support & Information Centre Torbay Hospital Annexe, Newton Road, Torquay TQ2 7BA Tel: 01803 617521Date:I ------------------------------------------------------------------------------------------------------Address ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------(PLEASE PRINT)I have had my medical history taken, have read the complementary therapiesinformation sheet and been given verbal information about reflexology / massage /aromatherapy (please delete whichever not applicable).I give my consent for treatment to go ahead.Please sign below: Please note: Any complementary therapies taking place within the centre are not offered as an alternative method of tumour reduction to conventional therapies such as surgery, radiotherapy, chemotherapy, endocrine or biological therapies. 15
    • Appendix 1COMPLEMENTARY THERAPISTS USED IN THE LODGE, CANCER SUPPORT CENTRE 2009JANET STICKLANDFederation of Holistic Therapists(Aromatherapy, massage& reflexology)MARIE DENHAMBritish Register of Complementary Practitioners(Reflexology)ROSIE HOLLANDInternational Federation of Professional Aromatherapists(Aromatherapy, massage & reflexology)MARY WEBBAssociation of Reflexologists(Reflexology)PAULINE THOMSONInternational therapy Examination Council(Massage)LINDA GRAYInternational Institute of Health & Holistic Therapies(Aromatherapy & massage)ROSEMARIE TOONInternational Institute of Health & Holistic Therapies(Reflexology)SUSAN LEESInternational Institute of Health & Holistic Therapies(Aromatherapy, massage & reflexology)GWEN DICKERAssociation of Reflexologists(Reflexology)Appendix 2 16
    • VOLUNTEER COMPLEMENTARY THERAPISTS USED IN THE LODGE, CANCER SUPPORT CENTRE 2010JANET STICKLANDFederation of Holistic Therapists(Aromatherapy, massage& reflexology)MARIE DENHAMBritish Register of Complementary Practitioners(Reflexology)ROSIE HOLLANDInternational Federation of Professional Aromatherapists(Aromatherapy, massage & reflexology)MARY WEBBAssociation of Reflexologists(Reflexology)PAULINE THOMSONInternational therapy Examination Council(Massage)ROSEMARIE TOONInternational Institute of Health & Holistic Therapies(Reflexology)SUSAN LEESInternational Institute of Health & Holistic Therapies(Aromatherapy, massage & reflexology)Appendix 3 17
    • The Lodge Complementary Therapy ServiceWe would like to offer patients and carers 2 free complementary therapy sessions each froma choice of massage, reflexology and aromatherapy. Patients can also decide to have all the4 sessions for themselves. Each session lasts approximately 45-50 minutes.Complementary therapies may help in the following:  Promoting a calmer, more relaxed state  Lifting mood and improving the sense of well-being  Improving self esteem and self worth  Feeling supported and cared forComplementary therapies are not offered as an alternative to conventional treatments, suchas surgery, chemotherapy or radiotherapy.For those who have never had a complementary therapy before, here is a brief description ofeach of them:MassageThis is the term used for a variety of techniques that involve touching, pressing, kneading andmanipulation. Therapeutic massage consists of gentle rhythmical touch, with movementsvaried to suit individuals needs. Massage may be beneficial in reducing anxiety, nausea andpain. It may also encourage relaxation.ReflexologyThis is based on the principle that there are reflex areas in the hands and feet that correspondto all of the glands, organs and parts of the body. The application of systematic pressure,using the thumb and fingers, to specific reflex points on the hands or feet, releasescongestion and promotes the flow of energy. Reflexology cannot diagnose specific medicalproblems, but aims to treat the person with a view to alleviating physical and emotionalsymptoms.AromatherapyThis is the use of essential plant oils to improve physical and mental well-being. The oils arediluted with a carrier oil or water and are absorbed through the skin. The therapeutic effectresults from a combination of the physiological effects of the oils and the relaxation of thegentle, rhythmic massage. Aromatherapy may be beneficial in reducing anxiety, tension, painand depression.Complementary therapists work with the person as a whole (holistic approach) and not justthe part of the body with cancer. All complementary therapists working in the Lodge are fullyqualified practitioners, who are registered and insured with the appropriate professional body. 18
    • If you are having a massage or aromatherapy massage, please bring 1 large towel with you.  A short medical history sheet and consent form need to be completed and signed before your therapy session commences. If you are undergoing treatment at the hospital a letter will be sent to your Consultant/Doctor informing them of the therapies you will be having.  At any point you are free to stop the therapy treatment  If you have concerns, complaints or compliments about your therapy treatment please speak to the centre manager.Possible reasons for not being able to have a complementary therapy:  If you have MRSA  If you have CDIFF  If you have had chemotherapy within 4 days  If you have a low blood count  If you have bony secondaries or lymphoedema  If you have varicose veins or phlebitis  If you have areas of unexplained pain, inflammation and swelling  If you have had recent surgery (less than 8 weeks previously)  If you have had radiotherapy, entry and exit sites must be avoided for up to 4 weeks after treatment has been completedTo book an appointment please call into the centre or telephone 01803 617521 Please note: Any complementary therapies taking place within the centre are not offered as an alternative method of tumour reduction to conventional therapies such as surgery, radiotherapy, chemotherapy, endocrine or biological therapies.Complementary therapy/ Cancer Services/SDHNHSFT/07.09/Review 07.11Appendix 4 19
    • Complementary Therapy Guidance 2010Version 1.0 – 26/06/10Review date May 2011 20
    • ContentsAgreement cover sheet ...........................................................................21Background Information...........................................................................23Purpose of guidance................................................................................23Introduction..............................................................................................24Scope 25 Aim of the guidance.........................................................................................................................26Network wide criteria................................................................................26 Clearance.........................................................................................................................................26 Registration of competent practitioners............................................................................................27 Insurance and indemnity..................................................................................................................29 Supervision......................................................................................................................................30 Professional Accountability..............................................................................................................30 Equipment and materials..................................................................................................................31 Local Trust policies..........................................................................................................................31 Written Information...........................................................................................................................31 Consent............................................................................................................................................32 Notes................................................................................................................................................33 Confidentiality...................................................................................................................................34Local responsibility/ requirements............................................................34 List of complementary therapy practitioners practising on NHS premises........................................34Distribution...............................................................................................35 Registration Form.............................................................................................................................36Acknowledgements..................................................................................41 Agreement cover sheet The criteria have been agreed by: 21
    • Position Chair Peninsula Cancer Network Date agreed Complementary Therapy GroupName Sue SmithOrganisation Plymouth Hospitals NHS Trust Position Chair Specialist Palliative Care Group Date agreedName Giles CharnaudOrganisation Rowcroft Hospice, Torbay Position Vice Chair Specialist Palliative Care Group Date agreedName Dr Debbie StevensOrganisation Royal Cornwall Hospitals NHS Trust Position Chair -Peninsula Cancer Network Executive Date agreed BoardName Anthony FarnsworthOrganisation Peninsula Cancer NetworkGuidance review date May 2011Contributors to current versionContributor Author/ Editor Section/ ContributionIndividual Sue Smith Full guidelineIndividual Nikki Thomas 22
    • Background InformationThe Peninsula Cancer Network exists to secure equal access to high qualitycare for all cancer patients; strive for better clinical outcomes and improve theexperience of patients, their carers and families throughout screening,diagnosis, treatment, aftercare and survival.The Network has an increasing role in the prevention of cancer and reducinghealth inequalities. To achieve these goals it collaborates with all healthcareproviders, commissioners, patients and their carers throughout Devon,Cornwall and the Isles of Scilly.The Peninsula Cancer Network serves a population of 1.7 million people andis comprised of the following organisations:Primary Care Trusts (PCTs)NHS Cornwall & Isles of ScillyNHS DevonNHS PlymouthTorbay Care TrustAcute HospitalsNorthern Devon Healthcare NHS TrustPlymouth Hospitals NHS TrustRoyal Cornwall Hospitals NHS TrustRoyal Devon & Exeter NHS Foundation TrustSouth Devon Healthcare NHS Foundation TrustHospicesHospiscare, ExeterMount Edgcumbe Hospice, CornwallNorth Devon HospiceRowcroft Hospice, TorquaySt Julia’s Hospice, CornwallSt Luke’s Hospice, PlymouthPurpose of guidanceIn October 2009, the Complementary Therapy (Safeguarding Practice) QualityMeasures for peer review were published. Although it is generallyrecommended that complementary therapy is made available to patients, theactual range of and the levels of service provision of such therapies are notsubject to agreed boundaries; and NHS commissioners do not have amandatory requirement to provide them.
    • The measures set out the clinical governance requirements for the Network toexercise over such complementary therapy as might be provided. They dealwith the case of practitioners offering therapy or consultations on theNetworks NHS premises and also the case where practitioners ororganisations are endorsed and cited in the patient information of theNetworks MDTs, chemotherapy services, radiotherapy departments andinformation services and centres. (Throughout this document when the termpatient information is cited it is referring to the definition above.)The measures intentionally focus on those clinical governance issues whichare directly relevant to the welfare of patients rather than those dealing withthe professional development of staff providing complementary therapy. Theguidelines aim to ensure a consistent approach and safe practice to patients.The criteria are confined to adult cancer services. Measures are currentlybeing developed that specifically address the provision of services for childrenand young adults with cancer.These guidelines meet the requirements for the Peninsula Cancer NetworkBoard (Measures 09-1A-301 and 302w), which is required to produce anddistribute criteria which should be agreed Network wide and which should bemet by practitioners in the Network or those cited in the Networks patientinformation.IntroductionThese guidelines set out the clinical governance requirements for therapistsor organisations that provide complementary therapy for adults with cancerand are either:  Employed by the NHS  Self employed and hold an NHS honorary contract  Employed by another organisation  Work in a voluntary capacity  Endorsed and cited in the patient informationAll practitioners offering complementary therapies on NHS premises orcited/endorsed in the patient information must adhere to these guidelines as apre-requirement to practice on NHS premises whether they are paid by theNHS or other agencies for their services or where the therapies are providedon a volunteer basis.Therapists who cannot meet the criteria as set out in this guidance must notbe permitted to practice complementary therapies in NHS settings and will notbe endorsed/cited in patient information.These guidelines will be distributed to all the Peninsula Cancer LocalityGroups, Trust CEO’s, voluntary / independent sector providers of palliativecare and any other organisations providing complementary therapy to patientswith cancer in the geographical area of the Peninsula Cancer Network.
    • The purpose of this guidance is to provide the criteria to which allcomplementary therapy practitioners within the Peninsula will agree andadhere.ScopeThe term complementary therapy is used to cover a range of specifictherapies which are offered to patients with cancer, as having potentialbenefit, but which are not offered as an alternative tumour reduction (cancerreduction, tumour ablation or removal) method to any of the conventionaltreatments offered by the network (surgery, radiotherapy, chemotherapy,endocrine therapy or biological therapy).The definition of complementary therapy is:-‘Complementary therapies are used alongside orthodox treatments with theaim of providing psychological and emotional support through the relief ofsymptoms’ NICE Supportive & Palliative Care Guidance (2004)The term complementary therapy may for example include any or all of thefollowing: reflexology, aromatherapy, healing, homeopathy, hypnotherapy,massage, reiki and shiatsu. This list is not comprehensive. The network mayoffer, or cite, practitioners in other therapies which it agrees are covered bythe term complementary therapy.However, the term and these criteria are not intended to apply to any of thefollowing since although they are not cancer reduction treatments, they arelargely covered by conventional arrangements and regulatory systems:symptom control using oral, parenteral or topical drugs from the NationalFormulary; symptom control by neuro-ablative methods; nutritional advice byqualified NHS dieticians; osteopathy; chiropractic; the various treatmentsoffered by qualified NHS physiotherapists; lymphoedema massage offered byqualified NHS staff, consultations and therapy offered by qualified clinicalpsychologists.It is recognised that volunteers provide hand and foot massage in NHSpremises across the Network. Although these services are not specificallycovered within these criteria, it is recommended that these volunteers aretrained in this practice and have a certificate to demonstrate theircompetence. An example of an organisation providing this training is the RedCross.Other services which have therapeutic value to patients, but are not strictlyconsidered complementary therapies may be delivered across the Network,e.g. colour therapy and Cancer Locality Groups are responsible for decidingthe appropriate qualifications required where these are provided.
    • Aim of the guidanceThe overall aim of the guidance is to ensure that high standards are set in theprovision of complementary therapies delivered throughout the Network thatwill: • Ensure services are as safe as possible • Improve the patient and carer experience • Ensure safe practice by appropriately qualified and supervised practitioners • Protect the rights of those patients or clients who are offered complementary therapy as part of their care • Make best use of practitioner’s skills in the interest of client care • Provide development and learning for all involved • Encourage the dissemination of good practiceAny practitioner wishing to employ a therapy not listed above should contactthe Head of Service/Cancer Lead or Director of Nursing who will liaise withthe Network Nurse Director.Network wide criteria ClearanceIf working on NHS premises, the therapist should be:I An NHS employeeI Self employed with an NHS honorary contractI Employed by an organisation with an employment policy which covers atleast the following:-  Occupational Health Clearance  Clearance for working with vulnerable adults (or children if relevant)  Criminal Records Bureau clearance  Written agreement to adhere to Trust policies and procedures (including health and safety, patient confidentially, equal opportunities etc)  In possession of relevant indemnity insurance which should be checked annually to ensure validity. A photocopy of the insurance document should be taken and placed on the therapist’s personnel file.f If the therapists are volunteers they should have gained the aboveclearances as per the locality policy applicable to volunteers.The NHS organisation must keep an up to date register of therapists whomeet these criteria and who are working on the premises/ endorsed in thepatient information literature.
    • Registration of competent practitionersThe Register encompasses all staff delivering complementary therapies, thisincludes: • Clinical staff who are also complementary therapy practitioners who deliver complementary therapy as part of their duties • Independent complementary therapy practitioners employed on a contractual basis • All Practitioners whether that are endorsed or cited within the Peninsula Patient Information literatureIn addition: • Student This policy does not recommend students working especially on cancer patients, however, where it is felt by the individual Trusts to include Students working towards Practitioner level, they will need to work under the supervision of a senior recognised Practitioner.All those included on the Register must provide evidence that they currentlyfulfil all the criteria requested within this document as a pre-requisite forpractising.All staff wishing to deliver or to supervise delivery of complementary therapieswill need to ascribe to and work within the Trust’s Policies Guidelines andProtocols.They must also provide evidence that they have updated their professionalregistration on an annual basis, see Registration document Appendix 2.The complementary therapy practitioner must be eligible for registration with arecognised professional body pertaining to their therapy. Health careprofessionals wishing to incorporate complementary therapies into their workare required to check with their professional body regarding eligibility to usetherapies as part of their professional practice.Regulation of complementary therapies is an ongoing process. Howevermany of the professional bodies have a regulatory procedure in situ and acode of professional conduct.Any complementary therapy practitioner working on Peninsula CancerNetwork NHS premises or cited/endorsed in the patient information, MUSThave a qualification relevant to their therapy and must have currentregistration with a relevant recognised body. The therapist’s certificate ofqualification, professional body registration or CHNC registration (whereapplicable) should be checked and a photocopy of the documents kept in thetherapist’s personnel file.
    • The Complementary & Natural Healthcare Council (CNHC) was set up as anational voluntary regulator in complementary therapies, but does not as yetregulate all therapies. For the therapies listed below, it does state thoseProfessional Associations or Training Institutes that have been approved forverifying that their Members meet the CNHC standards for registration.The complementary therapy disciplines that are currently eligible for entry tothe CHNC Register are:-t Massage Therapyt Nutritional therapyt Aromatherapyt Reflexologyt Shiatsut Alexander Technique teachingt Yoga Therapyt Bowen Therapyt Sports and Remedial TherapyIt is recommended that organisations check the CNHC website regularly toupdate on new therapies included; Website: http://www.cnhc.org.ukDuring 2010 the Register will open to more disciplines, as they become readyand wish to register. Those in this category which are relevant to these criteriaare:-a Hypnotherapya Cranial sacral therapya Naturopathya Reikia Hypnotherapya Microsystems Acupuncturea HealingAs these complementary therapies come on line, the CHNC website will listdetails of the professional associations or training institutions that have beenapproved for verifying that their members meet the CNHC standards forregistration. There are some therapies that are not currently eligible for entryto the CHNC register but are included in the National Cancer PatientInformation Pathways, which give details of the organisations that can helpidentify the professional registration recommended to identify a suitablyqualified therapist. The organisations quoted in the pathways with the websiteaddress are listed below.AcupunctureBacC – British Acupuncture Council www.acupuncture.org.uk020 8735 0400BMAS – British Medical Acupuncture Society www.medical-acupuncture.co.uk01606 786782HealingNational Federation of Spiritual Healers (now TheHealing Trust)www.thehealingtrust.org.uk
    • UK Healers www.ukhealers.info/hh.htmHomeopathyBritish Homeopathic Association and Faculty ofHomeopathywww.trusthomeopathy.orgThe Society of Homeopaths www.homeopathy-soh.orgHypnotherapyThe British Society of Clinical Hypnosiswww.bsch.org.ukCambridge Register of Advanced Hypnotherapists www.crah.co.ukRelaxation and VisualisationThese therapies are most usually offered by those therapists who arequalified in other disciplines such as counselling or hypnotherapy and sothose qualifications and professional registrations must apply.In future years it will be required that Complementary Therapists endorsed byor practicing on Peninsula Cancer Network NHS premises will belong to aprofessional body recognised as eligible to be registered with the CHNC.Recommended qualifications have been divided into two parts:RThose therapies that are currently eligible for entry to the CHNC registerRThose therapies listed in the measures that are not currently eligible forentry to the CHNC register but where guidelines for recommendedprofessional bodies are listed in the National Cancer Patient InformationPathways.Currently there are two complementary therapy disciplines listed in the PeerReview measures (Acupressure and Reiki) which do not have CHNCregistration or, any recommended professional bodies listed in the informationon the National Cancer Patient Information Pathways. There may also beother complementary therapies being practiced across the Network that arenot included in the above tables.The Network is not in a position to endorse qualifications or registrationstandards for complementary therapies independently. The list of therapiesincluded in the Network criteria will be reviewed in 2011 and new therapiesadded that have received CHNC registration. Insurance and indemnityWhere an independent complementary therapy practitioner is working undercontract for the Trust or Hospice, it is necessary to obtain evidence of thecurrent professional indemnity insurance to cover the period in question. Arecommended minimum level of cover is £2m. Evidence would take the formof a receipt of payment or a certificate for the period.Whereas some practitioners take out a separate insurance, for others, it isprovided through membership of a professional body. In both cases thepractitioner still needs to show evidence of membership of the professionalbody.
    • Where the practitioners are already employed by the Trust and are expandingtheir role, the following steps should be taken: 1. The manager, head of profession/service and practitioner need to ensure that any change of job role is written into the practitioner’s job description. 2. The Manager or Head of profession/service should confirm with the Human Resource Department that the practitioner is covered for practice by NHS Indemnity and is on the Trust register of approved practitioners. 3. It is strongly recommended that the practitioner also have additional professional indemnity cover as indicated for independent complementary therapy practitioners. SupervisionAll practitioners are responsible for ensuring they receive clinical supervisionin line with the employee organisation’s supervision policy. These will varythroughout the Peninsula; however, there are five possible options forarranging and receiving supervision: • One to one supervision from a practitioner in the same therapy • Co-supervision where the roles of supervisor and supervisee are shared • Peer supervision with other practitioners in the same therapy • Group supervision where a number of student and practitioners engage in supervision with a recognised complementary practitioner • Where a practitioner does not have access to clinical supervision within the Trust, supervision from a practitioner outside the Trust may be sought.In each instance, supervisors and practitioners will need to meet the criteriafor competent practice as outlined in these guidelines. Professional AccountabilityIt is the responsibility of practitioners considering training or practice in acomplementary therapy to be fully aware of the: • Position and requirements of their primary professional body towards the use of complementary therapies and that they meet these requirements • Requirements of their employing organisation and ensure that their extra training meets the necessary standards for practice as outlined in this policy • The practitioner must ensure that the therapy is complementary and agreed as part of the individual’s care plan and documented as such • The practitioner will work within the management framework and will maintain full communication with manager/supervisor
    • • The practitioner will be able to justify, if challenged, the use of a complementary therapy in terms of benefits and rights of client. • The practitioner will work within agreed local, regional and national framework and guidelines. Equipment and materials • MaterialsTherapists must adhere to any guidance on toxicity of substances contraindicated for patients with cancer advised by their code of professionalconduct and professional indemnity insurance.  EquipmentComplementary therapists who use their own equipment (e.g. massagetables) must ensure their equipment meets European CE standards. Theequipment must be maintained in accordance with the manufacturer’srecommendations.Equipment must be cleaned using disinfectant wipes and dried thoroughlybetween patients or the equipment must be protected with disposable covers,which is changed between patients. Most equipment for usage with patientshas manufacturers’ recommended cleaning methods and these must beadhered to. Local Trust policiesNHS organisations should be mindful that complementary therapists may nothave specific experience working within the NHS environment and soguidance should be given to aid them to provide therapies within a clinicalenvironment. The Practitioners must agree to work within Trust Policies, mostespecially those pertaining to confidentiality, infection control, health andsafety and manual handling. Where practitioners that have been endorsed orcited within Patient Information are working off site, Policies that includesterility and safety of equipment and toxicity of substances used by thecomplementary therapy practitioner also need to apply. Written InformationAll clients for complementary therapies need to be provided with writteninformation which includes: • What the therapy entails • The Statement that it is a Complementary NOT alternative treatment • Arrangements for the therapy including time and day, location, length of session, number of consultations routinely offered • Whether the sessions are free or paid for • Statement of qualification of the Practitioner or a declaration that they do not possess a qualification
    • • Any contra-indications • The communication strategy between Practitioner and referring healthcare professional • The approach to care planning and record keeping • That the Practitioner is registered with the TrustIt should be noted that this information should be made available in a suitableformat for those with learning disabilities, hearing or sight impairment and, ifrequired, translated for those for who English is not their first language ConsentThe patient/client should receive full information on the nature of the therapyincluding risks, benefits and alternatives available. Consent for the use of acomplementary therapy should therefore be agreed between the patient/clientand the practitioner prior to the therapy being provided.A written record of consent will be made in accordance with the policies andprocedures used by the practitioner’s department. This may be kept withinthe patient’s/client’s care plan or the recognised record keeping format.It should be noted that:-A person from whom informed consent to examination or treatment is soughtmust possess the necessary intellectual and legal capacity to give suchconsent.A person will have the intellectual capacity to give consent if able to • Understand in simple language what the examination or treatment is, its purposes and nature, and why it is being proposed • Understand its principal benefits, risks and alternatives • Understand in broad terms what will be the consequences of not undergoing the proposed examination or treatment • Retain the information for long enough to make an effective decision; and • Make a free choiceA person will have legal capacity to give consent to examination or treatmentif that person has attained the age specified by the relevant law for givingsuch consent.The relevant law specifying the age for giving such consent is different indifferent parts of the United Kingdom and is complicated. Thus, in some partsof the UK, patients under the age of 16 may have the legal capacity to giveconsent to certain examinations or treatments, while in other parts of the UK;such patients may not have such capacity.Because of the practical difficulties involved in determining how the relevantlaw applies in a particular case, practitioners are advised to act as follows:
    • In the case of patients under the age of 16, practitioners are advised not toinstitute any treatment unless they are satisfied that the patient’s parent orother legal guardian has given informed consent.In the case of patients over the age of 16 who do not have the intellectualcapacity to give consent practitioners are advised not to institute anytreatment unless they are satisfied that the treatment is in the best interests ofthe patient, in the sent that the action is taken to preserve the life, health orwell-being of the patient.Informed consent issues may be particularly relevant within the Hospiceswhere practitioners would adhere to the organisation’s policy regardingrecording of patient’s wishes should be observed. (Preferred Place of Caredocument, End of Life Care document)Other useful documents include: • Seeking Consent Working with people with learning disabilities. Dept of Health (2002) • Seeking Consent Working with older people. Dept. of Health (2002) • Seeking Consent Working with children. Dept. of Health (2002) • 12 Key Points on Consent (Aide memoir for Clinicians) • Guides for Patients – Consent what you have a right to expect. Adults Children and young people People with learning disabilities Parents Relatives and carers (Dept. of Health) www.doh.gov.uk/consentIn recognition that the medical practitioner retains overall responsibility for themedical care of the patient, when a complementary therapy is offered within aprogramme of care, the clinician must be consulted. The process for this willvary within the individual organisations and may take the form of an MDTdecision for a patient in the Hospice or a blanket referral from the Consultantsfor those patients being treated within the Cancer Centre. However, inrecognition of the practitioner’s individual duty of care, the clinician’s opinionmust be sought where there are any concerns regarding the client’s condition NotesEach therapist must keep clear and concise records of their therapeuticsessions. NHS organisations employing complementary therapists or makinguse of volunteer complementary therapists should ensure that a clear policy isin place in relation to the recording and storage of notes from complementarytherapists.Hospital computerised records are covered by the Data Protection Act. Anytherapist holding patients’ records/notes on their personal computer, outsidethe hospital must be registered with the Data Protection Service.
    • ConfidentialityComplementary therapists are bound by both the Code of Ethics of theirrelevant professional bodies and also by the guidance of the establishment inwhich they provide therapy.Confidential information should only be shared with the patient’s permission oronly when necessary for the patient’s welfare.Therapists are subject to the same complaints procedures as all otheremployees of the establishment in which they work.Local responsibility/ requirementsAll providers should produce a list of the therapies available within theirlocality including criteria for referral, number of sessions offered, any costimplications and contact numbers for further information. This list should beupdated annually and should be available to all clients. It is considered goodpractice for each locality to have protocols for all therapies that are offered onthe NHS premises. An example protocol has been included in Appendix 2.The Peninsula Cancer Network will hold on its website and make available byrequest a document detailing the availability of all complementary therapiesthroughout the Peninsula. List of complementary therapy practitioners practising on NHS premisesEach Cancer Local Implementation Group should produce a list annually ofthe complementary therapy practitioners offering their therapy or consultingwith their cancer patients on the NHS premises of the locality.The list should record the following information:T Name of the complementary therapistT Complementary therapy offeredT Qualification of the complementary therapistT NHS Premises at which the complementary therapist offer therapiesT Confirmation that the complementary therapist has complied annually withsecuring professional indemnity assurance and membership of the CNHC(where applicable)( The consent form used at each organisation( The employment status of the complementary therapist i.e. employed by theNHS, volunteer etc.In order to be compliant the Local Implementation Group must annually foreach practitioner:-e See documentation that they are an NHS employee or that their employingor volunteer recruitment organisation’s clearance policies are agreed by thechair of the Cancer Locality Group.c Check that the practitioner holds a professional qualification that is listedwithin this Network criteria
    • Check that each practitioner has written information for patients whichdemonstrates the items shown in (iii) above.d Check the consent and check that this demonstrates the requirements in (iv)above.For compliance, all of the practitioners on the list should meet the criteria. Thisinformation should be verified annually by the Local Cancer ImplementationGroup.DistributionThis document should be distributed to: • Cancer Local Implementation Groups • Trust Chief Executive Officers • Voluntary and Independent sector providers of palliative care • Any other organisations providing cancer complementary therapy in the geographical area covered by the Network.
    • Appendices Registration Form COMPLEMENTARY THERAPIST REGISTRATION FORM Name of Therapist………………………………………………………………… Post Title:…………………………………………………………………………… Registration Details: Therapy Professional Body Date of Registration Date of Renewal Practised:Date of CRB ClearanceDate of Child Protection TrainingDate of Statutory Update TrainingDate of Manual Handling TrainingDate of Contract Expiry I certify that the information given above is correct Signed……………………………………………. Date………………. Verified by (Manager)…………………………. Date………………. *completed form in Practitioner’s Personnel File.
    • Example of Local Protocol1. All prospective practitioners will be screened by the Voluntary ServicesDepartment in line with current departmental practices.2. Therapists will be responsible for observing all the guidelines in line withnormal volunteering policy, including equal opportunities, safe handling,health and safety, and hygiene.3. All practitioners will agree with and sign a declaration of patientconfidentiality.4. Therapists must hold an appropriate professional insurance policy for theirapproved therapy.5. Permission for a session must come from the patient themselves; althoughstaff may suggest a session or help a patient select one which is appropriateto their needs.6. Sessions will only be given after the therapist has met with, and discussedthe therapy with the patient. Patient’s medical and nursing notes should bemade available to the therapist.7. Details of each treatment will be documented by the therapist(s) within thepatient’s notes and will then be dated and signed by the therapist.8. All therapists will uphold the dignity of the patient at all times and strictlyobserve the ethical code of their professional body.9. Before offering complementary therapies to patients the complementarytherapist must inform the person in charge of the ward/ out patient area thattherapies are to be offered / given to ensure that complementary therapies arenot offered / provided to patients for which these are not suitable.10. Regular communication between the therapist and nursing staff and otherhealthcare professionals is encouraged. Therapist’s concerns regardingchanges in the patient’s condition should be discussed immediately with thenurse in charge, and documented in the patient’s record.11. All therapists are expected to be committed to continuing personaldevelopment and will be supported and encouraged to develop theirknowledge and skills in specialist areas.12. All patients will be offered an evaluation form to record their commentsregarding the therapies they receive which includes asking how good thetherapist is about giving appropriate information, how the patient has feltabout the session, and any other relevant comments they may wish to make.13. The location of the sessions will vary according to the patient’s needs andenvironment, but the wishes of the patient regarding privacy should berespected at all times.
    • 14. All sessions given by practitioners from the Voluntary ServicesDepartment are free of charge, and no charges or donations are to be soughtby therapists.Treatment GuidelinesTherapists must adhere to any guidance on toxicity of substances contraindicated for patients with cancer advised by their code of professionalconduct and professional indemnity insurance.  MassageGenerally, gentle, non-invasive massage techniques should be employed soas not to over stimulate the patient’s system. Kneading, pummelling and deepmassage are not recommended.Clinical Checklist/Contraindications1. Body TemperatureDo not treat patients with a high temperature.Very hot areas can indicate an infection, inflammation or intense cellularactivity. In oncology patients, cancerous sites are often hot. Therapists shouldcheck with staff first to establish appropriateness of treatment.2. Fluid Retention/Swelling/LymphoedemaAvoid the area. Never massage a swollen limb/trunk, unless you have beenspecifically trained in appropriate drainage techniques, or have been shown aparticular technique by the patient’s specialist care giver (e.g.physiotherapist).3. Undiagnosed Lumps or Areas of InflammationAVOID THE AREA – report this finding. (It may indicate a recent growth incancer patients which has not yet been diagnosed.)4. Skin Problems/RashesThese could be circulatory problems or reaction to medication/diet. AVOIDTHE AREA OF ANY RASHES – report this finding.5. Pinprick BruisingThese are indicators of a very low blood count. Check with nursing staff ormedical staff before treating. Massage very gently with careful light strokes tohelp the body feel warmer. It may be suitable to massage hands and feet onlyin order to avoid affected areas.6. RadiotherapyRadiotherapy treatment entry and exit sites should be avoided for up to sixweeks following treatment. Use very gentle strokes following radiotherapy asthe skin remains vulnerable to damage.7. Stoma Sites, Dressings and CathetersAVOID THESE. Massage elsewhere, i.e.: hands and feet.
    • 8. Scar Tissue/Broken Skin/Lesions/Recent operation sites or woundsAvoid areas of recent scar tissue/broken skin or lesions.9. Tumour SiteDo not massage over the tumour site, near the tumour site or adjacent oraffected lymph glands.10. Deep Vein Thrombosis (DVT)Do not massage feet or legs if the patient has a diagnosed or suspected deepvein thrombosis in the legs, or arm/hand if a thrombosis is suspected in thearm.11. Areas of InfectionAvoid all areas of external infection. Employ appropriate infection controltechniques.12. Injury and Bone Metastases (secondaries)Avoid areas of injury or bone metastases.13. Phlebitis (hot/inflamed veins)Avoid areas of phlebitis. Work above the area affected.14. Hot or inflamed JointsAvoid hot or inflamed joints, except to apply cooling oils where appropriate.15. Angina, Hypertension, HypotensionExercise caution with patients with these conditions, using gentle massagestrokes and balancing oils. Check with the nursing or medical staff as patientsmay need to be treated in an upright/sitting position.16. JaundiceExercise caution with patients with these conditions. Check with the nursing ormedical staff before proceeding.17. Low platelet countsThis will contra-indicate the use of massage using pressure techniques asthere is a greater likelihood of bruising.  ReflexologyContraindications:As with usual practice.GeneralGentle touch.Thrombosis/EmbolismDo not treat until the condition has been managed medically, or after youhave liaised with appropriate medical personnel.
    • PrecautionsLymphomas and leukaemias – very gentle sessions. In the case of stem celltransplants avoid the use of reflexology whilst the immune system issuppressed.Radiotherapy and ChemotherapyGentle treatments bearing in mind any vulnerable areas connected with sideeffects of treatment.Other TherapiesWhatever the therapy, the following general considerations should beregarded:r the patient’s physical and emotional stater treatment programmer side effects of treatmentr physical problems related to the patient’s condition.Therapy should be gentle with the main aim of relaxation and relief of stressand stress related symptoms. Therapists should, where possible, liaise withthe person’s medical or nursing team where treatment is imminent, ongoing orrecently completed.General Guidance When Giving a SessionHands must be washed immediately before and after treatments are given,and alcohol gel should be used in accordance with ward policy.No jewellery or watches should be worn on hands or lower arms.Adherence to the dress code should be carefully observed.Aprons should always be worn when working with any immune compromisedpatient.For in patients all treatments for patients are to be given on the patient’s ownbed, or at their bedside.All therapists should establish a working pressure that is comfortable for thepatient at all times.The length of each session will be in agreement with the patient and inrecognition of their specific needs at the time of the session. However, anaverage of 20-30 minutes is recommended, unless the patient is able totolerate more without being over tired.Always check with the nursing staff before treating a patient who isbeing barrier nursed, or has MRSA, so that cross-infection is avoided.  TrainingTraining is offered on the management of patients with cancer.  EvaluationInformation on complementary therapies should be collected regarding:Number of sessions givenLength of time spent in each therapy sessionType of treatment givenOils used during session (where relevant)
    •  SupervisionSupervision is not a mandatory requirement but is recommended in theinterests of safe best practice. Many therapists feel that their work is bestsupervised by someone with in-depth knowledge of their subject and as suchseek outside professional supervision. Supervision engaged in outside of thehospital is at the sole discretion the individual therapist and at their personalcost.  Private PracticeThe Trust recognises that volunteers also practice privately in their own time.However, volunteers should make it clear to all their clients that theirvolunteering within the NHS is totally unrelated to their private practice as atherapist.Volunteers may not seek to deliberately recruit patients during theirvolunteering for the Trust, but may in the course of discussions giveinformation about their private practice.Any requests for treatment from visitors, relatives or friends of patients, orhospital staff must be treated as private work, and no treatments may begiven on site unless agreed by Voluntary Services and senior ward staff.(This protocol is provided with kind permission of the VolunteerDepartment of University College Hospital London on which this isbased)AcknowledgementsWith thanks to the Peninsula Cancer Network Complementary therapy Groupand to the Yorkshire, Sussex and Essex Cancer networks for sharing theircomplementary therapy documents which have been used and adapted in thedevelopment of these guidelines.