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Introduction
Many complimentary therapies arise every year that claim to improve overall mood and
health of cancer patients, as well as even decreasing symptoms. Animal Assisted Activity, also
known as Animal Assisted Therapy or Pet Therapy, is a type of therapy that has been used for
decades that has had interesting results among a variety of patients. According to the American
Veterinary Medical Association (2016), Animal Assisted Activity can be defined as an
intervention delivered by certified health or human service providers that uses the interaction
between humans and animals to improve physical, social, emotional, and cognitive function.
While physiologic effects of Animal Assisted Activity have not been studied in depth,
there have been positive results from the use of the therapy related to improvements in mood and
an individual’s opinion of their health. This intervention is often used in hospitals, nursing
homes, and other health care facilities. Each hospital typically outlines the policies that the
programs and handlers of the animals must follow, but patients are normally allowed to pet,
brush, and talk to the animal. There have been links made between human-animal interactions
and increased neurochemical levels in the brain and positively affecting physiologic factors, but
the validity of the link has not been scientifically proven.
Animal Assisted Activity is an incredibly non-invasive intervention that is only used with
a patient’s consent. The pros generally outweigh the cons. On busy units, nurses may not have
the time they would like to spend with their patients to help comfort their anxieties and stress of
being hospitalized. The use of animals to help bring joy to a patient and relieve tension could be
beneficial to both the patient and the nurse. The animals must be calm and well trained, so they
are not overstimulating to the patient. Animal Assisted Activity can also be used as a distraction,
specifically to cancer patients who may be worrying about their treatments and outcomes.
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ResearchQuestion
In patients with cancer, does the use of Animal Assisted Activity before, during, and/or
after treatments affect the mood or side effects the patient experiences during that day of
treatment?
The goal of this research paper is to determine the effectiveness, if any, of Animal
Assisted Activity in patients with cancer receiving some form of treatment, curative or palliative.
The population that will be examined will be patients with cancer undergoing any form of
treatment. The intervention is the use of Animal Assisted therapy before, during, or after the
treatments, as opposed to no interactions with animals. The outcome to be examined will be the
effect the animals have on patient’s moods and side effects. The time frame will be in the
immediate vicinity and the day of the treatment.
Literature Review
The first study to be examined, conducted by Jessica Chubak and Rene Hawkes (2015),
questions the standards and characteristics of Animal Assisted Activity programs used in the top
twenty ranked pediatric oncology institutions. The study included twenty facilities, in which two
were not eligible to participate, leaving a total of eighteen hospitals to be analyzed. The study
conducted was a thirty-two question survey from experts from each hospital. The experts who
responded consisted of personnel in child life, volunteer services, or research staff.
The results of this study showed that each hospital’s program had been in place for at
least ten years, all of which had developed and written policies pertaining to the program. Of the
hospitals examined, dogs participated in every program, while two programs used a cat and a
miniature horse. The study also found that visits were generally allowed for patients before and
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after surgery, but not for patients with current infections, wounds, on contact precautions, in
isolation, or those undergoing bone marrow transplants. Every hospital had strict handwashing
procedures before and after touching the animal, which helps with potential infection control.
Some hospitals kept records of the visits to have the ability to track any adverse reactions that
could occur. The study found that a hospital in Quebec had an extremely high satisfaction rating
of the program and therapy, and that every parent said they would recommend the use of it
(Chubak & Hawkes 2015). The purpose of this article was to attempt to identify consistencies
with the programs so that other hospitals may adapt similar programs and policies to increase the
use of Animal Assisted Activity. I felt this study was useful in my research to develop a baseline
understanding of how top ranked hospitals allow the programs to operate and steps to maintain
safety and infection precautions.
The next study examined, conducted by Rebecca Johnson and Jennifer Haubner (2008),
questioned the extent to which Animal Assisted Activity affected mood, self-perceived health,
and sense of coherence among patients with cancer undergoing radiation treatment and looked to
discover the perspectives of those who underwent the study. This study consisted of thirty
participants across two hospitals who all were beginning first line radiation treatment for cancer
for a period of at least four weeks. This study was a longitudinal, randomized pretest/posttest
survey design, which used questionnaires to unveil the feelings of the participants. Ten
participants were assigned to receive a fifteen minute session of Animal Assisted Therapy
immediately before their treatment three times per week, while the remaining twenty were
randomly assigned to receive either a human visit session or silent reading session. In the Animal
Assisted Therapy sessions, the handlers were instructed not to speak to the participants to
prevent results from becoming disrupted. The participants were given the questionnaires at the
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start of the study and after the four weeks, which asked subjective questions about their mood,
sense of health, and sense of coherence.
The results of this study showed that there were actually increases in the numeric scores
of their anger/hospitality, depression/dejection subscale, and confusion, but decreased fatigue
and vigor scores, compared to the pre-tests in the animal group (Johnson & Haubner 2008). The
other groups showed no significant changes. The scale was nominal, with a score of one being
“not at all”, and 5 being “extremely”. This is not particularly solid evidence because the test
group is so small, but it shows that the visits did help decrease fatigue. In the self-perceived
health section of the study, the dog visit group reported an improvement in their emotional health
compared to the start of the study. The participants also reported that the visits helped relieve
anxiety and was relaxing. They also felt it was distracting in a positive aspect and helped take
their mind off of their treatments. The participants all stated that they felt this therapy would
benefit most patients in the early treatment of their diseases, because towards the end of the
treatment cycle, they can feel too tired to participate.
Overall, the results did not show statistically significant differences in numbers between
each group that participated, but did find that the mood was improved for the participants of the
Animal Assisted Activity intervention. The participants all viewed their experiences positively
and would recommend the therapy to another person. Although a subjective study, this report
opens doors for other researchers interested in this field to conduct more rigorous studies, take
other variables into consideration, and replicate the study on a larger scale.
The next study to be examined was performed by researcher Jessica Bibbo (2013), who
looked at the perceptions of staff members towards Animal Assisted Activity. This study
consisted of 34 staff members in one facility. The study involved a group of certified handlers
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and therapy animals that visited one at a time, three times per week, for four weeks. The staff
observed the visitations between the animals and patients whenever possible. At the end of the
study period, the staff members filled out a questionnaire developed by the researcher that
consisted of 26 questions, to be ranked on a scale of one to ten, one being “not in favor”, and ten
being “in favor.”
The mean score of the staff members regarding how much they liked the use of the
therapy was 8.24. The survey also determined a mean score of 7.71 in regards to the staff
members feelings on if this should be an intervention for patients with cancer. The staff agreed
with a 6.97 rating that the program is beneficial. Staff reported experiencing the positive effects
of the visits with the patients. One staff member reported that they felt the therapy interrupted the
care of the patient (Bibbo 2013). The researcher also correlates that the staff members who were
present during many visitations with their patients all felt that the therapy was beneficial. The
staff members did not feel that the visitations caused extra stress and work on their part.
Overall, the staff members viewed Animal Assisted Therapy positively and felt it should
be continued with the patients who are willing to participate. Some of the information seemed
skewed, as the ranges of some categories were two to nine out of ten. This leads me to believe
that one staff member must have had a bad experience with the program. However, the positive
results contribute to the use Animal Assisted Therapy with patients.
The final study to be examined was performed be researchers Takayuki Kumasaka,
Hideo Masu, Mika Kataoka, and Akiko Numao (2012). The study asked the question of whether
Animal Assisted Activities had an effect on the mood of terminal cancer patients in palliative
care units. The study was conducted with twenty participants from one hospital who were willing
to receive Animal Assisted Therapy sessions. The participants spent thirty minutes, once per
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month, interacting with dogs, cats, and rabbits in their therapy sessions. The researchers first
looked at the demographics of the participants and why they wanted to participate in the study.
Then, the moods of the patients were evaluated by the Face Scale before and after the therapy
session. They chose the Face Scale because it was simple to understand, did not require emotions
to be put into words, and was valid and reliable (Kumasaka et. al. 2012).
The results showed that every participant across the board showed a significant difference
in score after the treatment compared to before. The patients were informed that they were going
to visit with an animal that day, so their scores were already described as “happy” or “joyful”
because of their excitement. After the visit with the animal, their rating was lower, which
translates to an even happier or joyful rating on the scale. The researchers were able to conclude
that these visits with these patients were all positive and showed a significant improvement in
mood. They go further to state that this improvement in mood can help enhance the patient’s
quality of life, thus making their end of life journey a bit more comfortable. It is important to
remember that every patient is a unique individual and some may not enjoy the company of
animals. This must be taken into consideration so a patient does not have a negative experience,
which is why the studies described above were voluntary.
Implementation
Through a search of current studies performed regarding Animal Assisted Activity, it can
be determined that more research must be done to fully conclude whether this practice is a
worthwhile implementation in hospitals. However, the studies examined above did not present
any negative data. Based on the analysis of the research studies, it can be concluded that if a
patient is interested and willing to participate in Animal Assisted Activities, it can positively
affect their mood for the time being, especially if they are in a stressful situation such as
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undergoing chemotherapy or being hospitalized. Staff members working with patients and the
programs also see the practice as useful, since it positively affects the patient’s mood. This can
put the caregiver at ease knowing their patient is not alone.
There are barriers to implementing the findings from these studies, however. These
studies were fairly subjective and do not provide objective findings. There is a lack of concrete
evidence, such as physiologic variables or neurochemical levels. The reactions from the
participants were gathered by questionnaires, surveys, and other subjective scales. What may be
positive to one person may not be positive to another. Animal Assisted Activity may be
beneficial to some patients, but it may be stressful or upsetting to others.
Since Animal Assisted Therapy is a complementary therapy, patients have the choice
whether to participate. It may not be useful to every patient, so not every patient will benefit
from its effects. This barrier is somewhat already addressed, because the volunteers ask every
patient whether they would like to participate before the patient even sees an animal. Every
patient has the right to refuse the therapy.
Further studies must be performed to validate the findings presented in these studies. A
researcher may consider using objective data collection to determine whether the intervention
has any physiological effect on patients. They may also consider replicating the study on a larger
scale and focusing on specific populations. By focusing on specific populations, a researcher
may be able to conclude that Animal Assisted Activity is more beneficial in one population than
another.
Overall, if a hospital was willing to put policies in place to regulate the safety of Animal
Assisted Activities, this practice could be beneficial to many patients. In conclusion, this
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intervention is recommended to patients who are willing and able to participate who feel they
may benefit from the interaction. Information about the therapy sessions should be provided
before the interactions take place so the patient is completely informed.
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Resources
Chubak J., Hawkes R. Animal-assisted activities: results from a survey of top-ranked pediatric
oncology hospitals. Journal of Pediatric Oncology Nursing 2015.
Johnson R., Haubner J. Animal-assisted activity among patients with cancer: effects on mood,
fatigue, self-perceived health, and sense of coherence. Oncology Nursing Forum 2008;
35(2): 225-231.
Kumasaka T., Masu H., Kataoaka M., Numao A. Changes in patient mood through animal-
assisted activities in a palliative care unit. International Medical Journal 2012; 19(4):
373-377.
Bibbo J. Staff members’ perceptions of animal-assisted activity. Oncology Nursing Forum 2013;
40(4): 320-326.
American Veterinary Medical Association. Animal-assisted interventions: definitions. (2016).
Retrieved from: https://www.avma.org/KB/Policies/Pages/Animal-Assisted-
Interventions-Definitions.aspx
