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Three Lessons From a Randomized Trial of Massage and Meditation at End of Life: Patient Benefit, Outcome Measure Selection, and Design of Trials With Terminally Ill Patients

Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, ldowney{at}u.washington.edu, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harborview Medical Center, School of Medicine, University of Washington, Seattle

Ruth A. Engelberg, PhD

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harborview Medical Center, School of Medicine, University of Washington, Seattle

Leanna J. Standish, ND, PhD

Bastyr University Research Center, Kenmore

Leila Kozak, PhD

Bastyr University Research Center, Kenmore, Division of Oncology, Department of Medicine, Seattle Cancer Care Alliance, School of Medicine, University of Washington, Seattle Washington

William E. Lafferty, MD

Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle

Improving end-of-life care is a priority in the United States, but assigning priorities for standard care services requires evaluations using appropriate study design and appropriate outcome indicators. A recent randomized controlled trial with terminally ill patients produced no evidence of benefit from massage or guided meditation, when evaluated with measures of global quality of life or pain distress over the course of patient participation. However, reanalysis using a more targeted outcome, surrogates’ assessment of patients’ benefit from the study intervention, suggested significant gains from massage—the treatment patients gave their highest preassignment preference ratings. The authors conclude that adding a menu of complementary therapies as part of standard end-of-life care may yield significant benefit, that patient preference is an important predictor of outcome, and that modifications in trial design may be appropriate for end-of-life studies.

Key Words: complementary and alternative medicine • end of life • hospice care • palliative care • patient benefit • patient preference • clinical trial design • outcome measure selection

This version was published on August 1, 2009

American Journal of Hospice and Palliative Medicine®, Vol. 26, No. 4, 246-253 (2009)
DOI: 10.1177/1049909109331887


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