Teaching Caregivers of Hospice Patients to Administer Reiki

The time a patient and family caregiver (FCG) spend together in a patient's final days is filled with emotion. Patients may turn inward and be filled with peace, or they may be bothered by symptoms. Caregivers often experience feelings of helplessness and anticipatory grief. Learning and providing a skill such as Reiki may give caregivers a way to help the patient with symptoms while at the same time feeling useful. Patient and caregiver closeness may be enhanced. Reiki has been shown to be helpful with symptoms such as pain, anxiety, depression, fatigue, and others. However, teaching caregivers of terminal hospice patients, Reiki has not been studied. The knowledge gained from this feasibility study will guide future interventions aimed at the comfort of hospice patients and FCGs.

Approximately 1.49 million Medicare beneficiaries received hospice care during 2017, and most had a FCG. During the final days or weeks, FCGs are unsure of what do or how to best help the patient when everyday caregiving actives such as physical care or nutrition are not required or no longer desired by the patient. Caregiver symptoms of depression, anxiety, or anticipatory grief increase toward the end of life along with increased patient symptoms. Having a specific skill to help the patient with symptoms or simply to show care and provide touch may empower FCGs and improve the quality of life for both caregivers and patients.

• Reiki therapy (Other): Reiki is a complementary health approach where trained providers place their hands lightly on or just above a person, in discrete positions, with the goal of facilitating the person's own healing response. A Reiki practitioner will perform the initial teaching and instruct the caregivers how to perform a simple 10-minute Reiki and self-Reiki session.

Primary outcomes

• Establish successful enrollment of patient-caregiver dyads [10 days]: Successful enrollment will be measured by the number of dyads enrolled versus those approached
• Establish successful completion of patent-caregiver dyad data collection [10 days]: Successful completion of data collection will be measured by the number of dyads who complete all data collection surveys from dyads enrolled

Secondary outcomes

• Change in heart rate variability measured using a heart rate monitor [Day 1 and 2]: Explore heart rate variability as a measure of stress using a heart rate monitor in end-of-life patients and their caregivers
• Explore family caregiver feelings related to Reiki through the System usability Scale (modified) [Day 11]: Explore family caregiver feelings related to Reiki by having caregivers complete the System Usability Scale (modified) at the end of the 10 day intervention period. The System Usability Scale is a 13 item survey that measures whether respondents thought that learning Reiki went well, was understandable, and if they were confident using Reiki. Each item is answered by circling an answer on a Likert scale from "strongly disagree" to "strongly agree."
• Explore family caregiver feelings related to Reiki through the Reiki Experience Questionnaire (Reiki-EQ) [Day 11]: Explore family caregiver feelings related to Reiki by having caregivers complete the Reiki-EQ at the end of the 10 day intervention period. This questionnaire is a combination of Likert responses as well as optional an area for participants to write additional information if they would like. This questionnaire assesses what the participants thought about learning and providing Reiki.
• Compare daily symptoms between patients in the intervention and usual care group [Days 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10]: Examine and describe changes in 6 symptoms daily using the Daily Symptom Severity Assessment (SSA). The SSA measures 6 symptoms (pain, anxiety, shortness of breath, nausea, sleep, and sense of inner peace/happiness) using a visual analog scale
• Compare symptoms between patients in the intervention and usual care group [Days 0 and 11]: Examine and describe symptom profiles, present illness, and co-morbidities of patients using the Rotterdam Symptom Checklist. The Rotterdam Symptom Checklist is a list of 30 common symptoms. Following each symptom is a Likert scale with four choices ranging from "not at all" to "very much."
• Compare daily symptoms between caregivers in the intervention and usual care group [Days 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10]: Examine and describe changes in 6 symptoms daily using the Daily Symptom Severity Assessment (SSA). The SSA measures 6 symptoms (pain, anxiety, shortness of breath, nausea, sleep, and sense of inner peace/happiness) using a visual analog scale
• Compare symptoms between caregivers in the intervention and usual care group using the Rotterdam Symptom Checklist [Days 0 and 11]: Examine and describe symptom profiles, present illness, and co-morbidities of caregivers using the Rotterdam Symptom Checklist. The Rotterdam Symptom Checklist is a list of 30 common symptoms. Following each symptom is a Likert scale with four choices ranging from "not at all" to "very much."
• Compare symptoms between caregivers in the intervention and usual care group using the PROMIS-43 Symptom Profile [Days 0 and 11]: Examine and describe symptom profiles of family caregivers using the Patient Reported Outcomes Measurement Information System (PROMIS-43). The PROMIS-43 asks 6 questions within each of 7 symptom domains (physical function, anxiety, depression, fatigue, sleep disturbance, social activities, and pain interference) as well as a pain intensity score from 0 to 10. Questions in symptom domains are scored on a 5 level Likert score from "not at all" or "never" to "very much" or "always." Scores on this measure are totaled with a lower score indicating a better ability to function.
• Change in daily patient symptoms as measured by the daily Symptom Severity Assessment. [Days 1, 2, 3, 4, 5, 6, 7, 8, 9, 10]: Explore the patient symptoms within the intervention and usual care groups as measured by the daily Symptom Severity Assessment (SSA) over the study period. The SSA measures 6 symptoms (pain, anxiety, shortness of breath, nausea, sleep, and sense of inner peace/happiness) using a visual analog scale. Changes will be assessed within the intervention and usual care groups.
• Change in patient symptom profile as measured by the Rotterdam Symptom Checklist. [Days 0 and 11]: Explore the patient symptoms within the intervention and usual care groups as measured by the Rotterdam Symptom Checklist. Examine and describe symptom profiles, present illness, and co-morbidities of patients using the Rotterdam Symptom Checklist. The Rotterdam Symptom Checklist is a list of 30 common symptoms. Following each symptom is a Likert scale with four choices ranging from "not at all" to "very much."
• Change in caregiver daily symptoms as measured by the daily Symptom Severity Assessment. [Days 1, 2, 3, 4, 5, 6, 7, 8, 9, 10]: Explore the caregiver symptoms within the intervention and usual care groups as measured by the daily Symptom Severity Assessment (SSA) over the study period. The SSA measures 6 symptoms (pain, anxiety, shortness of breath, nausea, sleep, and sense of inner peace/happiness) using a visual analog scale. Changes will be assessed within the intervention and usual care groups.
• Change in caregiver symptom profile as measured by the Rotterdam Symptom Checklist. [Days 0 and 11]: Explore the caregiver symptoms within the intervention and usual care groups as measured by the Rotterdam Symptom Checklist. Examine and describe symptom profiles, present illness, and co-morbidities of patients using the Rotterdam Symptom Checklist. The Rotterdam Symptom Checklist is a list of 30 common symptoms. Following each symptom is a Likert scale with four choices ranging from "not at all" to "very much."
• Change in caregiver symptom profile as measured by PROMIS-43. [Days 0 and 11]: Explore the caregiver symptoms within the intervention and usual care groups as measured by Patient Reported Outcome Measurement Information System (PROMIS) symptom questionnaire over the study period. The PROMIS-43 asks 6 questions within each of 7 symptom domains (physical function, anxiety, depression, fatigue, sleep disturbance, social activities, and pain interference) as well as a pain intensity score from 0 to 10. Questions in symptom domains are scored on a 5 level Likert score from "not at all" or "never" to "very much" or "always." Scores on this measure are totaled with a lower score indicating a better ability to function.

Sex: All, ages: 18 Years to any, accepts healthy volunteers

Inclusion Criteria:

Patients will be eligible for the study if they are

* ≥ 18 years old
* receiving hospice at home.

Caregivers will be eligible if they are

* ≥ 18 years old,
* willing to complete measures, and if they are randomized to the Reiki group
* willing to learn Reiki therapy, provide at least two Reiki therapy sessions with the patient of at least 10 minutes twice per day with at least two hours between sessions and complete one 10-minute self-Reiki session per day. Two caregivers may participate in the study.

Exclusion Criteria:

Patients will be excluded if:

* they have a diagnosis of atrial fibrillation
* they have an active pacemaker, or
* death is expected in less than two weeks.

Caregivers will be excluded if they

* cannot understand or speak English
* have severe, uncorrected hearing loss
* have self-reported uncontrolled atrial fibrillation
* have a self-reported diagnosis of dementia
* have a self-reported psychiatric disorder (bipolar disorder, schizophrenia)
* are unwilling or unable to complete measures (both groups) or perform Reiki and self-Reiki (intervention cohort).

• Susan E Thrane, PhD, RN, Principal investigator, Ohio State University