Aromatherapy

Before study selection, a data extraction form with 43 items was developed, based on the checklist of guidelines for the design and evaluation of clinical trials (CONSORT, SPIRIT) [16 (link)–18 (link)]. Data extraction was done manually by two researchers (RBM, MR) without any extraction software. Five domains were analysed:

general information (title of the CCT, name and country of the corresponding author, language of publication, year and journal of publication, journal impact factor, area and type of intervention, personal dimension and key points of practice of PC evaluated, ethical approval and informed consent);

methods (eligible criteria, type of study design, method of randomisation, achievement of allocation concealment, type of blinding, and duration of follow-up);

sample (intervention, total number of randomised patients and number of patients in each group, duration and timing of treatment, dropout rate, and sample size calculation);

data analysis (type of analysis, statistical methods used, pre-defined outcomes, assessment tools, and group comparability);

results.

Included articles were classified by clinical domain (e.g. oncology, neurology) and type of intervention. Four types of interventions were considered: pharmacological, non-pharmacological (all non-pharmacological interventions provided by health care professionals that are specifically mentioned as part of the interdisciplinary palliative care interventions [19 (link)]), non-pharmacological complementary therapies (all non-pharmacological interventions, such as musical and aromatherapy, that are not considered as part of the core palliative care interdisciplinary interventions [19 (link)]), and home-care based (all pharmacological and non-pharmacological interventions provided in patient’s home).
We identified PC milestones (focus on whole-person, patient and family empowerment, good communication, improvement of quality of life and teamwork) most relevant in the aims of each study. Based on them, we proceeded with two different types of classifications, one according to the main personal dimensions (physical, psychological, social or spiritual dimensions), and a second level in line with other factors of PC practice (communication, symptoms control, family support and team work) [20 (link), 21 (link)].
The methodological quality of the included studies was assessed using the Cochrane Risk of Bias (RoB) tool [22 ]. This tool quantifies the association between certain design features and estimates of treatment effects. The RoB tool is a two-part instrument and includes the following areas: sequence generation, allocation concealment, blinding (of participants, investigators and outcome assessment), incomplete outcome data, selective outcome reporting and “other issues”. The first part refers to the description of what was reported in the trial, detailed enough for a judgement to be made based on this information. The second part appraises the risk of bias for each analysed area and classifies them in three categories: low, high or unclear risk of bias [15 (link), 23 ].
Independently, two authors (RBM, MR) extracted information on individual items from all included studies and assessed the two parts in each study. Discrepancies were resolved through discussion or by consultation with a third reviewer (JJF).

A database search was conducted to identify peer-reviewed original research published from January 1 2000 to December 31 2014 investigating the nature of CM use amongst the Australian population. The search included the following databases: AMED; CINAHL; and PubMed. The search terms employed were: complementary medicine; alternative medicine; natural medicine; herbal medicine; complementary therapies; traditional medicine; holistic health; phytotherapy; naturopathy; supplements; acupuncture; massage; yoga; aromatherapy; homeopathy and Australia. The following search strategy was used within all search fields in PubMed: (Australia) AND [(complementary medicine) OR alternative medicine) OR aromatherapy) OR natural medicine) OR yoga) OR herbal medicine) OR supplements) OR acupuncture) OR naturopathy) OR massage) OR complementary therapies) OR holistic health) OR homeopathy) OR traditional medicine) OR phytotherapy)]. Manual searching was also conducted to ensure known relevant articles were included in the review. All articles were imported into Mendeley, a bibliographic management software system and analysed based on title, abstract and full text. Articles were included if they reported peer-reviewed original research findings from new empirical data collection reporting on CM use in Australia, whilst articles were excluded if they were commentaries, editorials or literature reviews and were non-English. The database search was supplemented by an internet search using the same search terms as above, to identify any additional items, and bibliographic searching of included materials was also used to identify additional material. One author conducted the search and downloaded the results into Mendeley. Two authors independently examined the title and abstract of each result to identify relevant studies for inclusion. This review employed a mixed methods approach [18 (link)].

The pain coach educator program is intended for patients age 14 years and older with acute or chronic pain. Patients with psychosis, suicidal or violent behavior, incarceration, severe uncontrolled pain prior to medication, restrained or immobilized, or critically ill were excluded from the program. Patients were referred to the program by physicians or advanced practice providers through an Electronic Health Record (EHR) paging system, phone call, or verbal request from other healthcare professionals (e.g., nurse, physical therapist, pharmacist). Program staff also monitored the EHR tracking board to identify eligible ED patients. The pain coach educator then reviewed the EHR to assess the patient’s relevant medical history to determine appropriateness for the program. When possible, the pain coach educator conferred with a member of the patient’s healthcare team prior to and following the pain coaching session.
Pain coach educator program components are described in detail in a publicly available toolkit on the PAMI website (26 ). Briefly, sessions consisted of 1) patient education on basic pain neuroscience and prevention of acute to chronic pain transitions, 2) demonstration of integrative pain management techniques, 3) a review of options to improve pain and quality of life, and 4) provision of nonpharmacologic toolkit items and educational brochures, and 5) a review of appropriate OTC and topical analgesic pain management options. The program was intended to be delivered in a single session; however, it was possible for patients to participate in the program during a later admission, ED visit, or via telephone upon patient request. Coaching sessions were tailored based on an initial assessment, type of pain, and patient characteristics and preferences. Patients were provided with a variety of toolkit item options and educational brochures. Brochures covered 17 topics including OTC oral and topical medications, sleep, diet, and back exercises. Toolkit items included aromatherapy inhalers, stress ball symbolizing a pain management analogy (27 ), hot/cold gel pack, virtual reality cardboard viewer with suggested free virtual reality apps, wearable acupressure device, pain journal, and a QR code to pain management videos on the PAMI website (25 ). The pain coach educator customized toolkits for each patient based on their pain assessment, contraindications, patient interest, and patient characteristics (e.g., smart phone access, comorbidities). If the pain coach educator was unavailable, clinical team members could provide patients with toolkit items by accessing a stocked cart located within the ED clinical areas.