Complimentary therapy policy_for_centre-final_version-july_2010

COMPLEMENTARY THERAPY POLICY FOR THE LODGE CANCER SUPPORT &
INFORMATION CENTRE

Torbay Hospital Annexe, Newton Road, Torquay TQ2 7BA
Tel: 01803 617521

This policy is in agreement with the Peninsula Cancer Network criteria and has been agreed
by David Sinclair, Clinical Director of Cancer Services, Torbay Hospital on 7th July 2010 and
the Chair of the Network Board

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SOUTH DEVON HEALTHCARE NHS FOUNDATION TRUST

POLICY FOR THE DELIVERY OF A COMPLEMENTARY THERAPY

SERVICE WITHIN

THE LODGE CANCER SUPPORT CENTRE.

DEFINITIONS

The term ‘complementary therapy’ used within this policy refers only to the therapies provided
within the Cancer Support Centre. Those are massage, aromatherapy and reflexology.
The terms ‘practitioners’ and ‘therapists’ used within this policy only refer to those persons
providing therapy services within the cancer support centre.

BACKGROUND:

Although the scientific evidence base for complementary therapies is small, anecdotal
evidence suggests that many people find complementary therapies help them cope with the
experience 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 have
used complementary/alternative therapies for their condition. One Cochrane review (2003)
suggests that massage can confer short-term benefits for patients with cancer in terms of
psychological well-being and, probably, a reduction in anxiety and some physical symptoms.
The National Guidelines for the use of Complimentary Therapies in Supportive and Palliative
Care (National Council for Hospice and Specialist Palliative Care Services 2003) cites several
studies 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 that
patients and their carers frequently report reduced anxiety, less depression, greater
relaxation, better sleep, better symptom control and an improved sense of well-being after
complementary treatment.

AIM:

To ensure the effective and safe provision of a Complementary Therapy Service to people
with cancer and their carers attending the centre. The therapies offered will be used alongside
orthodox treatments with the aim of providing psychological and emotional support. They will
not 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
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 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 guidelines

RECRUITMENT and SELECTION

All complementary therapists will have to provide evidence that the following standards have
been met before any interviews can be undertaken:
Recruitment and selection will be as per Trust protocols.

Reflexology

Practitioners must hold a recognised qualification in reflexology to the minimum Level 2 or
NVQ 4 standard, be at least one year post qualification and have a minimum 100 hours
supervised clinical practise.
Practitioners should have an in-depth knowledge of physiology and anatomy, holding a
qualification in the subject to a minimum Level 2 or NVQ 4 standard.

Holistic massage

Practitioners must hold a recognised qualification in massage to the minimum Level 2 or
NVQ4 standard, be at least one year post qualification and have a minimum 100 hours
supervised clinical practise.
Practitioners undertaking aromatherapy massage should also have a recognised qualification
in aromatherapy.
Practitioners should have an in-depth knowledge of physiology and anatomy, holding a
qualification in the subject to a minimum Level 2 or NVQ 4 standard.

Aromatherapy

Practitioners must have undertaken a recognised training leading to competency in a
complementary therapy recognised by the Trust to a standard that entitles the practitioner to
full membership of the relevant professional association. The practitioner should be at least
one year post qualification.

All practitioners will hold full membership of a recognised professional body. Some of the
recognised 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)

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British Complementary Medicines Association (BCMA)

International Therapy Examination Council (ITEC)

REGISTRATION OF PRACTITIONERS

The centre manager will be responsible for producing an annual list of the therapists working
within the centre. This will contain their qualifications, therapies offered and employment
status. 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. The
files should contain copies of the practitioner’s certificates (qualifications, membership of an
appropriate regulatory body and insurance). A signed Trust honorary contract (to include CRB
check and Occupational Health Clearance), evidence of continuing CPD and their
professional 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 South
Devon 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.
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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 equipment
used 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 accessing
the service and of staff working in the Centre.
Complementary therapists must have read and signed a South Devon Healthcare NHS Trust
honorary contract which contains a staff code of conduct with regard to confidentiality.

ACCOUNTABILITY

Whilst 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
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 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

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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 fatigue
Nausea
Lowered immune function
Increased risk of bruising
Increased risk of infection
Hair loss
Altered sensation in extremities
Altered behaviour or personality
Altered smell preferences
Dryness or peeling of skin
Skin sensitive to touch
Particularly 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 their
physical and emotional condition. Be guided by their body language and consider massaging
part 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

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 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.

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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.

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*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 TREATMENT

CURRENT MEDICATION

DO YOU HAVE PROBLEMS WITH ANY OF THE FOLLOWING?

OPEN WOUNDS

MRSA/CDIFF

HIGH FEVER

SKIN 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, pulmonary
embolism 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 PROBLEMS

LYMPHOEDEMA
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PROSTHESIS / IMPLANTS

LOSS OR ALTERED SENSATION IN HANDS OR FEET

STRESS 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 correct

SIGNATURE:

DATE:

TO BE COMPLETED BY THE THERAPIST

Assessment undertaken by PRINT NAME SIGNATURE

1.)
2.)
3.)
4.)

Therapy prescribed Consent Aftercare advice

1.)
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.

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CODE OF PRACTICE FOR COMPLEMENTARY THERAPISTS

Therapists must hold an appropriate qualification recognised by South Devon
Healthcare NHS Foundation Trust and registered with a regulatory body.

Therapists will adhere to the code of ethics laid down by the professional
organisation(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 professional
body.

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 for
use.

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, treatment
will be discontinued.

Therapists will protect all confidential information concerning clients and will make
disclosures 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 the
centre

Therapists should not diagnose, prescribe or claim to cure.

Therapists should make no claims for their treatment which are not wholly true and
justifiable.

Therapists will not be paid by the client, nor accept gifts from them.

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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 with
them 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 has
been 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.)

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Cancer Support & Information Centre
Tel: 01803 617521

Date:

Dear

Your patient--------------------------------------------Hospital number------------------

Address -------------------------------------------------------------------------------------------

--------------------------------------------------------------------------------------------------------

Has been given an appointment to attend The Lodge for reflexology/massage
aromatherapy on:

If you have any concerns about this being undertaken could you please telephone
The Lodge prior to the appointment.

Yours sincerely

Gail Smith
Centre Co-ordinator

Please note:

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Cancer Support & Information Centre
Tel: 01803 617521

Date:

I ------------------------------------------------------------------------------------------------------

Address -------------------------------------------------------------------------------------------

--------------------------------------------------------------------------------------------------------

(PLEASE PRINT)

I have had my medical history taken, have read the complementary therapies
information 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:

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Appendix 1

COMPLEMENTARY THERAPISTS USED IN THE LODGE, CANCER SUPPORT CENTRE
2009

JANET STICKLAND
Federation of Holistic Therapists
(Aromatherapy, massage& reflexology)

MARIE DENHAM
British Register of Complementary Practitioners
(Reflexology)

ROSIE HOLLAND
International Federation of Professional Aromatherapists
(Aromatherapy, massage & reflexology)

MARY WEBB
Association of Reflexologists
(Reflexology)

PAULINE THOMSON
International therapy Examination Council
(Massage)

LINDA GRAY
International Institute of Health & Holistic Therapies
(Aromatherapy & massage)

ROSEMARIE TOON
(Reflexology)

SUSAN LEES

GWEN DICKER
(Reflexology)

Appendix 2
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VOLUNTEER COMPLEMENTARY THERAPISTS USED IN THE LODGE, CANCER
SUPPORT CENTRE 2010

JANET STICKLAND
Federation of Holistic Therapists
(Aromatherapy, massage& reflexology)

MARIE DENHAM
British Register of Complementary Practitioners
(Reflexology)

ROSIE HOLLAND
International Federation of Professional Aromatherapists

MARY WEBB
(Reflexology)

PAULINE THOMSON
International therapy Examination Council
(Massage)

ROSEMARIE TOON
(Reflexology)

SUSAN LEES

Appendix 3

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The Lodge Complementary Therapy Service
We would like to offer patients and carers 2 free complementary therapy sessions each from
a choice of massage, reflexology and aromatherapy. Patients can also decide to have all the
4 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 for

Complementary therapies are not offered as an alternative to conventional treatments, such
as surgery, chemotherapy or radiotherapy.

For those who have never had a complementary therapy before, here is a brief description of
each of them:

Massage

This is the term used for a variety of techniques that involve touching, pressing, kneading and
manipulation. Therapeutic massage consists of gentle rhythmical touch, with movements
varied to suit individuals needs. Massage may be beneficial in reducing anxiety, nausea and
pain. It may also encourage relaxation.

Reflexology

This is based on the principle that there are reflex areas in the hands and feet that correspond
to 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, releases
congestion and promotes the flow of energy. Reflexology cannot diagnose specific medical
problems, but aims to treat the person with a view to alleviating physical and emotional
symptoms.

Aromatherapy

This is the use of essential plant oils to improve physical and mental well-being. The oils are
diluted with a carrier oil or water and are absorbed through the skin. The therapeutic effect
results from a combination of the physiological effects of the oils and the relaxation of the
gentle, rhythmic massage. Aromatherapy may be beneficial in reducing anxiety, tension, pain
and depression.
Complementary therapists work with the person as a whole (holistic approach) and not just
the part of the body with cancer. All complementary therapists working in the Lodge are fully
qualified practitioners, who are registered and insured with the appropriate professional body.

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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 completed

To book an appointment please call into the centre or telephone 01803 617521

Please note:

Complementary therapy/ Cancer Services/SDHNHSFT/07.09/Review 07.11
Appendix 4

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Complementary Therapy Guidance

2010

Version 1.0 – 26/06/10
Review date May 2011

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Contents
Agreement cover sheet ...........................................................................21

Background Information...........................................................................23

Purpose of guidance................................................................................23

Introduction..............................................................................................24

Scope 25
Aim of the guidance.........................................................................................................................26

Network 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...................................................................................................................................34

Local responsibility/ requirements............................................................34
List of complementary therapy practitioners practising on NHS premises........................................34

Distribution...............................................................................................35
Registration Form.............................................................................................................................36

Acknowledgements..................................................................................41
Agreement cover sheet

The criteria have been agreed by:

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Position Chair Peninsula Cancer Network Date agreed
Complementary Therapy Group
Name Sue Smith
Organisation Plymouth Hospitals NHS Trust
Position Chair Specialist Palliative Care Group Date agreed
Name Giles Charnaud
Organisation Rowcroft Hospice, Torbay
Position Vice Chair Specialist Palliative Care Group Date agreed
Name Dr Debbie Stevens
Organisation Royal Cornwall Hospitals NHS Trust

Position Chair -Peninsula Cancer Network Executive Date agreed
Board
Name Anthony Farnsworth
Organisation Peninsula Cancer Network

Guidance review date May 2011
Contributors to current version
Contributor Author/ Editor Section/ Contribution
Individual Sue Smith Full guideline
Individual Nikki Thomas

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Background Information

The Peninsula Cancer Network exists to secure equal access to high quality
care for all cancer patients; strive for better clinical outcomes and improve the
experience 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 reducing
health inequalities. To achieve these goals it collaborates with all healthcare
providers, 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 and
is comprised of the following organisations:

Primary Care Trusts (PCTs)
NHS Cornwall & Isles of Scilly
NHS Devon
NHS Plymouth
Torbay Care Trust

Acute Hospitals
Northern Devon Healthcare NHS Trust
Plymouth Hospitals NHS Trust
Royal Cornwall Hospitals NHS Trust
Royal Devon & Exeter NHS Foundation Trust
South Devon Healthcare NHS Foundation Trust

Hospices
Hospiscare, Exeter
Mount Edgcumbe Hospice, Cornwall
North Devon Hospice
Rowcroft Hospice, Torquay
St Julia’s Hospice, Cornwall
St Luke’s Hospice, Plymouth

Purpose of guidance

In October 2009, the Complementary Therapy (Safeguarding Practice) Quality
Measures for peer review were published. Although it is generally
recommended that complementary therapy is made available to patients, the
actual range of and the levels of service provision of such therapies are not
subject to agreed boundaries; and NHS commissioners do not have a
mandatory requirement to provide them.

The measures set out the clinical governance requirements for the Network to
exercise over such complementary therapy as might be provided. They deal
with the case of practitioners offering therapy or consultations on the
Network's NHS premises and also the case where practitioners or
organisations are endorsed and cited in the patient information of the
Network's MDTs, chemotherapy services, radiotherapy departments and
information services and centres. (Throughout this document when the term
patient information is cited it is referring to the definition above.)

The measures intentionally focus on those clinical governance issues which
are directly relevant to the welfare of patients rather than those dealing with
the professional development of staff providing complementary therapy. The
guidelines aim to ensure a consistent approach and safe practice to patients.
The criteria are confined to adult cancer services. Measures are currently
being developed that specifically address the provision of services for children
and young adults with cancer.

These guidelines meet the requirements for the Peninsula Cancer Network
Board (Measures 09-1A-301 and 302w), which is required to produce and
distribute criteria which should be agreed Network wide and which should be
met by practitioners in the Network or those cited in the Network's patient
information.

Introduction

These guidelines set out the clinical governance requirements for therapists
or organisations that provide complementary therapy for adults with cancer
and 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 information

All practitioners offering complementary therapies on NHS premises or
cited/endorsed in the patient information must adhere to these guidelines as a
pre-requirement to practice on NHS premises whether they are paid by the
NHS or other agencies for their services or where the therapies are provided
on a volunteer basis.

Therapists who cannot meet the criteria as set out in this guidance must not
be permitted to practice complementary therapies in NHS settings and will not
be endorsed/cited in patient information.

These guidelines will be distributed to all the Peninsula Cancer Locality
Groups, Trust CEO’s, voluntary / independent sector providers of palliative
care and any other organisations providing complementary therapy to patients
with cancer in the geographical area of the Peninsula Cancer Network.

The purpose of this guidance is to provide the criteria to which all
complementary therapy practitioners within the Peninsula will agree and
adhere.

Scope

The term complementary therapy is used to cover a range of specific
therapies which are offered to patients with cancer, as having potential
benefit, but which are not offered as an alternative tumour reduction (cancer
reduction, tumour ablation or removal) method to any of the conventional
treatments 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 the
aim of providing psychological and emotional support through the relief of
symptoms’

NICE Supportive & Palliative Care Guidance (2004)

The term complementary therapy may for example include any or all of the
following: reflexology, aromatherapy, healing, homeopathy, hypnotherapy,
massage, reiki and shiatsu. This list is not comprehensive. The network may
offer, or cite, practitioners in other therapies which it agrees are covered by
the term complementary therapy.

However, the term and these criteria are not intended to apply to any of the
following since although they are not cancer reduction treatments, they are
largely covered by conventional arrangements and regulatory systems:
symptom control using oral, parenteral or topical drugs from the National
Formulary; symptom control by neuro-ablative methods; nutritional advice by
qualified NHS dieticians; osteopathy; chiropractic; the various treatments
offered by qualified NHS physiotherapists; lymphoedema massage offered by
qualified NHS staff, consultations and therapy offered by qualified clinical
psychologists.

It is recognised that volunteers provide hand and foot massage in NHS
premises across the Network. Although these services are not specifically
covered within these criteria, it is recommended that these volunteers are
trained in this practice and have a certificate to demonstrate their
competence. An example of an organisation providing this training is the Red
Cross.

Other services which have therapeutic value to patients, but are not strictly
considered complementary therapies may be delivered across the Network,
e.g. colour therapy and Cancer Locality Groups are responsible for deciding
the appropriate qualifications required where these are provided.

Aim of the guidance

The overall aim of the guidance is to ensure that high standards are set in the
provision of complementary therapies delivered throughout the Network that
will:

• 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 practice

Any practitioner wishing to employ a therapy not listed above should contact
the Head of Service/Cancer Lead or Director of Nursing who will liaise with
the Network Nurse Director.

Network wide criteria

Clearance

If working on NHS premises, the therapist should be:

I An NHS employee
I Self employed with an NHS honorary contract
I Employed by an organisation with an employment policy which covers at
least 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 above
clearances as per the locality policy applicable to volunteers.

The NHS organisation must keep an up to date register of therapists who
meet these criteria and who are working on the premises/ endorsed in the
patient information literature.

Registration of competent practitioners

The Register encompasses all staff delivering complementary therapies, this
includes:

• 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 literature

In 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 currently
fulfil all the criteria requested within this document as a pre-requisite for
practising.

All staff wishing to deliver or to supervise delivery of complementary therapies
will need to ascribe to and work within the Trust’s Policies Guidelines and
Protocols.

They must also provide evidence that they have updated their professional
registration on an annual basis, see Registration document Appendix 2.

The complementary therapy practitioner must be eligible for registration with a
recognised professional body pertaining to their therapy. Health care
professionals wishing to incorporate complementary therapies into their work
are required to check with their professional body regarding eligibility to use
therapies as part of their professional practice.

Regulation of complementary therapies is an ongoing process. However
many of the professional bodies have a regulatory procedure in situ and a
code of professional conduct.

Any complementary therapy practitioner working on Peninsula Cancer
Network NHS premises or cited/endorsed in the patient information, MUST
have a qualification relevant to their therapy and must have current
registration with a relevant recognised body. The therapist’s certificate of
qualification, professional body registration or CHNC registration (where
applicable) should be checked and a photocopy of the documents kept in the
therapist’s personnel file.

The Complementary & Natural Healthcare Council (CNHC) was set up as a
national voluntary regulator in complementary therapies, but does not as yet
regulate all therapies. For the therapies listed below, it does state those
Professional Associations or Training Institutes that have been approved for
verifying that their Members meet the CNHC standards for registration.

The complementary therapy disciplines that are currently eligible for entry to
the CHNC Register are:-
t Massage Therapy
t Nutritional therapy
t Aromatherapy
t Reflexology
t Shiatsu
t Alexander Technique teaching
t Yoga Therapy
t Bowen Therapy
t Sports and Remedial Therapy
It is recommended that organisations check the CNHC website regularly to
update on new therapies included; Website: http://www.cnhc.org.uk

During 2010 the Register will open to more disciplines, as they become ready
and wish to register. Those in this category which are relevant to these criteria
are:-
a Hypnotherapy
a Cranial sacral therapy
a Naturopathy
a Reiki
a Hypnotherapy
a Microsystems Acupuncture
a Healing

As these complementary therapies come on line, the CHNC website will list
details of the professional associations or training institutions that have been
approved for verifying that their members meet the CNHC standards for
registration. There are some therapies that are not currently eligible for entry
to the CHNC register but are included in the National Cancer Patient
Information Pathways, which give details of the organisations that can help
identify the professional registration recommended to identify a suitably
qualified therapist. The organisations quoted in the pathways with the website
address are listed below.

Acupuncture
BacC – British Acupuncture Council www.acupuncture.org.uk
020 8735 0400
BMAS – British Medical Acupuncture Society www.medical-acupuncture.co.uk
01606 786782
Healing
National Federation of Spiritual Healers (now The
Healing Trust)
www.thehealingtrust.org.uk

UK Healers www.ukhealers.info/hh.htm
Homeopathy
British Homeopathic Association and Faculty of
Homeopathy
www.trusthomeopathy.org
The Society of Homeopaths www.homeopathy-soh.org
Hypnotherapy
The British Society of Clinical Hypnosis
www.bsch.org.uk
Cambridge Register of Advanced Hypnotherapists www.crah.co.uk
Relaxation and Visualisation
These therapies are most usually offered by those therapists who are
qualified in other disciplines such as counselling or hypnotherapy and so
those qualifications and professional registrations must apply.

In future years it will be required that Complementary Therapists endorsed by
or practicing on Peninsula Cancer Network NHS premises will belong to a
professional 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 register
RThose therapies listed in the measures that are not currently eligible for
entry to the CHNC register but where guidelines for recommended
professional bodies are listed in the National Cancer Patient Information
Pathways.

Currently there are two complementary therapy disciplines listed in the Peer
Review measures (Acupressure and Reiki) which do not have CHNC
registration or, any recommended professional bodies listed in the information
on the National Cancer Patient Information Pathways. There may also be
other complementary therapies being practiced across the Network that are
not included in the above tables.

The Network is not in a position to endorse qualifications or registration
standards for complementary therapies independently. The list of therapies
included in the Network criteria will be reviewed in 2011 and new therapies
added that have received CHNC registration.

Insurance and indemnity

Where an independent complementary therapy practitioner is working under
contract for the Trust or Hospice, it is necessary to obtain evidence of the
current professional indemnity insurance to cover the period in question. A
recommended minimum level of cover is £2m. Evidence would take the form
of a receipt of payment or a certificate for the period.

Whereas some practitioners take out a separate insurance, for others, it is
provided through membership of a professional body. In both cases the
practitioner still needs to show evidence of membership of the professional
body.

Where the practitioners are already employed by the Trust and are expanding
their 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.

Supervision

All practitioners are responsible for ensuring they receive clinical supervision
in line with the employee organisation’s supervision policy. These will vary
throughout the Peninsula; however, there are five possible options for
arranging 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 criteria
for competent practice as outlined in these guidelines.

Professional Accountability

It is the responsibility of practitioners considering training or practice in a
complementary 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

• Materials

Therapists must adhere to any guidance on toxicity of substances contra
indicated for patients with cancer advised by their code of professional
conduct and professional indemnity insurance.

 Equipment

Complementary therapists who use their own equipment (e.g. massage
tables) must ensure their equipment meets European CE standards. The
equipment must be maintained in accordance with the manufacturer’s
recommendations.

Equipment must be cleaned using disinfectant wipes and dried thoroughly
between patients or the equipment must be protected with disposable covers,
which is changed between patients. Most equipment for usage with patients
has manufacturers’ recommended cleaning methods and these must be
adhered to.

Local Trust policies

NHS organisations should be mindful that complementary therapists may not
have specific experience working within the NHS environment and so
guidance should be given to aid them to provide therapies within a clinical
environment. The Practitioners must agree to work within Trust Policies, most
especially those pertaining to confidentiality, infection control, health and
safety and manual handling. Where practitioners that have been endorsed or
cited within Patient Information are working off site, Policies that include
sterility and safety of equipment and toxicity of substances used by the
complementary therapy practitioner also need to apply.

Written Information

All clients for complementary therapies need to be provided with written
information 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 Trust

It should be noted that this information should be made available in a suitable
format for those with learning disabilities, hearing or sight impairment and, if
required, translated for those for who English is not their first language

Consent

The patient/client should receive full information on the nature of the therapy
including risks, benefits and alternatives available. Consent for the use of a
complementary therapy should therefore be agreed between the patient/client
and the practitioner prior to the therapy being provided.

A written record of consent will be made in accordance with the policies and
procedures used by the practitioner’s department. This may be kept within
the 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 sought
must possess the necessary intellectual and legal capacity to give such
consent.

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 choice

A person will have legal capacity to give consent to examination or treatment
if that person has attained the age specified by the relevant law for giving
such consent.

The relevant law specifying the age for giving such consent is different in
different parts of the United Kingdom and is complicated. Thus, in some parts
of the UK, patients under the age of 16 may have the legal capacity to give
consent 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 relevant
law 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 to
institute any treatment unless they are satisfied that the patient’s parent or
other legal guardian has given informed consent.

In the case of patients over the age of 16 who do not have the intellectual
capacity to give consent practitioners are advised not to institute any
treatment unless they are satisfied that the treatment is in the best interests of
the patient, in the sent that the action is taken to preserve the life, health or
well-being of the patient.
Informed consent issues may be particularly relevant within the Hospices
where practitioners would adhere to the organisation’s policy regarding
recording of patient’s wishes should be observed. (Preferred Place of Care
document, 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/consent

In recognition that the medical practitioner retains overall responsibility for the
medical care of the patient, when a complementary therapy is offered within a
programme of care, the clinician must be consulted. The process for this will
vary within the individual organisations and may take the form of an MDT
decision for a patient in the Hospice or a blanket referral from the Consultants
for those patients being treated within the Cancer Centre. However, in
recognition of the practitioner’s individual duty of care, the clinician’s opinion
must be sought where there are any concerns regarding the client’s condition

Notes

Each therapist must keep clear and concise records of their therapeutic
sessions. NHS organisations employing complementary therapists or making
use of volunteer complementary therapists should ensure that a clear policy is
in place in relation to the recording and storage of notes from complementary
therapists.

Hospital computerised records are covered by the Data Protection Act. Any
therapist holding patients’ records/notes on their personal computer, outside
the hospital must be registered with the Data Protection Service.

Confidentiality

Complementary therapists are bound by both the Code of Ethics of their
relevant professional bodies and also by the guidance of the establishment in
which they provide therapy.

Confidential information should only be shared with the patient’s permission or
only when necessary for the patient’s welfare.

Therapists are subject to the same complaints procedures as all other
employees of the establishment in which they work.

Local responsibility/ requirements

All providers should produce a list of the therapies available within their
locality including criteria for referral, number of sessions offered, any cost
implications and contact numbers for further information. This list should be
updated annually and should be available to all clients. It is considered good
practice for each locality to have protocols for all therapies that are offered on
the NHS premises. An example protocol has been included in Appendix 2.

The Peninsula Cancer Network will hold on its website and make available by
request a document detailing the availability of all complementary therapies
throughout the Peninsula.

List of complementary therapy practitioners practising on NHS premises

Each Cancer Local Implementation Group should produce a list annually of
the complementary therapy practitioners offering their therapy or consulting
with their cancer patients on the NHS premises of the locality.

The list should record the following information:
T Name of the complementary therapist
T Complementary therapy offered
T Qualification of the complementary therapist
T NHS Premises at which the complementary therapist offer therapies
T Confirmation that the complementary therapist has complied annually with
securing 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 the
NHS, volunteer etc.

In order to be compliant the Local Implementation Group must annually for
each practitioner:-
e See documentation that they are an NHS employee or that their employing
or volunteer recruitment organisation’s clearance policies are agreed by the
chair of the Cancer Locality Group.
c Check that the practitioner holds a professional qualification that is listed
within this Network criteria

Check that each practitioner has written information for patients which
demonstrates 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. This
information should be verified annually by the Local Cancer Implementation
Group.

Distribution

This 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 Clearance

Date of Child Protection Training

Date of Statutory Update Training

Date of Manual Handling Training

Date 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 Protocol
1. All prospective practitioners will be screened by the Voluntary Services
Department in line with current departmental practices.

2. Therapists will be responsible for observing all the guidelines in line with
normal volunteering policy, including equal opportunities, safe handling,
health and safety, and hygiene.

3. All practitioners will agree with and sign a declaration of patient
confidentiality.

4. Therapists must hold an appropriate professional insurance policy for their
approved therapy.

5. Permission for a session must come from the patient themselves; although
staff may suggest a session or help a patient select one which is appropriate
to their needs.

6. Sessions will only be given after the therapist has met with, and discussed
the therapy with the patient. Patient’s medical and nursing notes should be
made available to the therapist.

7. Details of each treatment will be documented by the therapist(s) within the
patient’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 strictly
observe the ethical code of their professional body.

9. Before offering complementary therapies to patients the complementary
therapist must inform the person in charge of the ward/ out patient area that
therapies are to be offered / given to ensure that complementary therapies are
not offered / provided to patients for which these are not suitable.

10. Regular communication between the therapist and nursing staff and other
healthcare professionals is encouraged. Therapist’s concerns regarding
changes in the patient’s condition should be discussed immediately with the
nurse in charge, and documented in the patient’s record.

11. All therapists are expected to be committed to continuing personal
development and will be supported and encouraged to develop their
knowledge and skills in specialist areas.

12. All patients will be offered an evaluation form to record their comments
regarding the therapies they receive which includes asking how good the
therapist is about giving appropriate information, how the patient has felt
about 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 and
environment, but the wishes of the patient regarding privacy should be
respected at all times.

14. All sessions given by practitioners from the Voluntary Services
Department are free of charge, and no charges or donations are to be sought
by therapists.

Treatment Guidelines
Therapists must adhere to any guidance on toxicity of substances contra
indicated for patients with cancer advised by their code of professional
conduct and professional indemnity insurance.

 Massage

Generally, gentle, non-invasive massage techniques should be employed so
as not to over stimulate the patient’s system. Kneading, pummelling and deep
massage are not recommended.

Clinical Checklist/Contraindications

1. Body Temperature
Do not treat patients with a high temperature.
Very hot areas can indicate an infection, inflammation or intense cellular
activity. In oncology patients, cancerous sites are often hot. Therapists should
check with staff first to establish appropriateness of treatment.

2. Fluid Retention/Swelling/Lymphoedema
Avoid the area. Never massage a swollen limb/trunk, unless you have been
specifically trained in appropriate drainage techniques, or have been shown a
particular technique by the patient’s specialist care giver (e.g.
physiotherapist).

3. Undiagnosed Lumps or Areas of Inflammation
AVOID THE AREA – report this finding. (It may indicate a recent growth in
cancer patients which has not yet been diagnosed.)

4. Skin Problems/Rashes
These could be circulatory problems or reaction to medication/diet. AVOID
THE AREA OF ANY RASHES – report this finding.

5. Pinprick Bruising
These are indicators of a very low blood count. Check with nursing staff or
medical staff before treating. Massage very gently with careful light strokes to
help the body feel warmer. It may be suitable to massage hands and feet only
in order to avoid affected areas.

6. Radiotherapy
Radiotherapy treatment entry and exit sites should be avoided for up to six
weeks following treatment. Use very gentle strokes following radiotherapy as
the skin remains vulnerable to damage.

7. Stoma Sites, Dressings and Catheters
AVOID THESE. Massage elsewhere, i.e.: hands and feet.

8. Scar Tissue/Broken Skin/Lesions/Recent operation sites or wounds
Avoid areas of recent scar tissue/broken skin or lesions.

9. Tumour Site
Do not massage over the tumour site, near the tumour site or adjacent or
affected lymph glands.

10. Deep Vein Thrombosis (DVT)
Do not massage feet or legs if the patient has a diagnosed or suspected deep
vein thrombosis in the legs, or arm/hand if a thrombosis is suspected in the
arm.

11. Areas of Infection
Avoid all areas of external infection. Employ appropriate infection control
techniques.

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 Joints
Avoid hot or inflamed joints, except to apply cooling oils where appropriate.

15. Angina, Hypertension, Hypotension
Exercise caution with patients with these conditions, using gentle massage
strokes and balancing oils. Check with the nursing or medical staff as patients
may need to be treated in an upright/sitting position.

16. Jaundice
Exercise caution with patients with these conditions. Check with the nursing or
medical staff before proceeding.

17. Low platelet counts
This will contra-indicate the use of massage using pressure techniques as
there is a greater likelihood of bruising.

 Reflexology

Contraindications:
As with usual practice.

General
Gentle touch.

Thrombosis/Embolism
Do not treat until the condition has been managed medically, or after you
have liaised with appropriate medical personnel.

Precautions
Lymphomas and leukaemias – very gentle sessions. In the case of stem cell
transplants avoid the use of reflexology whilst the immune system is
suppressed.

Radiotherapy and Chemotherapy
Gentle treatments bearing in mind any vulnerable areas connected with side
effects of treatment.

Other Therapies
Whatever the therapy, the following general considerations should be
regarded:
r the patient’s physical and emotional state
r treatment programme
r side effects of treatment
r physical problems related to the patient’s condition.
Therapy should be gentle with the main aim of relaxation and relief of stress
and stress related symptoms. Therapists should, where possible, liaise with
the person’s medical or nursing team where treatment is imminent, ongoing or
recently completed.

General Guidance When Giving a Session
Hands 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 compromised
patient.
For in patients all treatments for patients are to be given on the patient’s own
bed, or at their bedside.
All therapists should establish a working pressure that is comfortable for the
patient at all times.
The length of each session will be in agreement with the patient and in
recognition of their specific needs at the time of the session. However, an
average of 20-30 minutes is recommended, unless the patient is able to
tolerate more without being over tired.

Always check with the nursing staff before treating a patient who is
being barrier nursed, or has MRSA, so that cross-infection is avoided.

 Training
Training is offered on the management of patients with cancer.

 Evaluation
Information on complementary therapies should be collected regarding:
Number of sessions given
Length of time spent in each therapy session
Type of treatment given
Oils used during session (where relevant)

 Supervision
Supervision is not a mandatory requirement but is recommended in the
interests of safe best practice. Many therapists feel that their work is best
supervised by someone with in-depth knowledge of their subject and as such
seek outside professional supervision. Supervision engaged in outside of the
hospital is at the sole discretion the individual therapist and at their personal
cost.

 Private Practice
The Trust recognises that volunteers also practice privately in their own time.
However, volunteers should make it clear to all their clients that their
volunteering within the NHS is totally unrelated to their private practice as a
therapist.

Volunteers may not seek to deliberately recruit patients during their
volunteering for the Trust, but may in the course of discussions give
information about their private practice.

Any requests for treatment from visitors, relatives or friends of patients, or
hospital staff must be treated as private work, and no treatments may be
given on site unless agreed by Voluntary Services and senior ward staff.

(This protocol is provided with kind permission of the Volunteer
Department of University College Hospital London on which this is
based)

Acknowledgements

With thanks to the Peninsula Cancer Network Complementary therapy Group
and to the Yorkshire, Sussex and Essex Cancer networks for sharing their
complementary therapy documents which have been used and adapted in the
development of these guidelines.

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