Animal-assisted therapy at a University Centre for Palliative Medicine – a qualitative content analysis of patient records

Abstract

BackgroundAnimal-assisted therapy (AAT) is a therapeutic concept, which has only recently been explored in more detail within the palliative care setting. A programme of AAT was begun in June 2014 at the Interdisciplinary Centre for Palliative Medicine of the University Hospital Dusseldorf, Germany. The AAT sessions were performed by two trained and certified dog assistant therapy teams (DATT). To date only very limited scientific data are available with regard to feasibility, therapeutic indications and efficacy of AAT in palliative care. The present qualitative study aims to describe the first year’s practice and experience of AAT after implementation as an integral part of adjunctive therapy options offered within an academic palliative care centre.MethodsThis study is a qualitative content analysis of all post-encounter protocols of AAT interventions recorded by the dog handlers from June 2014 through May 2015. Qualitative content analysis was conducted according to Mayring’s approach; the report followed the recommendations of the Standards for Reporting Qualitative Research (SRQR).ResultsFifty-two patients received 84 AAT interventions, with only 18 patients receiving more than one intervention due to discharge or death. In 19 cases relatives also participated in the AAT session. The inductive coding process yielded four main categories. One hundred and fifty-three codes related to the content and structure of the AAT sessions, with physical contact with the dog taking considerable precedence. The AAT sessions included conversations with the dog handler, 10.5% of which related to the current health state as well as to discussions around death and dying. Eighty-nine codes related to perceived emotional responses, with pleasure being the most often observed response. Two hundred and seventeen codes related to the effects of the AAT sessions, identifying the dog as a catalyst of communication and observing patients’ physical activation or relaxation.ConclusionsAAT may constitute a valuable and practicable adjunct to the interdisciplinary therapeutic repertoire of palliative care in the hospital setting. The results of this study suggest that patients may potentially benefit from AAT in terms of facilitated communication, positive emotional responses, enhanced physical relaxation or motivation for physical activation. These early stage results will need to be followed-up by more robust study designs.

A Systematic Literature Review of Animal Assisted Interventions in Oncology (Part I): Methods and Results

“…7,[29][30][31][32][33][34][35] Some collect data only after the session or treatment is completed and many may also lack a control condition group. [36][37][38][39][40][41][42][43] Medical case reports deal with AAI's effect on one patient each and showcase dramatic effects on one patient that may be lost in summary statistics. 44,45 Both quasi-experimental and pre-to post-intervention studies can provide data suggesting efficacy and highlight potential mechanisms underlying AAI's benefits, while also capturing the subjective experiences of many participants.…”

“…Even though data collection from the subject of an intervention is paramount, these studies highlight the important perspectives of medical personnel and family members. In two special cases, Gagnon et al 37 and Schmitz et al 40 surveyed parents and handlers, respectively, as proxies for patients too young to provide useful research data. Generally, investigators note the potential of AAI to enhance relationships between patients, caregivers, and other family members, thus necessitating data collection from multiple stakeholders.…”

A Systematic Literature Review of Animal Assisted Interventions in Oncology (Part II):Theoretical Mechanisms and Frameworks

“…Similarly, White et al 66 provides several anecdotes showing that the therapy animal adds to the counseling support network such as "I was more open to the [counselor] than I have been with other people [counselors] in the past" and "they're just very comforting, I think, dogs are very not judgmental." Other researchers also comment that a therapy animal can be a non-judgemental listener 30,59,[67][68][69] or facilitate interactions with medical staff, 8,66,[69][70][71] both increasing a patient's sense of perceived support during stressful treatment processes. This conception of patient support can also explain previously discussed 10 mechanistic vehicles such as compatible personalities, positive physical touch, improved human interactions and the underlying neurobiological factors seeing that therapy animals are specifically introduced to patients as part of the medical support staff.…”

“…31 Other studies that asked questions concerning patient attitudes towards pets largely found no significant correlation between these measures and the treatment outcomes of interest. 31,58,59,65,67,70,71,78,79 For prospective researchers, one troublesome aspect of this particular AAI conception is its necessitation of longitudinal studies that can allow a bond to fully develop, though tools like the Monash Dog Owner Relationship Scale 80 and the Lexington Attachment Scale can provide some indication of a bond's strength. 81,82 Additionally, the bond in question is a metaphysical phenomenon that cannot be interrogated directly and must be studied proximally through its effects.…”

“…85 Therapy dogs specifically improve a patient's life as they are non-judgmental and display joy when interacting with bonded persons. 70,[86][87][88] This would generally mean that any positive AAI effects come from a better understanding of the self through interaction with the therapy animal. This is illustrated by…”