Humor Interventions in a Palliative Care Setting

Abstract

<strong>Background:</strong> The effect of humor intervention in a palliative care setting could prove beneficial and is worth investigating. However, data on humor interventions for palliative care patients are scarce. The impact of humor on palliative care staff members has been more extensively investigated and consistently demonstrates positive effects. <br /> Aim: This study aimed to review the literature, develop a study protocol, and evaluate applicability and the effects of a humor intervention in a palliative care setting, and of humor workshops for health care professionals working in palliative care. <br /> <strong>Design:</strong> Based on a systematic literature review, a study protocol for a humor intervention in a palliative care setting was developed. A two-step intervention was selected and the intervention and control groups completed questionnaires on life satisfaction, cheerfulness, symptom burden, and perceived stress, and provided saliva samples to measure oxytocin levels. Staff members were invited to participate in 1-2 humor workshops based on the concept of the Humor Helps to Cure Foundation were evaluated within the parameters of cheerfulness, perceived stress and oxytocin levels. <br /> <strong>Setting:</strong> The clinical study was a randomized controlled monocenter study on patients treated in a palliative care ward. Participants had to be conscious and alert enough to complete data collection. Overall, 55 patients were included and randomized to the intervention or control group. In addition, 31 out of 37 staff members took part in one of four humor workshops. <br /> <strong>Results:</strong> The systematic review found two studies on humor interventions and 11 on humor assessment. The patient perspective was underrepresented, but humor showed to have a beneficial effect. The study protocol had to be adapted due to a high attrition rate due to lengthy questionnaires and the inapplicability of quantitative sensory testing (QST). The number of questionnaires was reduced and oxytocin in saliva was included instead of QST. In the clinical trial, seriousness, bad mood, and stress were reduced in the intervention group compared to the control group. Cheerfulness increased significantly after the intervention. However, the complex intervention proved too burdensome for most patients, even though the study design had been drafted specifically for a palliative care setting. Staff humor workshops resulted in a small but not significant oxytocin increase. For staff, distress and bad mood were reduced, seriousness decreased, and cheerfulness increased significantly. <br /> <strong>Conclusion:</strong> The literature review emphasized the need for systematic research to evaluate the effect of humor interventions on patients. The study protocol demonstrated the importance of brief and valid assessment instruments for data collection in palliative care patients. Those who were able to participate benefited from the effects of the intervention on multiple levels. For future research short and simple interventions, biomarkers for well-being and proxy assessments in addition to patient related outcomes are needed to include patients with reduced cognitive and physical performance status at the end of their lives. Data and feedback from staff confirmed the value of humor for palliative care professionals.