Clinical bottom line
Non-pharmacological interventions (NPIs) offer valuable adjunctive options for managing anxiety in palliative care patients, with evidence supporting modalities such as aromatherapy, music therapy, and therapeutic robotic companions. These approaches can reduce anxiety and improve comfort without adding pharmacologic burden, making them particularly relevant in advanced illness where polypharmacy is a concern. While promising, the heterogeneity of interventions and patient populations necessitates individualized application and further rigorous study to optimize protocols (Coelho et al., 2017; Akbaş Uysal et al., 2024).
What the evidence shows
Coelho et al. (2017) conducted a scoping review of NPIs in palliative care, identifying a broad range of interventions including relaxation techniques, music therapy, aromatherapy, and touch therapies. They found consistent reports of anxiety reduction and enhanced patient comfort, though methodological variability limited definitive conclusions.
Akbaş Uysal et al. (2024) performed a randomized controlled trial assessing aromatherapy combined with music in palliative care patients, demonstrating significant reductions in anxiety, pain, and stress levels compared to controls. This supports multimodal sensory interventions as effective, low-risk strategies.
Rashid et al. (2023) systematically reviewed the use of the therapeutic robot ‘Paro’ in older adults with dementia, showing reductions in behavioral and psychological symptoms including anxiety. Although focused on dementia, these findings suggest potential applicability of robotic companions in palliative settings to alleviate anxiety.
Pyszora et al. (2022) highlight the role of NPIs in managing anxiety in advanced COPD patients receiving palliative care, emphasizing breathing exercises and mindfulness as beneficial adjuncts.
Caveats and uncertainty
Studies vary widely in intervention types, durations, and outcome measures, complicating synthesis.
Sample sizes are often small, and blinding is challenging in NPI trials.
Patient heterogeneity in palliative populations affects generalizability.
Long-term effects and optimal dosing/frequency of NPIs remain unclear.
Integration with pharmacological management requires further study to define best combined approaches.
How this may change practice
Clinicians should consider incorporating NPIs such as aromatherapy, music therapy, and relaxation techniques as complementary anxiety management tools in palliative care.
Personalized selection based on patient preferences, cognitive status, and symptom burden can enhance engagement and efficacy.
Training interdisciplinary teams in delivering NPIs may improve accessibility and consistency.
Ongoing assessment of anxiety and response to NPIs should guide iterative care planning.
Future research should focus on standardized protocols and integration with pharmacologic therapies.