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Methods to help evaluate treatment
Introduction
Examples of treatment aims How
to evaluate Accurate records
Useful criteria
Supporting evidence Rationales
for treatment Conclusion
There is little information available on the effective evaluation of treatment in aromatherapy. In the current climate of evidence-based healthcare practice and the movement towards statutory regulation in the UK, it is important for all therapists to adopt a methodical way of planning, recording and evaluation treatment until our governing organisations can sort themselves out into an authoritative resource to help provide appropriate guidance for consistent practice.
There is very little guidance on what and what we should put on our treatment records, many of us are still using common terminology without reference to botanical names (although even botanical classifications do not seem to have much credence these days), species, variation, chemotype or source of supply and batch numbers. Without this sort of information, we cannot enable the duplication of successful treatments or contribute to any sort of systematic review into the effectiveness of aromatherapy - something the profession badly needs in order to help it move away from ill-informed, old-fashioned, and ritualistic practices.
Below are some suggestions to help you evaluate the effectiveness of your treatment.
REMEMBER - don't regard unsuccessful treatment as failure - use the knowledge to re-evaluate and plan a different approach (see Improving practice). Learning which essential oils do not work is as important as learning which ones do! Your client may expect immediate success so you need to explain that this is not always the case - if necessary, offer a free follow-up in order to readjust your treatment plan.
Your treatment plan should always state an aim - without an aim, you cannot evaluate success. Your aim should be specific and realistic.
Examples
The following examples are taken from defining aims using the nursing care plan - aims should be concise and measurable, that way we know if treatment has been successful. Measurable doesn't mean wholly statistical or in terms of a value, but can be measurable in lots of ways, both through client perception, observations, or client satisfaction with the outcome.
Good: To immediately relieve nasal congestion through massage and inhalation using expectorant and mucolytic essential oils. To offer client blend for home use to use as steam inhalation.
Poor: To treat nasal congestion... or ....to cure nasal congestion.
Although the ultimate aims are the same, the first is written in such a way from you to be able to evaluate your treatment by asking - was nasal congestion immediately relieved (ask the client), then subsequent evaluation can be obtained at the follow-up visit to ascertain how long the nasal passages remained clear, and the effectiveness of the home blend using the same criteria. This way you are adding a quantitative and measurable element to your evaluation (ie: how long the passages remained clear) as well as a more subjective evaluation from the client themselves.
Good: To reduce dry eczema on legs and arms using massage with essential oils.
Poor: To treat eczema.
By being more specific about the aim, evaluation is easier - in order to evaluate accurately, you need to estimate the area covered by eczema prior to treatment, then provide evidence of further estimations at follow-up visits. In severe cases, with the clients permission, you could take a photograph of the affected area with subsequent photos as treatment progresses.
REMEMBER Treatment aims should be clear, precise and measurable.
Ways of evaluating
Effective evaluation is concerned with the difference between two points: The condition before treatment and the condition after treatment.
Accurate records
You need to record the the starting point, sometimes called the 'base line' which we use to measure progress (ie: the initial presenting condition BEFORE treatment) in your assessment. Many clients may already be using conventional medication or other complementary interventions prior to consulting you so you also need to record this in the assessment as it will influence the outcome of your treatment.
Example: If you prescribe Lavendula angustifolia for insomnia with the client also taking sleeping pills, herbal teas, or just started a caffeine-free diet etc: you must consider this when evaluating treatment and record as such so not to distort the evaluation.
How can we evaluate an holistic therapy?
Evaluation is based on qualitative information (that which cannot be specifically measured or is open to interpretation ie: feelings, communication, language and emotions), and quantitative methods (that which is measurable in terms of scale, severity, statistically comparable etc). Quantitiative evidence usually has more value in the medical profession because it is more reliable and less open to interpretation.
As aromatherapy is an holistic intervention, often treatment will affect many aspects such as mood, stress, attitude, and motivation as well as any existing physical condition, making most methods of evaluation based on a qualitative approach. However, there is no reason why therapists cannot ask their client how they feel before a treatment, then how they feel afterwards, or how treatment has helped over the longer term. While this is usually regarded as anecdotal or qualitative in nature, it can be given more weight and moved into the quantitative type by adapting the use of simple rating scales (see grading symptoms below). Self rating scales are an accepted method of measuring client and treatment satisfaction in nursing practice and therapists can learn a lot from their application. Using a scale with a regular client can also give you a quick indication as to how they are currently feeling in relation to previous treatments.
Useful criteria for evaluating treatment
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Estimation of area affected (use percentage of body, or area in square inches/cms) |
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Descriptive - Physical (colour, swelling, shape, range of movement, size, area), Non-physical (how does client feel, perception, ability to cope, emotions, appearance, body language, more talkative, less talkative, more upset etc) |
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Photographs/sketches of affected area. |
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Grading symptoms - Ask the client to grade severity of symptoms (marks out of 10: 10 being most severe, 1 or 0 being no symptoms). For specific conditions prior to the first treatment, start at the number 5, this way you have room to record both improvement, and deterioration. Graded scales are particularly useful when addressing emotional symptoms or pain and discomfort, but you may need to spend some time explaining how the system works to the client. |
While it is recognised that aromatherapy is indeed a holistic practice and in some cases, evaluation is often based on client perceptions and feelings, evaluation should as far as possible include a mixture of the above. You may even like to develop your own emotional scale based on several questions which can then be presented as a total score - by doing this, you are applying a quantitative element to something which has traditionally been a very subjective area.
REMEMBER - Record signs and symptoms before treatment in your initial assessment, then the results/outcome in your evaluation.
Supporting evidence
In order to move aromatherapy in line with other health practices, is it important to base your treatment on reliable and supportive evidence. Aromatherapy is readily dismissed by other professions on the basis of too much dependence on anecdotal evidence. While anecdotal evidence is useful, is is often inaccurate and can be based on old practices. Use anecdotal evidence if you wish but you need to be discriminative of the source and accuracy. Aromatherapy will not survive on anecdotal evidence alone and we need to move in line with modern clinical practices. This includes reference in our treatment documentation to previous case studies, current research, properly researched texts, textbooks, professional workshops and articles.
Rationales for treatment
The reason for your treatment to address particular ailment or problem is called the rationale. Evidence-based practice is always based on a rationale. For this reason, Aromacaring has provided space on the treatment record to record the rationale for your selected treatment. This gives credence and professional acceptability to the treatments you offer, shows that you are keeping up to date with advances in practice, contributes to your professional development by enabling you to show evidence of keeping up to date with current research, and, most importantly, helps the development of the profession as a whole.
Conclusion
Whether or not aromatherapy in the UK can sort itself into a single organisation with statutory regulation remains to be seen - in the meantime, it is the individual practitioner who can really make a difference. Real change and credibility will only come from grass root level upwards, so while we may not be experts in chemistry or research, we are the ones that put theory into practice and put the public in touch with the profession. We can help by providing accurate records and be discriminative about what we do and why until the major associations and training establishments can offer a uniform and methodical infrastructure on which to practice and implement evidence-based practice.
© Jane Ellwood July 2001