AATs in both inpatient and outpatient settings have evolved over many years. Reports date back to the late 1700s, when rabbits were used to calm patients at a Quaker institution, and in the mid-1800s, when German clinicians used animals to relax patients with epilepsy to prevent further seizure episodes.2 Florence Nightingale also made substantial discoveries regarding AAT when she observed that small pets helped reduce anxiety and improve recovery in children and adults living in psychiatric institutions.3 AAT reduces the psychological stressors a patient experiences during a hospitalization or clinic visit, ultimately helping to reduce overall systemic stress, which improves catecholamine responses, heart rate, blood pressure, and overall well-being.2 Research has shown that incorporating AAT into many different healthcare settings has a positive impact on patient outcomes.
The American Veterinary Medical Association classifies therapeutic animal-assisted interventions into 3 categories: animal-assisted activities that utilize companion animals, AAT that utilizes therapy animals, and service animal programs that utilize service animals.4 Each category serves a different purpose, and the therapy animals require different levels of training. In this article, the term AAT refers to animal-assisted therapy intended to promote the health and well-being of patients and providers in healthcare facilities. AAT is a scheduled encounter with a certified therapy team consisting of an animal and its handler for the purpose of supporting or improving patients’ social, emotional, physical, or cognitive functioning.3 There is growing evidence of physiological and psychosocial benefits of AAT with various populations, including healthcare providers.
Healthcare facilities should be considered a place to heal and get better, but for many people visits for treatments bring a lot of stress and loneliness. This can be problematic because stress responses decrease healing times and patient satisfaction. AAT is a goal-directed intervention in which an animal meeting specific criteria is an integral part of the treatment process and is delivered and/or directed by health or human service providers working within the scope of their profession.5 Complementary and alternative therapies, including AAT, are among some of the techniques designed to create a superior healing environment.
Based on numerous literature reviews, AAT confers a therapeutic purpose in both adult and pediatric inpatient populations, and it provides health benefits to patients with almost any disease process.2 AAT can also be utilized for rehabilitation purposes by encouraging patients to participate more during their rehabilitation visits. For example, Abate and colleagues found that patients were more likely to ambulate with assistance of a therapy canine than with a therapist alone.1
AAT has been shown to have benefits in a variety of settings. It promotes a sense of well-being and has been shown to decrease stress levels in those interacting with an AAT animal. It has also been noted to promote a calming effect on those in stressful situations. Positive interactions can occur as a result of changes in the neurochemical levels in the brain. AAT has been utilized in schools, community organizations, and a variety of healthcare settings. Research has been done showing the benefits of AAT on caregivers and patients, but little has been found showing the benefits of having an AAT dog as part of the oncology staff. The thinking behind developing our program was to provide a safe haven for oncology providers to de-stress and have some downtime while also having some fun.
AAT is a supportive therapy that is currently underutilized in the outpatient oncology setting. AAT has been used to provide support for cancer patients, but a review of the literature indicates that little has been done using AAT to focus on oncology providers. Working in oncology has many rewards, but it can also be challenging and stressful. Oncology providers have a burnout rate of 44.7% related to the emotional exhaustion and volume of patients receiving care.6 The Abramson Cancer Center wanted to develop programs to address staff burnout and boost morale. In 2016, we evaluated our current supportive care programs and developed an AAT program focusing on oncology providers. We hypothesized that this program would help reduce provider stress and promote well-being among our oncology team.
Understanding different ways to provide comfort and decrease stress in healthcare environments for patients and providers is important to healing, preventing caregiver burnout, and improving patient outcomes.
In 2014, Patient & Family Support Services (PFS) at the Abramson Cancer Center took ownership of developing an AAT program. PFS first reviewed and adapted the inpatient AAT policy. A plan was then developed to roll out our program in the outpatient setting, including a naming contest that yielded the program title “De-Stress with Darla Days.” One of the nurse navigators trained her dog to become a certified therapy dog (Darla). AAT training involves many hours of instruction and practice in a mock healthcare setting to ensure that the animal is comfortable in the environment. Training is ongoing because our canine companions need to be on good doggie behavior at all times. Darla comes “to work” on specific days each week. Initially, 75 staff completed a survey measuring the impact of Darla’s visit on their stress level. Qualitative surveys were given to providers asking their stress levels before and after a visit with Darla and were asked to describe their experience with the therapy dog. Survey results have been very positive, with staff reporting a decrease in stress and an overall feeling of well-being after a visit from Darla. Staff reported previsit stress levels of 4 or 5, with 5 being the highest stress level. Stress levels decreased to 1 or 2 after Darla’s visit.
It is amazing to observe the interactions between AAT animals and humans. Animals are very instinctive and can sense when something is wrong or someone needs extra love. For example, one day a staff member received sad news and was visibly upset. Darla picked up on that emotion and immediately went to the staff member to provide extra support and love just when it was needed, and she spent a good part of her day providing comfort to our team member. Another example occurred when Darla was able to provide bereavement support for one of our patients who had recently lost his beloved dog of 14 years. He had not had a chance to grieve, and she helped him start to move through that process by just being present.
Darla checks in every morning when she comes to work to say hello and be sure everyone is doing OK, and to see if anyone needs a little extra attention.
There has been an overwhelming response to our program. Darla has provided a lot of support and boosts morale every time she is here with her bright and engaging personality. Our program has been so well received that we are looking to expand our AAT program in the hope of having a therapy dog on-site every day. We have expanded the program to include patient visitation in the clinic waiting areas. Staff and patients alike often request therapy dog visits, and Darla’s schedule is adjusted to meet the needs of both the patients and staff. Our therapy dog has participated in many organization-wide initiatives, such as Take Your Child to Work programs and House Staff Appreciation Week.
In conclusion, current evidence shows that AAT does in fact improve outcomes for patients, providers, and caregivers. Furthermore, research shows that AAT has been linked with both objective and subjective benefits for reducing physiological and psychological symptoms. It is critical to note that AAT should not be the only intervention used in patient care, but it is a beneficial adjunct intervention that nurses and healthcare professionals can utilize. In the future, to fully consider the use of AAT, more research that focuses on the impact of AAT in different patient populations, on different providers, and settings involving larger patient samples is needed. Further research will lead to increased acceptance and availability of this unique integrative therapy.1 As a volunteer service, AAT dogs can provide an effective and cost-free option for enhancing patient care and staff morale. AAT can be a part of any healthcare team and provide many benefits to patients, caregivers, and the oncology staff caring for those patients.
References
- Abate SV, Zucconi M, Boxer BA. Impact of canine-assisted ambulation on hospitalized chronic heart failure patients’ ambulation outcomes and satisfaction: a pilot study. J Cardiovasc Nurs. 2011;26:224-230.
- Snipelisky D, Burton MC. Canine-assisted therapy in the inpatient setting. South Med J. 2014;107:265-273.
- Ernst L. Animal-assisted therapy: an exploration of its history, healing benefits, and how skilled nursing facilities can set up programs. Annals of Long-Term Care. www.managedhealthcareconnect.com/article/animal-assisted-therapy-exploration-its-history-healing-benefits-and-how-skilled-nursing. 2014.
- Calcaterra V, Veggiotti P, Palestrini C, et al. Post-operative benefits of animal-assisted therapy in pediatric surgery: a randomized study. PLoS One. 2015;10:e0125813.
- American Veterinary Medical Association. Animal-Assisted Interventions: Definitions. www.avma.org/KB/Policies/Pages/Animal-Assisted-Interventions-Definitions.aspx.
- Shanafelt T, Dyrbye L. Oncologist burnout: causes, consequences, and responses. J Clin Oncol. 2012;30:1235-1241.
