Health & Faith: Use of Prayer. Duke Grant.

Duke Received Health Leadership Grant for Mind-Body-Spirit Treatments and Research
by Marsha A. Green

On July 18, the Medtronic Foundation announced a million-dollar Health Leadership Grant to DUMC. This grant will support the expansion of a program that provides access to traditional, mind-body-spirit, and complementary approaches to medicine for patients with chronic heart failure. The program will be the first in the country to attempt to examine and quantify the value of mind-body-spirit interventions for the treatment of chronic heart failure.

INSIDE spoke with Marty Sullivan, MD, and Mitch Krucoff, MD, co-directors of the program, to explore how this grant came about, and what impact it will have on medicine, both here at Duke, and farther afield.

Q: This is a major grant from Medtronic. Is it the first?

Dr. Krucoff, director, Interventional Clinical Trials, DCRI: Our original contact with Medtronic came through their interest in the MANTRA study that we have been conducting for many years. MANTRA was probably the first systematic approach of clinical investigations into noetic therapies-spiritual and energy therapies used in healing. Back then, Medtronic was giving out short-term grants, and we were privileged to be in a dialogue with them that led to their current, larger, and longer-term grants.

Q: Aside from the size of the grant-a million dollars over three years-what is so special about this grant?

Dr. Sullivan, co-director, Duke Center for Integrative Medicine: A lot of work has already been done to look at how health is affected by stress, by prayer, by mental states. This program will expand on that by focusing on chronic heart failure patients and collecting data to quantify how concentrating on these factors affects the outcome of this disease.

We want to explore spiritual issues in a way that respects all religious backgrounds. We believe that there are global aspects of spirituality that do not depend on any one tradition: aspects such as forgiveness, acceptance, meditation, and prayer. This program can help people explore what these aspects mean to them, personally. If you look at the most recent literature on spirituality and health it points to the fact that there is something powerful there. If we can facilitate an increase in something that protects against illness, let's do it.

A unique aspect of the program is that the researchers are going to take great pains to find out what interventions patients want by going to the experts-the patients themselves. We will be doing many focus groups during the first year of the five-year study. Once we explain the possibilities, and listen to the patients, we will tailor the interventions to meet their needs. That's why we call it "patient centered" care, because it is truly the patient who is at the center of deciding upon the care.

Krucoff: We are very excited about the opportunity to integrate traditional, complementary, and spiritual aspects of medicine-to re-examine what a healing environment is in an institutional setting. Duke is well known for its innovative research and high technology. We would also like Duke to become a hospital where spiritual energy is as important as electrical energy.

Q: Who will this program impact, and how?

Sullivan: The program will have two distinct parts: outpatient and inpatient. All patients participating in the program will be drawn from the Duke Congestive Heart Failure (CHF) program, run by Chris O'Connor, MD, and from DUHS outpatient clinics.

Outpatients will be offered six to twelve week support groups aimed at improving coping skills, Mindfulness training, emotional expression and empathetic sharing, and learned optimism. Data on the outpatients will be collected before, during, and after the interventions to assess results.

Inpatients will be offered music therapy, imagery and relaxation, and touch therapy on an individual basis. Inpatients will also be asked to view a standard videotape that explains other mind-body-spirit techniques.

Krucoff: We are starting with a small number patients at the beginning-hundreds, rather than thousands. However, by starting small, we can do it well. This grant is as much about learning how to deliver care to the entire person, and educating staff in these areas, as it is about collecting the data on outcomes. We have learned that in working in new areas, small successful steps are the path to large successes.

Q: Why congestive heart failure?

Sullivan: As we develop more drugs and devices to cope with acute heart problems, we are left with more and more people with a chronic illness. Somewhere between two and four million people suffer from chronic heart failure in this country. It is a life-threatening illness-the death rate is higher than that of cancer. Nevertheless, it is also a chronic illness-something that people have to learn to live with. We believe that these patients can truly benefit from treatment that looks at them as whole people-body, mind, and spirit. We also believe it is important to address how these patients look at end of life issues.

Q: In addition to the CHF program, what other existing strengths at Duke are you tapping into?

Krucoff: One of the reasons we were awarded this grant is that we were in a position to orchestrate a unique, formidable combination of disciplines that can all focus on the same questions. The program draws heavily on the Center for Integrative Medicine, the Institute for Care and the End of Life, the DCRI, with its statistics and data management ability, and its ability to look at economics and quality of life, and the ongoing MANTRA study that is centered in the DCRI. Clinically, we have a world-renowned Cardiology Department, a wonderful congestive heart failure, on-site music and touch therapy, and a unique resource in Jon Seskevich. He has been practicing these types of interventions with patients for almost two decades, and has produced tapes, videos, and other supportive material. It helps to have a clinical luminary like that in our midst.

Most important, this program has the true support of the leadership of the Medical Center. I can say unequivocally that Dr. Snyderman, Dr. Haynes, Dr. Meador of the Institute on the Care at the End of Life, Dean Jones of the Divinity School, and many other leaders at Duke fully support not only this program, but the whole notion of looking at what it takes to create a healing environment in an institution such as Duke.

Q: The grant stipulates that education be a part of the program. How will that happen?

Sullivan: An important component of the program is education for Duke faculty and staff, particularly those caring for cardiovascular patients. The program will expand the training in Mindfulness Based Stress Reduction, imagery, use of music therapy, touch, and building rapport. The Duke Center for Integrative Medicine already has developed an intervention that involves a 20-minute combined application of music, imagery, and touch, called MIT. We hope to train more people in its use.

The exciting thing is that although the primary focus is on offering treatment and gathering data on outcomes, this Medtronic grant is really for all employees. Anyone interested can get involved in the training. We have data from our mindfulness-based class that it really does decrease feelings of burnout. So, even if you take a class in order to help treat patients, it can also benefit you.

Q: Will this reach beyond Duke Hospital?

Krucoff: Initially we will be focusing on patient, faculty, and staff here at Duke. But it is our intention and hope that the data that emerges from this foundation grant work will be strong enough to be the basis of scientific manuscripts, published papers, and reports in many scientific and humanitarian venues around the country and the world. That is central to our vision of this whole thing.

Sullivan: I believe that in 10-20 years we will have a very different view of mind-body-spirit approaches to medical care. We are growing more aware of these issues in end-of-life and palliative care circles. We have a way to go in general medicine in helping patients cope with serious illness. This program is an important step in the right direction here at Duke, and we hope it will have an effect wherever medicine is practiced.

© Inside DUMC 2000: August 28, 2000, Vol 9 Number 16
Duke University Medical Center Office of Publications
http://dukemednews.duke.edu/global/download.pdf?ids=486

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