[shalvoy.1]

Full title of this month’s club: Using weighted blankets as intervention for anxiety in cancer survivors

There are two articles for you to read. The first article discusses assessing and treating anxiety in older adults. It does not specifically speak to weighted blankets. It does speak to the pitfalls of current anxiety treatment in our older oncology population.

Remember to reply to at least 3 of the 4 prompts on this page and to at least 2 of your peers’ posts.

Here are the links to the articles:

Symptomatology, assessment, and treatment of anxiety in older adults with cancer

Weighted BlanketsAnxiety reduction in adult patients receiving chemotherapy

Citations:

K.M. Trevino, R.M. Saracino and A.J. Roth, Symptomatology, assessment, and treatment of anxiety in older adults with
cancer, J Geriatr Oncol, https://doi.org/10.1016/j.jgo.2020.06.011

Vinson, J., Powers, J., & Mosesso, K. (2020). Weighted Blankets: Anxiety Reduction in Adult Patients Receiving Chemotherapy. Clinical journal of oncology nursing, 24(4), 360–368. https://doi.org/10.1188/20.CJON.360-368

• This topic was modified 3 years, 10 months ago by shalvoy.1.

[blackwell.72]

Thank you Emily for leading and Thank you Renee for the citations!

1. What was the knowledge gained from the article?
I didn’t realize that older adults had more anxiety and that is lasted into the post treatment era– I just thought it was a very anxious time for any age. I also didn’t realize that anxiety felt during treatment does not end when treatment ends.
A study in 2008 showed that 78% of non-hospitalized participants were more relaxed when using weighted blankets – I will now recommend this to my anxious and insomniac patients and I am going to recommend that all staff be given a weighted blanket to help in their care of self which is highly encouraged.

2.Will the research/information in this article change or influence your practice?
I am not sure that it will as far as assessing. I already ask about sleeping, eating, depression which all can show signs of anxiety. However, post treatment at follow up visits I will certainly be sure to continue to assess.
I will recommend a weighted blanket especially for those in treatment. This may be especially important during this time that we are not allowing their support people be present during infusions/appointments.

4. Do you agree/disagree with the conclusions of the author, why?
I do agree that quality of life will improve and severity of symptoms by treating the anxiety. Even though no clinically significant changes in vital signs or adverse advents were noted, the blankets may provide a placebo effect.
Since patients did report feeling more relaxed I am all for trying it.

[callihan.9]

1. What was the knowledge gained from the article?
I have personally seen the stress our older population goes through when diagnosed with cancer. This article was very enlightening that their are resources out there for our patients. I utilize our social workers and PCRM in every clinic I work to help reduce the anxiety. I am not a fan of putting another medication in the mix, since we throw so much on them when diagnosed, and would love to know the nonpharmocological treatments that work best for older patients. I have seen, helping with their issues gives them some relief but they still worry about their family and spouses. I believe if we encourage post treatment survivorship this will help with the ongoing anxiety our patients feel.
Weighted blankets our huge in our society these days and I know several people that use them and swear by their effectiveness. The ambulatory float pool gives knotted blankets to 1st time chemotherapy patients. These blankets are 2 ply and have a little weight to them. Our patients are very thankful for them. I have had people tell me that weight of the blanket comforts them by acting like a “hug”. I did not realize their were different sizes but now will utilize that information when I talk with patients/ people about the use of them.

2. Will the research/information in this article change or influence your practice? If so how?
Absolutely for the weighted blanket. I will encourage the use during therapy if the our anxious and even at home on bad days. I would love to follow up when I know the patient has used them to make sure that it works, if not I want to make the team aware that they need another form of stress reducer.
Encouraging our patients to utilize all resources while a patient/survivor has always been a priority for me. If the patient is need of medication to help with anxiety I notify the team and follow up that this is addressed.

4. Do you agree/disagree with the conclusions of the author, why?
I do agree that our patients (young and old) need help dealing with their journey through cancer. I believe we are at the front of the line for making their journey as tolerable as possible and if we know that they are struggling it is our calling to help. I prefer more of a non pharmacy approve first, since we throw so much medicine at them at the beginning, but also know that some people need that. We just need to be able to have conversations with our patients and listen to for the ques.
The weighted blanket makes total sense, how many of us like a good blanket when we are not feeling well? I personally have at least 7 blankets, all in different material (weights) lying around my house. And love to curl up with one to relax. Knowing the size of weight might be a little tricky but I would err on the side of less first to make sure the blanket effect works. I am surprised it doesn’t lower their BP & P

[burk.109]

What knowledge was gained from this article?
One thing that I learned from reading these articles was that weight and height determine the size/weight of the blanket used. This makes complete sense but I did not think about this when thinking about a weighted blanket. I do find it interesting that it’s more about the area of coverage when using weighted blankets in patients with certain diagnosis compared to the desired 10% weight of the patient.

What other questions does this article raise about current practice?
This seems like an ideal non pharmacological use to reduce stress but I wonder what type of liability the nursing staff would have in this matter. Obviously, if these blankets were “the units” blankets we would need to make sure that weight was correct and provide additional monitoring when in use. Another factor would be cleaning these and making sure they are able to be used in multiple patients. Our unit was looking in to this and I know they are quite expensive to stock multiple on the unit. It seems like an additional nursing responsibility but we could educate patients on the use and patients could bring their own blanket in for use during treatment?

Do you agree/disagree with conclusions?
I agree that it is a good way to help reduce stress without using medications in patients, especially when in some cases they are given a lot of medications on the unit. I do wonder what the guidelines would be for monitoring if this were to be a unit driven intervention, which makes me question if it’s something that could be done. It’s definitely worth looking in to.

[goodman.100]

1. What was the knowledge gained from the article?
I knew, from years of interacting with patients, that oncology patients experience high levels of anxiety but it was good to see this verified and quantified in both articles. I did not know that weighted blankets are already used for a variety of conditions. It makes sense that we should use them for our patients.

2. Will the research/information in this article change or influence your practice? If so how?
While we do not currently offer weighted blankets to patients, we do have warm blankets. I have already seen that these can make a huge difference for some patients. I will now begin offering these more frequently, specifically to patients with anxiety symptoms. If weighted blankets ever become available at the James I will advocate for them.

4. Do you agree/disagree with the conclusions of the author, why?
I agree with the authors’ conclusions. Their evidence and information is solid and outcomes good, specifically since weighted blankets are a simple and immediate intervention that does not cause problematic lingering side effects like medications do. You can drive yourself home after using a weighted blanket, while that is not recommended for some medications such as Ativan or Benadryl. My wife sleeps with a weighted blanket and I have seen how it has helped her sleep better.

[blackwell.72]

Mindy Blackwell – gyn/onc MR

Good Idea Greg Goodman to think more about offering the warm blankets since we do not offer the weighted blankets. Excellent point about being able to drive if using the blanket vs. meds that can sedate.

Burk.109 – I thought about all the extra liability too and have just started telling patients about the blankets and possible benefits. they can get their own if they are interested although $ could be an issue. Some patients seem perplexed so I compare it to a Thundershirt for a dog and then they get it and many have said they are going to get one. I have only been talking about this for a couple weeks so I haven’t seen anyone come in w/ one yet or hear that they have on at home.

Callihan.9 – I am 100% more in favor of non-pharmacological interventions when available. this also makes the patient feel a little more empowered over their situation because they can get it on their own and not have to have a doctor write a prescription etc,. Unfortunately, if it is not “medical” or “pharmacological” insurance doesn’t always pay as much or at all.

Once a patient has one in chemo, others will see them and that will probably encourage more patients to try it once they see another using it. I have not really looked into them so I am not aware if they are very affordable or not but I will try to soon.

[blackwell.72]

Quick amazon search and I found that they start at 25.99 and up on Amazon and there are always sales and coupons to shop locally.  One says weighted “heating” blanket (more expensive) but it appears that it is not an electric heated blanket but just the weight of it provides warmth.  So i would make sure they read the full description.  Also, they have micro glass beads in them so a rip or tear would be a concern with pets or small children and probably some of our patients too.

If your clinic earns “Bravo” money maybe purchasing some to give patients would be an option, just a suggestion because they probably would be a one patient use unless there was a way to launder them in between patients.

[goodman.100]

My wife sleeps with a weighted blanket and she loves it. It is a bit too hot for me. I see they have some “cooling” weighted blankets too. Maybe I should try one of those.
I had an experience with the comfort of touch when I had Lasik several years ago. They explained the procedure and said one of the nurses in the OR would apply a “comforting touch” during the procedure. The most uncomfortable part was the laser that cuts the flap our of your cornea- it presses a suction cup down onto your eyeball to keep it from moving around. It presses down very firmly. But at the same time it pressed down, a nurse put her hands on my shoulders and upper arms and squeezed. Surprisingly, this pressure (almost like a hug) distracted me enough from the discomfort in my eyes that it didn’t seem that bad. The laser scalpel also only lasted about 2 seconds. I wish we had weighted blankets in our infusion clinics for this reason.

[pauley.18]

What was the knowledge gained from the article?
The knowledge that I gained from the article on anxiety is of course anxiety causes a cascade of issues if left untreated. I know most of the patient population that I work with in oncology have some level of anxiety, some more than others, just as in individual lives that are not undergoing oncology treatment.
Will the research/information in this article change or influence your practice? If so how?
Both articles will help me in identifying anxiety in the patients I am working with and suggestions on how to alleviate some of their symptoms. It would be great to be able to offer them the weighted blankets while here in clinic, but an obstacle I see are whether multiple patients can use the same blankets. And if multiple patients can’t use the blankets and we suggest to a patient the utilization of a weighted blanket, if they do not already own one, can they afford to purchase one? I would imagine they are enduring additional costs for treatments they are undergoing, could this cause more anxiety for the patient.
What other questions does the article raise about current practice?
I would say that the articles raise awareness of utilizing other methods for relief of anxiety that doesn’t involve just prescription medication. But, as with many alternative therapies, can nursing provide the intervention without training or a policy to follow??. I mean this with regards to the weighted blankets, as they do come in varying weights and which one would be appropriate for who.
Do you agree/disagree with the conclusions of the author, why?
I do agree with the authors of both articles. Patients with anxiety will not always do well with their treatments and in some cases not return for treatment. The use of multiple methods may be needed to help ease the anxiety level of a patient while in our care, hence giving them more optimal outcomes of their treatment.

[pauley.18]

This is a reply to callihan, sorry I don’t know the first name. I too would like to push for non-medication interventions and had a thought while reading your post. If there was a way to get a grant or something for weighted blankets to be given to patients, then the problem for cost may be eliminated for the patient and it could be utilized at home as well as during clinic visits.

[pauley.18]

This is a response to burke, again sorry I don’t know the first name. My thought is along the same as yours with the implication on nursing. The weighted blanket is considered an intervention, do we need a policy. Do we have to worry about other patients seeing the weighted blanket and wanting to utilize as well when they may not be feeling anxiety. I like the idea of any type of intervention that is non-medication oriented as medication cannot always be used long term.

[callihan.9]

Greg I know the warm blankets are a HUGE success in the infusion clinics too. To watch the patient as you place the blanket over them is so rewarding.

Pauley I agree we need different ways of accessing and relieving our patients anxiety. I know the “unknown” is the worst part of their journey & when they get through the “first” of anything they are more comfortable. BUT I have also found that some of our patients hold in their anxiety and maybe feel it is part of the journey. Being personable and bringing life outside their clinic appointments sometimes is the best way to help them open up about their true anxiety. And then we can help them find ways to reduce it.

[burk.109]

Mindy- I did some research too that showed amazon had some more cost effective ones. I think patient providing there own seems ideal. I know that if you have them in clinic you have to worry about disinfecting so I think that changes the type of material you can use for the blanket. Seems like a better option for patient to purchase to me! I do think there are patients though that this could clearly benefit.

[burk.109]

Greg–that’s great to know about your experience. I was hesitant at first but I really do think that could be beneficial in some circumstances. As nurses I think we would have to assess each patient in a way that would determine if they could be benefited from the use. Again, causing more nursing time but if it stops the use of pharmacological intervention and the time it takes to get those orders in line it would be beneficial for both patient and nurse!

[smith.10494]

1. Knowledge gained? I had not thought about how older patients might experience more anxiety with a cancer diagnosis or during treatment, although it makes sense, now that I think about it. I also had not thought about weighted blankets to help reduce an oncology patient’s anxiety/stress level,. My son with ADHD has a weighted blanket but he doesn’t use it for anxiety. It is calming for him and helps him to fall asleep, so it makes sense it would work to reduce anxiety.
2. How might it change/influence practice? Since our last articles about alternative therapies, I have found myself discussing mindfulness, care of self, etc with patients. Most do not want to take more medications, especially a medication that causes them to feel drowsy or loopy, and many spend a lot of time worrying about their family/others rather than focusing on themselves, which I truly believe contributes to heightened anxiety.
3. Questions raised? Weighted blankets might not work for patients with breathing issues or those in a lot of pain. Weighted blankets might not be a bad idea for caregivers too, as they have a lot to deal with caring for their loved one.
4. Agree or disagree with authors? I do agree with both articles.

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