Massage - Oncology History and Consent

• I am aware that my massage will need to be rescheduled if my child has received immunisation/vaccination in the past 48 - 72 hours.
• I acknowledge that the oncology massage therapist will adjust the massage pressure and techniques to suit the child’s current health status and there is an (unlikely) possibility of slight bruising and/or 1–2 days of muscular discomfort following the massage session. I acknowledge that with any treatment there are risks involved and that I/the child can ask questions at any time.
• I acknowledge that the oncology massage therapist is not qualified to give any form of diagnosis or medical advice. I will consult the child’s doctor or health professional for any health care concerns or diagnosis.
• I acknowledge that the massage therapy is contraindicated if the child has any of the following:
  • Blood clot/s or blood condition
  • DVT (Deep Vein Thrombosis)
  • High blood pressure
  • Fever
  • Acute infection
  • Open wounds, sores or lesions
  • Skin conditions or disorders which may be contagious or cause inflammation
  • Received immunisation/vaccination in the past 48–72 hours
  • Diarrhea or other undiagnosed illness/sickness
  • Heat, redness or swelling of the skin
  • Severe Neutropenia.
• I will advise the oncology massage therapist of any of the above conditions as there is a strong possibly that the massage session will need to be rescheduled to a later date.
• I have given the oncology massage therapist the child’s full medical history to the best of my knowledge and if any changes occur in the child’s medical history, I will inform the oncology massage therapist prior to the massage appointment.
• I understand that the child always has the right to refuse massage therapy. The oncology massage therapist will ask the child for their permission and the massage session will only begin if the child is awake, alert and gives the therapist permission to begin the massage treatment.
• The oncology massage therapist will adjust the massage treatment considering the child’s health history and undergoing medical treatment they are receiving. The areas of the body that may be in the oncology massage therapy treatment plan may include head and face, neck, abdomen, back, arms, hands, legs and feet. I understand that the child has a choice to refuse any of these areas of their body massaged and have the choice of positioning, lighting and music.
• I understand that I am to be present in the treatment room for the full duration of the child’s massage and at any time I/the child can withdraw consent, and treatment will stop immediately. I acknowledge I/the child has the opportunity to ask questions regarding the child’s treatment at any time.
• The therapist has discussed the massage procedures, the areas of the body to be treated, the undressing and dressing procedures, the draping procedures and the positioning for and during the treatment.
• I understand that the physical assessment and treatment may involve partial undressing and may require the therapist to palpate (touch) the area(s) relevant to my presenting condition.
• I release the massage therapist (Sarah Hughes) and Cancer Care Association from all liability for any harm that may unintentionally result from this treatment.

Privacy & Confidentiality

I authorise the oncology massage therapist to release or obtain information regarding the child’s massage treatment and medical history to/from my child’s medical and health practitioners (e.g. oncologist, Nurse Consultants) regarding the appropriateness of massage techniques for my medical health conditions identified above or any important information that may be useful for my medical and health practitioners. I also authorise the massage therapist to share any important information with the Childhood Cancer Association Family Service Team. Confidentiality is respected and at no time is any information received during the massage session given to another person, except to above personnel.

I understand that as part of providing the massage therapy service, we will need to collect and record personal information that is relevant to service provision. This information is a necessary part of the services provided and guides treatment. The information is stored securely. It is only accessed by the massage therapist and as required, by authorised staff and personnel engaged by the Childhood Cancer Association. The information is stored in a physical filing cabinet at the Childhood Cancer Association office, and all archived files are held in a secure cloud-based storage system. All files, for clients aged under 18 at the time of treatment, will be retained until they are 25 years of age.