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Hoey EM, Pino M. Procedural Detailing: A Patient's Practice for Normalizing Routine Behaviors. HEALTH COMMUNICATION 2024; 39:1285-1297. [PMID: 37198912 DOI: 10.1080/10410236.2023.2211364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
In palliative care in the UK, occupational and/or physiotherapists consult with patients to assess how they are managing their activities for daily living in light of their life-limiting condition(s), and to identify any activities that might benefit from therapeutic intervention. In this paper we use conversation analysis to describe a patient's practice in these consultations, which we call "procedural detailing," whereby they produce a step-by-step description of how they do some everyday activity, such that it is depicted as adequate, stable, and unproblematic. Based on a collection of 15 cases identified in video recordings of consultations in a large English hospice, we demonstrate how patients use this practice to normalize their routine conduct and thereby reject or rule out an actual or anticipated therapeutic recommendation. Our analysis suggests that such descriptions let patients participate in shared decision-making by revealing their preference for routines that preserve their level of independence and dignity.
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Affiliation(s)
- Elliott M Hoey
- Department of Language, Literature and Communication, Vrije Universiteit Amsterdam
| | - Marco Pino
- School of Social Sciences and Humanities, Loughborough University
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Figueroa Gray M, Randall S, Banegas M, Ryan GW, Henrikson NB. Personal legacy and treatment choices for serious illness: a scoping review. BMJ Support Palliat Care 2024:spcare-2023-004439. [PMID: 38267198 DOI: 10.1136/spcare-2023-004439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/12/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Legacy-how one hopes to be remembered after death-is an unexplored and important dimension of decision-making for people facing serious illness. OBJECTIVES We conducted a scoping review to answer the following research questions: (1) How do people making treatment choices conceive of legacy? and (2) What treatment choices do people make with legacy in mind? ELIGIBILITY CRITERIA Participants included people facing serious illness who discussed how they wanted to be remembered after their own death, or how they hoped to impact others, as they made treatment choices. Studies in English published between 1990 and 2022 were included. SOURCES OF EVIDENCE We conducted searches in electronic databases including Medline/PubMed, CINAHL, PsycInfo, SocialWork, AnthropologyPlus, Web of Science, ProQuest and EMBASE databases. DATA SYNTHESIS We used an electronic screening tool to screen abstracts and review full-text articles suitable for inclusion. We analysed included articles using Atlas.ti. We constructed tables and narratively synthesised the findings. RESULTS We identified three major intersecting legacy goals that influence choices people facing serious illness make about their treatment and health behaviours, and the types of choices people make with legacy in mind. The three legacy goals are: remembrance of the individual self, remembrance of the social self and impact on others' well-being. CONCLUSIONS We identify the importance of legacy to patient treatment choices. Understanding for whom this construct is important, what types of legacy goals people hold and how those goals impact treatment choices is necessary to provide patient-centred whole-person care to people facing serious illness.
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Affiliation(s)
| | | | - Mateo Banegas
- Radiation Medicine and Applied Science, University of California San Diego, La Jolla, California, USA
| | - Gery W Ryan
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California, USA
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
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Roberts A. A Two-Phase Qualitative Enquiry Into Storytelling's Potential to Support Palliative Care Patient-Led Change, Using a Systematic Review Approach. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228231223270. [PMID: 38194348 DOI: 10.1177/00302228231223270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
A terminal diagnosis can diminish an individual's sense of agency and identity. Leading change appears to restore a sense of agential self. The first phase of this literature review explores factors influencing patient-led change across the palliative care ecosystem. The second phase illuminates how storytelling can support palliative care patients in leading ecosystem-wide change. 35 studies were identified in Phase 1 and 36 in Phase 2. This research highlights the need to situate patient leadership activity within a palliative care ecosystem to understand factors likely to support or hinder patient leadership activity within it. The evidence indicates the potential use of storytelling to support patients with a life-limiting illness to lead change across the palliative care ecosystem. This challenges current conceptualisations of such patients and offers them instead as an additional source of palliative care support.
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Affiliation(s)
- Amanda Roberts
- Department of Education, University of Hertfordshire Schools of Law and Education, Hatfield, UK
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Granholm Valmari E, Andersson J, Johansson A, Nygren U. Defining the complexities of an occupational pattern-A concept analysis and theoretical validation. Scand J Occup Ther 2024; 31:2362840. [PMID: 38889321 DOI: 10.1080/11038128.2024.2362840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/29/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The concept of an occupational pattern in occupational therapy and occupational science has evolved with varying definitions, ranging from activity patterns to patterns of daily occupation. AIMS This study aimed to explore the concept of occupational pattern, develop an updated definition of the concept, and theoretically validate the concept's definition. METHOD Walker and Avant's concept analysis method was used, where both theoretical frameworks and peer-reviewed scientific literature were searched and synthesized to clarify and define the concept. Furthermore, seven occupational therapists theoretically validated the concept. FINDINGS The analysis included forty-nine references from various research contexts and theoretical perspectives. The synthesis yielded a conceptualization of the concept of occupational pattern, outlining it into three overarching categories: 'content in an individual's occupational pattern', 'designing an occupational pattern', and 'balancing the occupational pattern'. IMPLICATIONS An updated operational definition of the multifaceted concept of an occupational pattern now exists, with practical implications for enhancing the education of occupational therapy students and guiding the utilization of the concept. Moreover, it holds significance for instrument development and outcome measurement in research; especially in lifestyle intervention studies within the field of occupational therapy.
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Affiliation(s)
| | - Jesper Andersson
- Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Anna Johansson
- Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Ulla Nygren
- Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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End-of-Life Care and the Role of Occupational Therapy. Am J Occup Ther 2023; 77:7713410210. [PMID: 38154142 DOI: 10.5014/ajot.2023.77s3002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
This AOTA Position Statement describes the role of occupational therapy practitioners in providing services to clients who are living with terminal conditions and who are at the end of life, as well as their role in providing services and support to caregivers.
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Wæhrens EE, Morgan DD, la Cour K, Lyons KD, Lozano ML, De Carlo MMP, Rezende G, Pilegaard MS. International consensus on occupational therapy interventions for people with palliative care needs: A European Association for Palliative Care Group Concept Mapping study. Palliat Med 2023; 37:1389-1401. [PMID: 37534430 DOI: 10.1177/02692163231188155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
BACKGROUND While evidence shows that occupational therapists can play a key role in the care of people with palliative care needs, more knowledge about effective occupational therapy interventions for this group is needed. AIM To identify, organise and prioritise intervention components considered to be effective within occupational therapy for people with palliative care needs from the perspective of occupational therapy clinicians, managers and researchers. DESIGN Group Concept Mapping utilising a mixed methods participatory approach. Using a focus prompt, participants brainstormed, sorted, labelled and rated generated statements about effective occupational therapy intervention components. Multidimensional scaling analysis and cluster analysis were conducted. SETTING/PARTICIPANTS Snowball recruitment was used to recruit participants. Participants included occupational therapists worldwide who were able to read and write in English and were working as clinicians, managers and/or researchers with occupational therapy interventions for people with palliative care needs. RESULTS Seventy-two occupational therapists from 15 countries participated in the study representing Asia (n = 3, 20%), Europe (n = 8, 53%), Oceania (n = 2, 13%) and North America (n = 2, 13%). A total of 117 statements were identified and organised into five clusters: (1) being client-centred, (2) promoting occupational engagement to optimise quality of life, (3) involving the social and relational environment, (4) enabling occupations and (5) facilitating occupational adaptation. CONCLUSIONS Five clusters of core occupational therapy intervention components were considered to be effective when supporting people with palliative care needs. Research should use this knowledge to inform future occupational therapy interventions for this group of people.
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Affiliation(s)
- Eva Ejlersen Wæhrens
- User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense C, Denmark
- The ADL Unit, The Parker Institute, Copenhagen University Hospital, Denmark
| | - Deidre D Morgan
- Research Centre for Palliative Care, Death and Dying (RePaDD), Flinders University, Adelaide, SA, Australia
| | - Karen la Cour
- User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Kathleen Doyle Lyons
- The Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Mario Lozano Lozano
- The Department of Physical Therapy, University of Granada, Granada, Andalucía, Spain
- Instituto de Investigación Biosanitaria ibs, GRANADA, Granada, Andalucía, Spain
- The Sport and Health Joint University Institute (IMUDS), Granada, Andalucía, Spain
| | - Marysia Mr Prado De Carlo
- Division of Occupational Therapy, Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil
| | - Gabriela Rezende
- Division of Occupational Therapy, Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil
| | - Marc Sampedro Pilegaard
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Social Medicine and Rehabilitation, Gødstrup Hospital, Denmark
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Chow JK, Pickens ND, Fletcher T, Bowyer P, Thompson M. Missed Opportunities to Ease Suffering: An Explanatory Model of Occupational Therapy Utilization in End-of-Life Care. Am J Hosp Palliat Care 2023; 40:1004-1012. [PMID: 36469746 DOI: 10.1177/10499091221143917] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Background: With disease progression, a terminally ill person may experience loss of physical and cognitive skills required to perform everyday activities. Such functional loss can erode autonomy and cause existential suffering. Supported engagement in everyday activities may help terminally ill people stay involved in living and cope with dying. Occupational therapy enables people to engage in valued activities at the end of life, yet remains under-utilized. Objectives: To address the perceived under-utilization of end-of-life care occupational therapy, the authors investigated how utilization of occupational therapy in end-of-life care is determined from the perspective of decision-makers and occupational therapists and then developed a model of the process. Methods: Using a grounded theory method, authors conducted two semi-structured interviews with 20 decision-makers and 21 occupational therapists. Theoretical sampling followed by paradigm analysis, yielded a data-grounded model. Results: The authors developed The Model of Occupational Therapy Utilization in End-of-Life Care. Service utilization was primarily contingent upon the decision-makers' awareness of occupational therapy's role in end-of-life care and further influenced by place of care cost constraints and participants' ability to adjust focus of the occupational therapy to accommodate the patient's dying process. Conclusion: Limited awareness of occupational therapy's role in end-of-life care warrants research on whether modification of model constructs may increase awareness and utilization. Education is indicated to teach providers about suffering due to functional loss and how to adjust focus of occupational therapy to sustain occupational participation through decline, across different care settings, and along a range between rehabilitation-focused to participation-focused outcomes.
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Affiliation(s)
| | - Noralyn D Pickens
- School of Occupational Therapy, Texas Woman's University, Dallas, TX, USA
| | - Tina Fletcher
- School of Occupational Therapy, Texas Woman's University, Dallas, TX, USA
| | - Patricia Bowyer
- School of Occupational Therapy, Texas Woman's University, Dallas, TX, USA
| | - Mary Thompson
- School of Physical Therapy, Texas Woman's University, Dallas, TX, USA
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Lim GH, Yong C, Breen LJ, Keesing S, Buchanan A. Occupational therapy practice with terminally ill Chinese older adults in Singapore: A qualitative exploratory study. Aust Occup Ther J 2023; 70:18-31. [PMID: 35791064 PMCID: PMC10083987 DOI: 10.1111/1440-1630.12828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION As the majority of occupational therapy philosophy has Western origins, occupational therapists working with palliative care clients in Singapore can provide invaluable insight into the practice of occupational therapy within a non-Western, family-centric population. This study aimed to describe occupational therapists' perceptions of the occupations of terminally ill Chinese older adults and their caregivers and explore occupational therapy practice with terminally ill Chinese older adults in Singapore. METHODS Eleven occupational therapists were recruited via convenience and snowball sampling. Inclusion criteria were being fully registered with the Allied Health Professionals Council (Singapore) with at least 2 years of working experience and currently working with/had experience working with terminally ill patients within the past 2 years. Interviews were transcribed verbatim, and data were analysed using reflexive thematic analysis. FINDINGS Five themes were constructed from the data: (1) Independence may not be for everyone, (2) it is a family unit, (3) contributing to others' lives is important, (4) what respecting clients means, and (5) a different way of engaging. These themes describe how occupational therapists adapted their practice to better meet the needs of clients and families in Singapore. DISCUSSION In family-centric societies, it may be more relevant for occupational therapists to facilitate interdependence instead of independence in activities of daily living. In addition, activities that contribute to others' lives tangibly/intangibly may be more meaningful and relevant. Finally, occupational therapists could engage clients through the 'being' instead of 'doing' dimension of occupation. CONCLUSION While occupational therapists in Singapore faced some challenges working with terminally ill clients and families due to differences between occupational therapy philosophy and practice context, by reframing their thinking, they were able to adapt their practices to meet the needs of a family-centric population.
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Affiliation(s)
- Geck Hoon Lim
- Curtin School of Allied Health, Curtin University, Perth, Australia.,Health and Social Sciences, Singapore Institute of Technology, Singapore
| | | | - Lauren J Breen
- Curtin School of Population Health, Curtin University, Perth, Australia.,Curtin enAble Institute, Curtin University, Perth, Australia
| | - Sharon Keesing
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Angus Buchanan
- Curtin School of Allied Health, Curtin University, Perth, Australia
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Lim GH, Breen LJ, Keesing S, Buchanan A. Understanding Occupations of Terminally Ill Chinese Adults and Their Caregivers: A Scoping Review. Occup Ther Health Care 2023; 37:75-100. [PMID: 34505796 DOI: 10.1080/07380577.2021.1972379] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This scoping review explored the occupations of terminally ill Chinese adults and their caregivers. Seven databases were searched for peer-reviewed journal articles published in English or Chinese before June 2020. Of the 16 studies that met the selection criteria, only one directly used the term "occupations" while the other 15 studies contained descriptions of occupations. Eight themes were extracted and compared with existing literature. The top two reported themes were occupations surrounding life roles and tasks and those surrounding food and eating. More study is required about the occupational engagement of this client group.
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Affiliation(s)
- Geck Hoon Lim
- Health & Social Sciences, Singapore Institute of Technology, Singapore.,Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Lauren J Breen
- Curtin School of Population Health, Curtin University, Perth, Australia.,Curtin enAble Institute, Curtin University, Perth, Australia
| | - Sharon Keesing
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Angus Buchanan
- Curtin School of Allied Health, Curtin University, Perth, Australia
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Pape AE, Gschnell M, Maul J, Volberg C. [Physical therapy and occupational therapy in German palliative care: Where do we stand?]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 175:59-66. [PMID: 36402688 DOI: 10.1016/j.zefq.2022.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 10/07/2022] [Accepted: 10/13/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Physical therapy (PT) and occupational therapy (OT) as supportive forms of treatment in palliative care, together with other treatment measures, can create participation for seriously ill patients in the form of a life that is as autonomous as possible until the end of life. However, specially trained staff are needed for the care of palliative patients in order to do justice to the clients' special life situation. In Germany, no corresponding survey on the subject has so far been conducted. So it is unclear to what extent PT and OT are offered in palliative care structures in this country, which tasks are assigned to the respective professional groups, and what the level of knowledge is that caregivers have about treatment options. AIM Compilation of an overview of the provision, need and use of PT and OT in the various areas of palliative care in Germany. If there is a lack of provision, the reasons for this will be identified. METHODS In this cross-sectional survey, a self-designed 9-item questionnaire was sent out to a total of 260 hospices, 323 palliative care units and 304 specialized outpatient palliative care services (SOPC) listed on the homepage of the German Society for Palliative Medicine (DGP). The respondents' answers were analysed using a purely descriptive approach. RESULTS The response rate was 439 (49.5%). A total of 434 questionnaires (49%) were included in the analysis. A heterogeneous distribution of PT and OT offers between outpatient, inpatient, and hospice palliative care can be seen, with the outpatient area showing a significantly fewer offerings. 29% of the SOPC teams can offer neither PT nor OT. This is mostly due to a shortage of skilled workers or a lack of funding opportunities. The different areas of responsibility of physiotherapists and occupational therapists are known to the majority of respondents (hospice 87%, palliative care unit 83%, SOPC 81%) and are also reflected in the distribution of tasks between the two professional groups. Especially palliative care units and SOPC teams state that they would like to offer more PT and OT (palliative care units 42% more PT and 58% more OT; SOPC 65% more PT and 50% more OT). DISCUSSION This cross-sectional survey is the first of its kind to provide an overview of the PT and OT offerings in the different sectors of German palliative care. In a comparison of the two forms of therapy, occupational therapists are used less frequently than physiotherapists. An international comparison of the study situation also shows that the use of OT in palliative care, in particular, has not yet been implemented satisfactorily. Outside Germany, the main reasons for this are a shortage of specialists and a lack of knowledge about the tasks of OT. CONCLUSION PT and OT are frequently used treatment options in all areas of German palliative care. In order to better classify structural problems in care, further differentiated surveys should be conducted. Furthermore, a better knowledge base should be created through research and information activities of both professional groups in palliative care.
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Affiliation(s)
- Anna Elisabeth Pape
- Klinik für Geriatrie, Physikalische Medizin und Rehabilitation, Klinikum Bremen-Ost, Bremen, Deutschland
| | - Martin Gschnell
- Klinik für Dermatologie und Allergologie, Hauttumorzentrum, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - Julian Maul
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - Christian Volberg
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg, Deutschland; AG Ethik in der Medizin, Fachbereich 20, Dekanat Humanmedizin, Philipps-Universität Marburg, Marburg, Deutschland.
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Beerda DCE, Zegers AD, van Andel ES, Becker-Commissaris A, van der Vorst MJDL, Tange D, Duijts SFA, Brom L. Experiences and perspectives of patients with advanced cancer regarding work resumption and work retention: a qualitative interview study. Support Care Cancer 2022; 30:9713-9721. [DOI: 10.1007/s00520-022-07436-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022]
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Manning B, Kelly R, Broome K. Assistive technology in palliative care: a statewide equipment programme. BMJ Support Palliat Care 2022:spcare-2022-004048. [PMID: 36396344 DOI: 10.1136/spcare-2022-004048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This paper examines the impact of the Medical Aids Subsidy Scheme (MASS) Palliative Care Equipment Programme (PCEP), a new initiative across Queensland, Australia, and explores the translational potential of this large scale, comprehensive, government funded programme to other jurisdictions. METHODS The five dimensions of the Reach, Effectiveness, Adoption, Implementation and Maintenance framework were retrospectively applied to MASS PCEP, with primary programme data compared with data from secondary sources. RESULTS Extensive Reach and Adoption of the programme was demonstrated, with 3695 unique clients accessing the programme from the 17 Queensland hospital and health services. Seventy-four per cent of clients had a cancer diagnosis. Operationalising Effectiveness, Implementation and Maintenance dimensions revealed many positive programme aspects at individual and organisational levels, as well as ongoing challenges including transporting equipment to rural and remote regions and the impact on the workforce to respond to referrals and prescribe assistive products. Programme participants had a shorter public hospital stay (4.5 days), compared with the Queensland palliative care average (7.1 days). CONCLUSIONS The programme has high translational potential to other jurisdictions. Assistive equipment at the end stages of life may enhance well-being by extending time spent at home, increasing independence and reducing carer burden.
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Affiliation(s)
- Bridget Manning
- Medical Aids Subsidy Scheme, Metro South Hospital and Health Service, Cannon Hill, Queensland, Australia
| | - Renae Kelly
- Medical Aids Subsidy Scheme, Metro South Hospital and Health Service, Cannon Hill, Queensland, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Kieran Broome
- Medical Aids Subsidy Scheme, Metro South Hospital and Health Service, Cannon Hill, Queensland, Australia
- School of Health & Behavioural Sciences, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
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Lim GH, Yong C, Breen LJ, Keesing S, Buchanan A. Occupations of Terminally Ill Chinese Older Adults and Their Caregivers in Singapore: A Qualitative Exploratory Study. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221108288. [PMID: 35701184 DOI: 10.1177/00302228221108288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Occupations are everyday activities people do that bring meaning and purpose to life and is culturally shaped. This research aimed to explore the occupations of Chinese older adults living with a terminal illness and their caregivers in Singapore. Using a qualitative exploratory approach, 16 care recipient-family caregiver dyads were recruited from a local hospice provider. Semi-structured interviews were carried out and reflexive thematic analysis was employed. Three themes and seven subthemes described the challenges and changes to daily life faced by care recipients and caregivers as they adjusted to living with the terminal condition. Findings suggest that in a family-centric society, the occupations of care recipients are greatly impacted by their families. It is imperative to engage with family members in goal setting and intervention plans to facilitate therapy gains and carry-over into real life. These results may be applicable to other family-centric societies, but further research is required.
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Affiliation(s)
- Geck Hoon Lim
- Curtin School of Allied Health, Curtin University, Bentley, WA, Australia
- Health & Social Sciences, Singapore Institute of Technology, Singapore, Singapore
| | - Celine Yong
- Allied Health, Assisi Hospice, Singapore, Singapore
| | - Lauren J Breen
- School of Population Health, Curtin University, Bentley, WA, Australia
- Curtin enAble Institute, Curtin University, Bentley, WA, Australia
| | - Sharon Keesing
- Curtin School of Allied Health, Curtin University, Bentley, WA, Australia
| | - Angus Buchanan
- Curtin School of Allied Health, Curtin University, Bentley, WA, Australia
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The Complexities of Prescribing Assistive Equipment at the End of Life—Patient and Caregivers’ Perspectives. Healthcare (Basel) 2022; 10:healthcare10061005. [PMID: 35742056 PMCID: PMC9222988 DOI: 10.3390/healthcare10061005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 02/01/2023] Open
Abstract
Ongoing participation in valued and essential everyday activities remains a priority for people with advanced disease. This study sought to understand factors influencing patients with advanced disease and caregivers’ utilisation of assistive equipment that enable this participation. Employing a pragmatic approach, purposive sampling identified participants who were interviewed in their homes. A semi-structured interview guide was employed to elicit community dwelling patients’ and caregivers’ perspectives about assistive equipment utilisation. Recorded interviews were analysed inductively and themes were constructed from the data. Fourteen interviews were conducted with patients and caregivers. Patients had a range of cancers and COPD. Three empirically developed themes demonstrate the complexities associated with the use of assistive equipment at the end of life: 1. Enabling engagement in everyday activities; 2. Dependency—a two-way street; 3. The pragmatics of choosing, using or declining assistive equipment. Participants were motivated to use assistive equipment when it optimised their function, enabled participation and supported their values, roles and interests. Conversely, use of assistive equipment could be met with ambivalence as it represented deterioration or could cause conflict within relationships. Caregivers found assistive equipment made it easier for them to provide physical care. Skilled proactive assistive equipment prescription and training by allied health professionals enhanced patient and caregiver confidence and capacity to engage in everyday activities.
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Pilegaard MS, Timm H, Birkemose HK, Dupont SB, Joergensen DS, la Cour K. A resource-oriented intervention addressing balance in everyday activities and quality of life in people with advanced cancer: protocol for a feasibility study. Pilot Feasibility Stud 2022; 8:86. [PMID: 35443699 PMCID: PMC9019951 DOI: 10.1186/s40814-022-01038-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background People with advanced cancer need to balance their resources and energy in order to experience enjoyment and quality of life in the time they have left. A resource-oriented intervention is developed targeting these aspects. The present protocol presents a feasibility study of this resource-oriented intervention in people with advanced cancer. Methods A feasibility study with a repeated-measurement design without a control group will be conducted at the research clinic of REHPA, the Danish Knowledge Center for Rehabilitation and Palliative Care. Data will be gathered at baseline, during and after a 5-day residential stay, after 6 weeks, during a 2-day follow-up stay and after 12 weeks. In total, 20–25 home-living adults (≥ 18 years) with advanced cancer reporting needs in everyday life will be recruited. The intervention consists of workshops and engagement in physical and creative everyday activities provided by a multidisciplinary team. Outcome measures are quality of life, physical function and fatigue, which will be assessed using the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire Core-30. Balance in everyday activities will be assessed using the Occupational Balance Questionnaire. Feasibility data will also be collected regarding (1) fidelity, (2) adherence, (3) dose and (4) reach and mechanisms of impact. For exploration of mechanism of impact, participant observations and focus group interviews will be used. Discussion This study presents a new approach in rehabilitation and palliative care aimed at supporting people with advanced cancer; instead of identification of problems, the present resource-oriented palliative rehabilitation intervention will target people’s resources, enhancing balance in everyday activities and underpinning enjoyment and quality of life. The results from the feasibility study can inform ways in which to support the everyday life of people with advanced cancer and thus have potential to improve their quality of life. The long-term perspectives are to evaluate the intervention in terms of effect, process and cost-effectiveness. This will provide evidence to adjust the content of rehabilitation and palliative care for this group of people. Trial registration NCT04772690 Name of the registry: Balance, Activity and Quality of Life (BAL) Date of registry: February 26, 2021
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Affiliation(s)
- Marc Sampedro Pilegaard
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, 5700, Nyborg, Denmark. .,The Research Unit for User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, 5000, Odense C, Denmark.
| | - Helle Timm
- The National Institute of Public Health, University of Southern Denmark, Copenhagen K, Denmark
| | - Heidi Klit Birkemose
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, 2200, Copenhagen N, Denmark
| | - Sandra Bakkegaard Dupont
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, 5700, Nyborg, Denmark
| | - Dorthe Soested Joergensen
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, 5700, Nyborg, Denmark
| | - Karen la Cour
- The Research Unit for User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, 5000, Odense C, Denmark
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Pilegaard MS, la Cour K, Baldursdóttir F, Morgan D, Oestergaard LG, Brandt Å. Assistive devices among people living at home with advanced cancer: Use, non-use and who have unmet needs for assistive devices? Eur J Cancer Care (Engl) 2022; 31:e13572. [PMID: 35289004 PMCID: PMC9539586 DOI: 10.1111/ecc.13572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/21/2022] [Accepted: 03/02/2022] [Indexed: 12/25/2022]
Abstract
Objective To investigate which assistive devices people with advanced cancer have and whether they are in use. In addition, to explore the characteristics of people with advanced cancer who have unmet needs for assistive devices. Methods This descriptive cross‐sectional study used data from a randomised controlled trial evaluating efficacy of an occupational therapy‐based intervention. Participants were 237 people with advanced cancer. Data were collected by means of instruments about demography, functioning and assistive devices. Results The most frequent assistive devices possessed by the participants were as follows: (1) small aids for dressing (47%), (2) Pillow for positioning (40%) and (3) electrically operated adjustable bed (39%). The prevalence of assistive devices was 92% (95% confidence interval [CI]: 88%–95%) with 14.2% non‐use, largest for trolley tables (50%). In all, 27.4% of the participants were found to have unmet needs for assistive devices. These participants had similar characteristics to the other participants except from lower activity of daily living (ADL) ability (p values = <0.001). Conclusion The assistive devices possessed by the participants were primarily for positioning and resting, and most were in use. More than a fourth of the participants had unmet needs for assistive devices and were characterised by lower ADL ability.
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Affiliation(s)
- Marc Sampedro Pilegaard
- The Research Unit for User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen la Cour
- The Research Unit for User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Fjóla Baldursdóttir
- The Research Unit for User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Deidre Morgan
- Research Centre for Palliative Care, Death and Dying (RePaDD), Flinders University, Adelaide, South Australia, Australia
| | - Lisa Gregersen Oestergaard
- The Research Unit for User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,DEFACTUM, Aarhus, Denmark
| | - Åse Brandt
- The Research Unit for User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Morgan DD, Taylor RR, Ivy M, George S, Farrow C, Lee V. Contemporary occupational priorities at the end of life mapped against Model of Human Occupation constructs: A scoping review. Aust Occup Ther J 2022; 69:341-373. [PMID: 35199343 DOI: 10.1111/1440-1630.12792] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/21/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION People with end-of-life care needs are seen in an increasingly diverse range of health and community settings. Opportunity for continued occupational participation is highly valued by people at the end of life. This scoping review sought to identify the priorities and preferences for participation at the end of life and to map findings using the model of human occupation. METHODS A search strategy informed by the research question was developed in collaboration with a research librarian. Data sources used were Ovid Medline(R), CINAHL, Ovid Emcare, Scopus, Web of Science and PsychInfo. Studies that focused on clinician perspectives, clinical care, grief and loss, did not clearly identify end-stage diseases, <18 years and written in languages other than English were excluded. FINDINGS Forty-four studies were included with a total of 1,070 study participants. Inductively developed themes were mapped against the model of human occupation constructs of volition (personal causation, values, interests), habituation (habits of occupational performance and routine), performance capacity and the lived body within the physical, social and occupational environment. The majority of findings sat within the construct of volition, particularly around sense of personal capacity, self-efficacy and values. At the end of life, people prioritise ongoing engagement in valued occupations even if participation is effortful. As disease progresses, opportunity to exert influence and control over this participation and engagement increases in importance. Personal causation plays an important role in the experience of occupational participation at this time. CONCLUSION This review provides important insights into the occupational priorities of people at the end of life and the importance of supporting agency and volition at this time. The model of human occupation and its client-centred focus offer a framework for a more robust examination of ways to enhance volitional capacity and enable occupational participation for people at the end of life.
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Affiliation(s)
- Deidre D Morgan
- Research Centre for Palliative Care, Death and Dying (RePaDD), College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Renée R Taylor
- Director, Model of Human Occupation Clearinghouse, Department of Occupational Therapy, University of Illinois, Chicago, Illinois, USA
| | - Mack Ivy
- Rehabilitation Services, MD Anderson Cancer Center, Manvel, Texas, USA
| | - Stacey George
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Caroline Farrow
- SA Health, Northern Adelaide Palliative Care Service, Adelaide, South Australia, Australia
| | - Vincci Lee
- Eastern Health, Box Hill Hospital, Box Hill, Victoria, Australia
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Morgan DD, Marston C, Barnard E, Farrow C. Conserving dignity and facilitating adaptation to dependency with intimate hygiene for people with advanced disease: A qualitative study. Palliat Med 2021; 35:1366-1377. [PMID: 34044651 DOI: 10.1177/02692163211017388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND People at the end of life experience increased dependence with self-care as disease progresses, including care with intimate hygiene. Dependence with intimate hygiene has been identified as a factor that may compromise dignity at the end of life. However, adaption to increased dependency and subsequent impact on dignity with intimate hygiene is an under-researched area. AIM This study sought to understand how people at the end of life experience dignity with intimate hygiene when function declines and how people adapt to increased dependence with intimate hygiene needs. DESIGN A qualitative design was employed using a hermeneutic phenomenological perspective which privileges participant perspectives. Findings were mapped against occupational therapy and dignity literature. SETTING/PARTICIPANTS Participants were people with advanced disease receiving inpatient or community palliative care. RESULTS Eighteen interviews were conducted with people about their experiences and perspectives of dignity with intimate hygiene. The following themes were constructed from the data: (1) There's a way of doing and a way of asking, (2) Putting each other at ease, (3) It's just how it is, (4) Regaining and retaining control. How people adjust to dependence with intimate hygiene is individually mediated. Patterns of occupational adaptation to increased dependence with intimate hygiene and practical implications for care are discussed. CONCLUSION Adaptation to increased dependence with intimate hygiene is facilitated by enabling moments of micro-competence and agency over how care is received. Carers play a pivotal role in compromising or conserving the dignity with intimate hygiene at the end of life.
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Affiliation(s)
- Deidre D Morgan
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Research Centre for Palliative Care, Death and Dying (RePaDD), Adelaide, SA, Australia
| | - Celia Marston
- Clinical Lead, Occupational Therapy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Research Lead, Occupational Therapy, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Elizabeth Barnard
- Department for Health and Wellbeing: SA Health, Northern Adelaide Local Health Network (NALHN), Adelaide, SA, Australia
| | - Caroline Farrow
- Department for Health and Wellbeing: SA Health, Northern Adelaide Palliative Service (NAPS), Northern Adelaide Local Health Network (NALHN), Adelaide, SA, Australia
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Yamaga T, Asano K, Ikeya M, Nakanishi K. Successful occupational therapy at end of life for a patient with prostate sarcoma. BMJ Case Rep 2021; 14:14/6/e242056. [PMID: 34155016 DOI: 10.1136/bcr-2021-242056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Most previous studies on palliative rehabilitation highlight medical care, with occupational therapy (OT) primarily focused on normal and instrumental activities of daily living. This clinical report describes the case of a 35-year-old patient with prostate sarcoma with a poor prognosis who received OT to help him focus on participating in a meaningful occupation. Initially, the patient was depressed and withdrawn, but with OT, he was able to participate in an occupation, and his life became more active. Although the patient was at the end of his life, he was able to maintain a high quality of life during the limited time period.
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Affiliation(s)
- Takayoshi Yamaga
- Occupational Therapy, Health Science University, Minamitsuru-gun, Yamanashi, Japan
| | - Katsutoshi Asano
- Occupational Therapy, Health Science University, Minamitsuru-gun, Yamanashi, Japan
| | - Masanao Ikeya
- Occupational Therapy, Health Science University, Minamitsuru-gun, Yamanashi, Japan
| | - Kosuke Nakanishi
- Occupational Therapy, Health Science University, Minamitsuru-gun, Yamanashi, Japan
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20
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Jiao K, Chow AY, Wang J, Chan II. Factors facilitating positive outcomes in community-based end-of-life care: A cross-sectional qualitative study of patients and family caregivers. Palliat Med 2021; 35:1181-1190. [PMID: 33947292 DOI: 10.1177/02692163211007376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Delivery of community-based end-of-life care for patients and family members has been recognized as an important public health care approach. Despite differences in different healthcare settings and the significance of a person-centered approach, little research has investigated facilitators of community-based end-of-life care from the perspective of service recipients. In particular, there has been limited exploration of strategies to ensure positive outcomes at an operational level. AIM To explore factors facilitating positive end-of-life care provision in community-based settings and how these are achieved in practice, from the perspectives of patients and family caregivers. DESIGN A qualitative cross-sectional descriptive study was undertaken through semi-structured interviews with patients and family caregivers subjected to thematic analysis. SETTING/PARTICIPANTS Ten patients and 16 family caregivers were recruited from an end-of-life community care program provided by four non-governmental organizations in Hong Kong. RESULTS Seven core themes were identified: positive emotions about the relationship, positive appraisals of the relationship, care through inquiring about recipients' circumstances, instrumentality of care (i.e. information, coaching on care, practical help, psychological support, multiple activities), comprehensiveness of care (i.e. diversity, post-death care, family-level wellbeing), structure of care (i.e. timely follow-up, well-developed system), and qualities of workers. CONCLUSIONS Improvement in service quality might be achieved through alternating the perceptions or emotional reactions of care recipients toward care providers and increased use of sensitive inquiry. Comprehensive care and positive outcomes might be facilitated by addressing the dualities of care by providing diverse choices in pre-death and post-death care.
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Affiliation(s)
- Keyuan Jiao
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Amy Ym Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China.,Jockey Club End-of-life Community Project (JCECC), Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Juan Wang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Iris Ik Chan
- Jockey Club End-of-life Community Project (JCECC), Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
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21
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Mueller E, Arthur P, Ivy M, Pryor L, Armstead A, Li CY. Addressing the Gap: Occupational Therapy in Hospice Care. Occup Ther Health Care 2021; 35:125-137. [PMID: 33546567 PMCID: PMC8192430 DOI: 10.1080/07380577.2021.1879410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 01/05/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
Patients receiving hospice care have a host of occupational challenges, though few are being seen in occupational therapy for treatment. Occupational therapy can help those receiving hospice care live with dignity before death. Data retrieved from the National Home and Hospice Care Survey were analyzed using independent t-tests, Wilcoxon rank-sum tests, Chi-square tests and logistic regressions. Only 10.6% of the participants received occupational therapy. Patients who received occupational therapy were significantly older and had shorter lengths of hospice care service compared to their counterparts. Over 85% of the patients needed assistance with at least one task of activity of daily living (ADL). Findings suggested a need to increase occupational therapy workforce in hospice care and advocate the value of occupational therapy services in hospice settings.
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Affiliation(s)
- Emily Mueller
- Department of Occupational Therapy, University of Texas Medical Branch, Galveston, Texas, USA
| | - Paul Arthur
- Department of Occupational Therapy, St. Catherine University, St. Paul, Minnesota, USA
- Department of Occupational Therapy, University of Southern Indiana, Evansville, Indiana, USA
| | - Mack Ivy
- Rehabilitation Services, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Loree Pryor
- Department of Occupational Therapy, University of Texas Medical Branch, Galveston, Texas, USA
| | - Amber Armstead
- Department of Occupational Therapy, University of Texas Medical Branch, Galveston, Texas, USA
| | - Chih-Ying Li
- Department of Occupational Therapy, University of Texas Medical Branch, Galveston, Texas, USA
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22
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la Cour K, Gregersen Oestergaard L, Brandt Å, Offersen SMH, Lindahl-Jacobsen L, Cutchin M, Pilegaard MS. Process evaluation of the Cancer Home-Life Intervention: What can we learn from it for future intervention studies? Palliat Med 2020; 34:1425-1435. [PMID: 32611224 DOI: 10.1177/0269216320939227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Cancer Home-Life Intervention showed no significant effects, and examination of the processes affecting or inhibiting outcomes is relevant. AIM To evaluate the Cancer Home-Life Intervention for its processes of implementation, mechanisms of impact and contextual factors. DESIGN Process evaluation conducted alongside the randomised controlled trial, using quantitative and qualitative methods (ClinicalTrials.gov NCT02356627). The Cancer Home-Life Intervention is a tailored, occupational therapy-based programme. SETTING/PARTICIPANTS This study took place in participants' homes and at hospital. A total of 113 home-dwelling adults (⩾18 years) with advanced cancer who had received the Cancer Home-Life Intervention were included, together with five intervention-therapists. RESULTS All 113 participants (100%) received a first home visit; 32 participants (26%) received a second visit; and 4 participants (3%) received a third visit. Median number of delivered intervention components were 3 (interquartile range: 2; 4). Identified barriers for effect included unclear decision process for intervention dosage; participants' low expectations; participants' lack of energy; and insufficient time to adopt new strategies. The trial design constituted a barrier as the intervention could only be provided within a specific short period of time and not when relevant. Intervention components working to solve practical everyday problems, enhance enjoyment and increase a sense of safety were perceived as useful. CONCLUSION Future interventions can benefit from inclusion criteria closely related to the intervention focus and clear procedures for when to continue, follow-up and terminate intervention. Decisions about dose and timing may benefit from learning theory by taking into account the time and practice needed to acquire new skills.
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Affiliation(s)
- Karen la Cour
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| | - Lisa Gregersen Oestergaard
- DEFACTUM, Central Denmark Region, Aarhus, Denmark.,Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark.,The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Åse Brandt
- The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Sara Marie Hebsgaard Offersen
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Aarhus, Denmark
| | - Line Lindahl-Jacobsen
- The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark.,University College Absalon, Center for Nutrition and Rehabilitation, Sorø, Denmark
| | - Malcolm Cutchin
- Department of Health Care Sciences, Wayne State University, Detroit, MI, USA
| | - Marc Sampedro Pilegaard
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark.,The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
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23
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Dönmez ÇF, Johnston B. Living in the moment for people approaching the end of life: A concept analysis. Int J Nurs Stud 2020; 108:103584. [PMID: 32450405 DOI: 10.1016/j.ijnurstu.2020.103584] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/26/2020] [Accepted: 03/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND 'Living in the moment' is an essential part of dignity-conserving practice in end-of-life care settings. Although living in the moment is important for care at the end of life, from the perspective of both the person and their family, there is no clear conceptual understanding of what it represents. OBJECTIVE To explore the concept of 'living in the moment' in the context of dignity-conserving care at the end of life. DESIGN A concept analysis. DATA SOURCES The databases of Medline, CinAHL, PubMed, Web of Science, PsycINFO, SocINDEX and Cochrane were searched for studies published between 1941 and 2019, and searches of dictionaries and grey literature, as well as hand-searching were conducted, to yield qualitative, mixed methods and systematic reviews published in English, related to the term 'living in the moment'. METHOD The methods of Walker and Avant were used to identify antecedents, attributes and consequences of the concept of 'living in the moment'. RESULTS The literature review generated a total of 37 papers for this concept analysis. The attributes identified were (1) simple pleasure, (2) prioritising relationships, (3) living each day to the fullest, (4) maintaining normality, and (5) not worrying about the future. The antecedents were (1) awareness of dying, (2) living with life-threatening illness, (3) positive individual growth, and (4) living with an uncertain future. The consequences were (1) a good quality of life, (2) preserving dignity, and (3) coping with the uncertainty of life. CONCLUSIONS A universal definition and conceptual model of the main concept, including theoretical relationships between its antecedents, attributes and consequences, was developed. The definition and proposed conceptual model can allow instruments to be developed that measure the effects, existence or attributes of the concept, and identify a theoretical model, and can also lead to new perspectives and strategies for implementation by nurses to improve dignified person-centred care at the end of life.
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Affiliation(s)
- Çiğdem Fulya Dönmez
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK; School of Heath Sciences, Department of Nursing, Istanbul Arel University, Istanbul, Turkey.
| | - Bridget Johnston
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK; Florence Nightingale Foundation Clinical Professor of Nursing, School of Medicine, Dentistry & Nursing, and NHS Greater Glasgow and Clyde, College of Medical, Veterinary & Life Sciences, University of Glasgow, 57-61 Oakfield Avenue, Glasgow G12 8LL, Scotland, UK.
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Wagman P, Johansson A, Jansson I, Lygnegård F, Edström E, Björklund Carlstedt A, Morville AL, Ahlstrand I, Fristedt S. Making sustainability in occupational therapy visible by relating to the Agenda 2030 goals – A case description of a Swedish university. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2020. [DOI: 10.1080/14473828.2020.1718266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Petra Wagman
- Department of Rehabilitation, Jönköping University, School of Health & Welfare, Jönköping, Sweden
| | - Ann Johansson
- Department of Rehabilitation, Jönköping University, School of Health & Welfare, Jönköping, Sweden
| | - Inger Jansson
- Department of Rehabilitation, Jönköping University, School of Health & Welfare, Jönköping, Sweden
| | - Frida Lygnegård
- Department of Rehabilitation, Jönköping University, School of Health & Welfare, Jönköping, Sweden
| | - Eva Edström
- Department of Rehabilitation, Jönköping University, School of Health & Welfare, Jönköping, Sweden
| | | | - Anne-Le Morville
- Department of Rehabilitation, Jönköping University, School of Health & Welfare, Jönköping, Sweden
| | - Inger Ahlstrand
- Department of Rehabilitation, Jönköping University, School of Health & Welfare, Jönköping, Sweden
| | - Sofi Fristedt
- Department of Rehabilitation, Jönköping University, School of Health & Welfare, Jönköping, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
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25
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Sampedro Pilegaard M, la Cour K, Brandt Å, Lozano-Lozano M, Gregersen Oestergaard L. Impact of pain, fatigue and dyspnoea on occupational performance in people with advanced cancer: A longitudinal study. Scand J Occup Ther 2019; 27:507-516. [PMID: 31729272 DOI: 10.1080/11038128.2019.1690042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Pain, fatigue and dyspnoea are symptoms commonly experienced by people with advanced cancer, which may impact on their occupational performance. It is not known whether these symptoms impact their occupational performance over time.Objective: To examine correlation between pain, fatigue and dyspnoea and occupational performance and the impact of such symptoms on occupational performance over time in people with advanced cancer.Material and Methods: A longitudinal study was conducted including 242 participants assessed at baseline and after six and 12 weeks. Spearman's rank-order test and mixed linear models were performed.Results: The correlation between pain, fatigue and dyspnoea and occupational performance at baseline spanned from trivial to moderate (Spearman's rho: -0.004 to 0.34). Only pain had a statistically significant impact on activities of daily living (ADL) motor ability over time (p = 0.01). Participants with no pain problems had the largest decrease in ADL motor ability (-0.24 logits (95%-CI: -0.37 to -0.12)), but the observed decrease was not clinically relevant (≥-0.30).Conclusion: Pain, fatigue and dyspnoea did not seem to highly correlate with occupational performance or impact occupational performance over time of people with advanced cancer.
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Affiliation(s)
- Marc Sampedro Pilegaard
- The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark.,Odense Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Denmark
| | - Karen la Cour
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
| | - Åse Brandt
- The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Mario Lozano-Lozano
- The Department of Physical Therapy, University of Granada, Granada, Spain.,The "Cuídate", Support Unit for Oncology Patients (UAPO), Granada, Spain.,Department of Physical and Occupational Therapy, The Sport and Health Joint University Institute (IMUDS), Granada, Spain
| | - Lisa Gregersen Oestergaard
- The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus C, Denmark.,Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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26
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Hammill K, Bye R, Cook C. Occupational engagement of people living with a life-limiting illness: Occupational therapists' perceptions. Aust Occup Ther J 2019; 66:145-153. [PMID: 30666645 DOI: 10.1111/1440-1630.12557] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM Occupational therapists working in palliative care aim to enable clients living with a life-limiting illness to continue participating in meaningful activities for as long as possible. However, little is published about the occupations people living with a life-limiting illness wish to engage in, and how occupational therapists can best enable occupational engagement. Therefore, this study aimed to gain an in-depth understanding of occupational therapists' perceptions on clients' occupational engagement post-diagnosis of a life-limiting condition. METHODS Occupational therapists working in Australia with people with a life-limiting illness were recruited to participate in a national online survey over the period of a month. Recruitment used a purposive, snowball sampling technique, resulting in 144 survey responses. Data were analysed using modified grounded theory methods. RESULTS Findings revealed two interrelated categories and four subcategories. The first category, focusing on life is concerned with therapists' perceptions of how clients continue to focus on living post diagnosis and encompasses two subcategories: (i) prioritised engagement and (ii) altered engagement. The second category, preparing for death, centres on therapists' perceptions of what clients do to practically prepare for death and find closure as their illness progresses, and is comprised of the two subcategories: (i) practical preparation for death and (ii) "facilitating closure". CONCLUSION Therapists perceived that meaningful occupational engagement changes over time as occupational performance levels decrease and clients prepare for death.
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Affiliation(s)
- Kathrine Hammill
- School of Science & Health - Occupational Therapy, Western Sydney University, Penrith, New South Wales, Australia
| | - Rosalind Bye
- School of Science & Health - Occupational Therapy, Western Sydney University, Penrith, New South Wales, Australia
| | - Catherine Cook
- School of Science & Health - Occupational Therapy, Western Sydney University, Penrith, New South Wales, Australia
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