Occupational therapy in palliative care: Is it under-utilised in Western Australia?

Identifying Facilitators of and Barriers to Referrals to Occupational Therapy Services by Israeli Cancer Health Care Professionals: A Qualitative Study

IMPORTANCE

Persons living with and beyond cancer (PLWBC) are rarely referred to occupational therapy services despite their functional difficulties. An understanding of the barriers to and facilitators of occupational therapy referrals from the perspective of cancer health care professionals could help minimize referral gaps.

OBJECTIVE

To explore cancer health care professionals' perspectives on and knowledge of occupational therapy's role in cancer care, identify the barriers, and explore solutions to optimize referrals.

DESIGN

Multiexplanatory qualitative case study.

SETTING

Community and hospital cancer clinics in Israel.

PARTICIPANTS

Six in-person focus groups of cancer care Israeli nurses and social workers, totaling 28 participants.

RESULTS

Two main themes were identified: (1) barriers to occupational therapy referrals and (2) partial facilitators of occupational therapy referrals. The four barriers subthemes were (1) gaps in knowledge about symptoms' effects on daily functioning, (2) gaps in knowledge regarding occupational therapy's role in cancer care, (3) bureaucratic and organizational barriers, and (4) unavailability of occupational therapy services. The two facilitators subthemes were (1) collaborations and communication with occupational therapists and (2) awareness of occupational therapy services. Participants suggested practical solutions for improving occupational therapy referrals, interdisciplinary collaboration and communication, and integrating occupational therapy into cancer care.

CONCLUSIONS AND RELEVANCE

Barriers to referrals included gaps in participants' knowledge that link side effects to functional difficulties indicating a need for referral to occupational therapy. Participants' suggestions to bolster referrals can be implemented by occupational therapists to reduce patients' unmet needs and bridge existing gaps in cancer care. Plain-Language Summary: This research helped to identify barriers and facilitators regarding insufficient knowledge about occupational therapy's role in cancer care and adds a better understanding of gaps in referrals to occupational therapy. In addition, cancer health care professionals who participated in the study suggested practical solutions for reducing barriers and maximizing support for referral. With these nuances, occupational therapy practitioners can work with medical cancer care units (i.e., acute care hospitals, medical cancer centers, and community health care clinics) to target the use of strategies that work for their units to ensure that persons living with and beyond cancer receive needed occupational therapy services.

Barriers and facilitators to palliative care for patients with non-curable cancer in Colombia: perspectives of allied health and social care professionals

BACKGROUND

Palliative care aims to improve the quality of life of people with life-limiting illness and their families by addressing physical, psychological, social and spiritual suffering. Allied Health and Social Care Professionals (AHSCP) are key to delivering comprehensive, high quality palliative care. In recent years, Colombia has developed changes in the legal, and regulatory framework for access to palliative care but barriers and facilitators to palliative care for patients with non-curable cancer have not been explored from the perspective of AHSCP.

METHOD

This study aims to address this knowledge gap in two cities in Colombia: one in a medium-sized city in a rural area (Popayan) and one in a highly urbanized area (Bogota). Two focus groups with AHSCP were conducted using the World Cafe method, and a subsequent thematic analysis was performed to establish the main barriers and facilitators.

RESULTS

A wide range of 18 AHSCPs attended the two World Cafe groups in Popayan and Bogota. As a result of this iterative process, we established five thematic areas: (i) Humanizing care, (ii) Normalizing palliative care: referral at the time of diagnosis, (iii) Misunderstandings related to palliative care, (iv) Barriers within the health system, and (v) Geographic barriers.

CONCLUSION

This study provided the perspectives of AHSCPs in Colombia in relation to barriers and facilitators in the framework of comprehensive palliative care attention. Participants identified misconceptions about palliative care, which are explained by the lack of inclusion of this area in the educational programs of health professionals and AHSCPs, along with the limited supply and access to palliative care, especially in rural areas.

How to Enable Participation until the End of Life? A Survey of German Occupational Therapists Working in Palliative Care

BACKGROUND

In palliative care, the needs of people with life-limiting illnesses must be addressed with the support of a multidisciplinary team. Occupational therapy is a profession that focuses on activity and participation. In Germany, there are no surveys to date that demonstrate the work of occupational therapists in palliative care and which problems can occur in this field.

AIM

The aim of this study is to describe the work and problems of occupational therapists in German palliative care.

DESIGN

The survey consists of 17 questions and could be conducted anonymously. Descriptive statistics and a thematic analysis of the free text responses were used to analyze data.

SETTING/PARTICIPANTS

Respondents were German occupational therapists who are members of the "German Association of Occupational Therapy".

RESULTS

A total of 281 valid responses were evaluated, of which 120 respondents work in the context of palliative care. Most of them provide needs-based therapies (74%), train relatives (69%), or help patients with positioning (69%) or relaxation therapy (66%). Four themes were developed in the free text responses that describe problems in the utilization of occupational therapy in palliative care.

CONCLUSIONS

The evaluation shows that occupational therapy in palliative care offers a variety of possible applications and approaches. The findings urgently need to be implemented in daily practice to improve the status of occupational therapists. This requires appropriate billing modalities and clear guidelines. There is still a significant need for research and training in this area.

[Physical therapy and occupational therapy in German palliative care: Where do we stand?]

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.

Occupational Therapy Practice in Palliative and End-of-Life Care in Québec

Background. There is an emerging evidence base about the scope of occupational therapy in palliative and end-of-life care, but little is known about this practice in Québec or barriers impeding it. Purpose. To describe Québec occupational therapists’ practice in palliative and end-of-life care and barriers they encounter. Method. Using the Québec regulatory board members list, we invited occupational therapists working in palliative and end-of-life care to answer an online survey comprising 24 closed- and 5 open-ended questions. We analyzed data using descriptive statistics and content analysis. Findings. The 67 survey participants mainly optimized comfort and safety in meaningful occupations such as mobility, transfers, and hygiene. Barriers to their practice included organizational obstacles and unfamiliarity with their role. Implications. Findings highlight the need to improve education and awareness among occupational therapists and other healthcare professionals about the scope of what occupational therapists can do in palliative and end-of-life care.

Role of occupational therapy in rehabilitation of cancer patients

Background. Most adult cancer survivors report a significant decrease of their quality of life and limitations in performing activities of daily living. Occupational therapy is a form of rehabilitation treatment that uses certain techniques and tools aimed at improving functional capacity, improve social participation and overall quality of life. Objective. The overall purpose of this narrative review is to provide a better understanding of the role that occupational therapy can play in the rehabilitation of cancer patients with a focus on the most important cancer-related aspects amenable and manageable by occupational therapy interventions and to increase awareness regarding this form of rehabilitation. Discussion. Given the fact that there is constant grow in the number of cancer survivors with complex needs, rehabilitation and occupational therapy strategies can increase functionality and health-related quality of life of patients with cancer at any point of the disease, but it remains underused, due to certain barriers. Conclusions. Occupational therapy, as part of cancer rehabilitation therapy, can lead to improvements in both short and long-term outcomes, while being cost-effective as goals are always set in collaboration with the patients and are aimed to identify and improve the activities most important and relevant for them. Keywords: occupational therapy, cancer, rehabilitation, activities of daily living, quality of life,

Evaluating a multidimensional strategy to improve the professional self-care of occupational therapists working with people with life limiting illness

BACKGROUND

The term 'life limiting conditions' refers to premature death following decline from chronic conditions, which is a common circumstance in which occupational therapists work with people at the end of life. The challenges for clinicians of working with these patients have long been recognised, and may have a significant impact on their professional self-care. This study aimed to evaluate a multidimensional workplace strategy to improve the professional self-care of occupational therapists working with people living with a life limiting condition.

METHODS

A pre and post mixed methods survey approach were utilised, with baseline data collection prior to the implementation of a multidimensional workplace strategy. The strategy included professional resilience education, targeted supervision prompts, changes to departmental culture and the promotion of self-care services across multiple organisational levels. Follow up data collection was undertaken after the strategy had been in place for 2 years. Quantitative data were analysed descriptively, while qualitative data were subjected to thematic analysis.

RESULTS

One hundred three occupational therapists responded (n = 55 pre, n = 48 post) across multiple service settings. Complex emotional responses and lived experiences were identified by participants working with patients with life limiting conditions, which were not influenced by the workplace strategy. Working with these patients was acknowledged to challenge the traditional focus of occupational therapy on rehabilitation and recovery. Participants were confident about their ability to access self-care support, and supervision emerged as a key medium. While the strategy increased the proportion of occupational therapists undertaking targeted training, around half identified ongoing unmet need around professional self-care with this patient group. Demographic factors (e.g. practice setting, years of experience) also had a significant impact on the experience and needs of participants.

CONCLUSIONS

The multidimensional workplace strategy resulted in some improvements in professional self-care for occupational therapists, particularly around their use of supervision and awareness of available support resources. However, it did not impact upon their lived experience of working with people with life limiting conditions, and there remain significant gaps in our knowledge of support strategies for self-care of occupational therapist working with this patient group.

Occupational therapy training on palliative and end-of-life care: Scoping review

Introduction

While occupational therapists promote quality of life enabling occupation, many receive little to no training on palliative and end-of-life care. This study synthesizes relevant literature to find out what is known about training for them on this matter.

Methods

A scoping review using Arksey and O’Malley’s five-stage framework exploring literature on palliative and end-of-life care training in occupational therapy (French or English; undergraduate or graduate). The first author screened the titles, abstracts, and keywords and selected literature to be read by the teams to extract and include relevant knowledge. Corroborated thematic analysis synthesized the findings.

Result

Out of the 384 publications initially identified, 25 were included in the review. To be trained in palliative and end-of-life care, occupational therapists have to (a) be exposed to knowledge on specific (b) topics required for competent practice using (c) educational strategies supporting learning about palliative and end-of-life care.

Conclusion

Whereas introductory-level knowledge of palliative and end-of-life care should be offered to all students, advanced training should allow occupational therapists to master the philosophy of this type of care, deepen the understanding of topics such as being confronted with death, and empower them to advocate for their unique contribution.

Impact of a comprehensive functional rehabilitation programme on the quality of life of the oncological patient with dyspnoea

BACKGROUND

Dyspnoea is one of leading causes of loss of autonomy in patients with advanced-stage cancer. Pharmacological measures achieve a reduction of the symptom, but without generalizing this improvement to functionality. We propose the inclusion of a comprehensive functional rehabilitation programme. The purpose is to test the efficacy of an integral respiratory rehabilitation programme to improve autonomy levels and relieve cancer-related dyspnoea.

METHODS

Experimental design, prospective, longitudinal, randomized study based on a parallel fixed allocation scheme using an experimental group and a control group. The intervention group participated in comprehensive functional rehabilitation, while the control group only received standard drug treatment. Single blind masking, but statistical analysis was performed by non-study personnel.

RESULTS

Final sample of 113 individuals, 52 in the control group and 61 in the experimental group, from the Oncology Unit of the University Hospital Complex of Salamanca. Statistically significant differences (are observed) between the members of both groups in the levels of functionality (p = .000), in the levels of dyspnoea (p =.001) and in the sub-items of the Euro-QOL questionnaire, except in the sub-item related to pain (p = .311). No major adverse effects or side effects are observed.

CONCLUSION

Non-pharmacological interventions using a comprehensive functional rehabilitation programme improve functionality and relieve dyspnoea in cancer patients.

The Changing Nature of Palliative Care: Implications for Allied Health Professionals' Educational and Training Needs

CareSearch is an Australian Government Department of Health funded repository of evidence-based palliative care information and resources. The CareSearch Allied Health Hub was developed in 2013 to support all allied health professionals working with palliative care clients in all clinical settings. This cross-sectional online survey sought to elicit allied health professionals palliative care experiences and subsequent considerations for educational and clinical practice needs. The survey was disseminated nationally via a range of organisations. Data was collected about palliative care knowledge, experience working with palliative care clients and professional development needs. Data were evaluated by profession, experience and practice setting. In total, 217 respondents answered one or more survey questions (94%). Respondents (65%) reported seeing >15 palliative care clients per month with 84% seen in hospital and community settings. Undergraduate education underprepared or partially prepared allied health professionals to work with these clients (96%) and 67% identified the need for further education. Access to postgraduate professional development was limited by available backfill and funding. Study findings support the importance of free, accessible, relevant educational and professional development resources to support clinical practice. This is particularly relevant for allied health professionals who have limited opportunities to attend formal professional development sessions.

Enabling activity in palliative care: focus groups among occupational therapists

Background

Activity participation may support clients in palliative care to maintain dignity and quality of life. Literature and policy documents state that occupational therapists should be part of the team in palliative care but provide limited guidance on how interventions should be employed. Thus, the aim was to describe occupational therapists’ experiences of enabling activity for seriously ill and dying clients.

Methods

In a descriptive, qualitative study, three focus groups with occupational therapists (n = 14) were conducted. The data were analysed using qualitative content analysis.

Results

The findings showed that occupational therapists enabled activity in clients in palliative care while considering the client’s individual preferences. Motivation was seen to facilitate activity, while environmental restrictions were thought to act as barriers. The occupational therapists wanted to bring activities physically closer to the clients and felt a need for more client contact to enable activity.

Conclusions

Occupational therapists’ interventions in palliative care include prioritizing and planning activities according to clients’ preferences and capacities. The individual nature of these activities makes it impossible to create standardized protocol for interventions, but the study results can be used to describe occupational therapists’ strategies and to guide their work, especially for occupational therapists without experience in palliative care.

Electronic supplementary material

The online version of this article (10.1186/s12904-019-0394-9) contains supplementary material, which is available to authorized users.

Exploring the impact of brain cancer on people and their participation

Introduction

Brain cancer diagnoses are rising, and the prognosis is commonly life-limiting. Brain cancer symptoms and the side effects of treatment are imposing and harmful. Little is known about the effect of these symptoms and treatments on occupational participation or about the role that occupational therapy can play for people with brain cancer.

Methods

Sixteen participants with brain cancer were purposively recruited from a single site. Data was collected using semi-structured interviews. Interviews were analysed thematically.

Results

Three overarching themes were identified: (a) ‘there’s a lot of things that I can’t do anymore’: adverse effects of tumour and treatments; (b) ‘you adjust with adversity’: accepting altered occupational participation levels; (c) occupational therapy: ‘why is she here?’

Conclusions

Findings highlight a connection between brain cancer symptoms, treatment side effects and occupational participation. A disconnect was found between occupational therapy services and occupational needs. Further research could explore whether realigning occupational therapy services to address the concerns identified in this study leads to enhanced occupational participation through the journey of brain cancer.

Mapping the scope of occupational therapy practice in palliative care: A European Association for Palliative Care cross-sectional survey

BACKGROUND

Occupational therapists play an integral role in the care of people with life-limiting illnesses. However, little is known about the scope of occupational therapy service provision in palliative care across Europe and factors influencing service delivery.

AIM

This study aimed to map the scope of occupational therapy palliative care interventions across Europe and to explore occupational therapists' perceptions of opportunities and challenges when delivering and developing palliative care services.

DESIGN

A 49-item online cross-sectional survey comprised of fixed and free text responses was securely hosted via the European Association for Palliative Care website. Survey design, content and recruitment processes were reviewed and formally approved by the European Association for Palliative Care Board of Directors. Descriptive statistics and thematic analysis were used to analyse data. Setting/respondents: Respondents were European occupational therapists whose caseload included palliative care recipients (full-time or part-time).

RESULTS

In total, 237 valid responses were analysed. Findings demonstrated a consistency in occupational therapy practice in palliative care between European countries. Clinician time was prioritised towards indirect patient care, with limited involvement in service development, leadership and research. A need for undergraduate and postgraduate education was identified. Organisational expectations and understanding of the scope of the occupational therapy role constrain the delivery of services to support patients and carers.

CONCLUSION

Further development of occupational therapy in palliative care, particularly capacity building in leadership and research activities, is warranted. There is a need for continuing education and awareness raising of the role of occupational therapy in palliative care.

Allied health: integral to transforming health

Objective South Australia is taking an innovative step in transforming the way its healthcare is organised and delivered to better manage current and future demands on the health system. In an environment of transforming health services, there are clear opportunities for allied health to assist in determining solutions to various healthcare challenges. A recent opinion piece proposed 10 clinician-driven strategies to assist in maximising value and sustainability of healthcare in Australia. The present study aimed to seek the perspectives of allied health clinicians, educators, researchers, policy makers and managers on these strategies and their relevance to allied health. Methods A survey of allied health practitioners was undertaken to capture their perspectives on the 10 clinician-driven strategies for maximising value and sustainability of healthcare in Australia. Survey findings were then layered with evidence from the literature. Results Highly relevant across allied health are the strategies of discontinuation of low value practices, targeting clinical interventions to those getting greatest benefit, active involvement of patients in shared decision making and self-management and advocating for integrated systems of care. Conclusions Allied health professionals have been involved in the South Australian healthcare system for a prolonged period, but their services are poorly recognised, often overlooked and not greatly supported in existing traditional practices. The results of the present study highlight ways in which healthcare services can implement strategies not only to improve the quality of patient outcomes, but also to offer innovative solutions for future, sustainable healthcare. The findings call for concerted efforts to increase the utilisation of allied health services to ensure the 'maximum value for spend' of the increasingly scarce health dollar. What is known about the topic? In medicine, clinician-driven strategies have been proposed to minimise inappropriate and costly care and maximise highly appropriate and less expensive care. These strategies were developed based on clinical experiences and with supporting evidence from scientific studies. What does this paper add? Major changes to the health system are required to slow down the growth in healthcare expenditure. This paper describes opportunities in which allied health practitioners can implement similar strategies not only to improve the quality of patient outcomes, but also to offer cost-effective solutions for a sustainable healthcare. What are the implications for practitioners? Allied health practitioners can provide solutions to healthcare challenges and assist in the transformation of healthcare in Australia. However, for this to happen, there should be concerted efforts to increase recognition of and support for the use of allied health services.

Occupational Therapy for Adults With Cancer: Why It Matters

Adults with cancer may be at risk for limitations in functional status and quality of life (QOL). Occupational therapy is a supportive service with the specific mission to help people functionally engage in life as safely and independently as possible with the primary goal of improving QOL. Unfortunately, for people with cancer, occupational therapy remains underused. The overall purpose of this review is to provide an understanding of what occupational therapy is and its relevance to patients with cancer, highlight the reasons to refer, and, last, provide general advice on how to access services.

Patients’ and caregivers’ perceptions of occupational therapy and adapting to discharge home from an inpatient palliative care setting

Introduction

There is limited research into the role of occupational therapy in discharge planning in palliative care. This study aimed to explore patients’ and caregivers’ perceptions of occupational therapy in the context of discharge home from an inpatient palliative care setting.

Method

Semi-structured interviews were conducted with patients and caregivers following discharge home from inpatient palliative care. Participants were selected using purposive sampling and data was thematically analysed.

Results

Five caregivers and three patients were interviewed. Three main themes emerged: (1) shared roles in discharge planning; (2) perceived benefits of occupational therapy; and (3) adapting to discharge home. Patients and caregivers viewed occupational therapy as the practical help needed to achieve discharge. They had difficulty differentiating between professional roles and perceived the discharge process as a shared responsibility between themselves and the clinicians. Adapting to discharge home involved coping with the uncertain and unexpected, where limited understanding of professional roles meant participants did not know who to seek assistance from.

Conclusion

Occupational therapy was viewed as the practical help needed for discharge home from a palliative care setting. Clinicians need to take primary responsibility for understanding each other’s roles and providing information on who can assist after discharge.

Enabling occupation at the end of life: A literature review

OBJECTIVE

Occupation, or meaningful activity, can contribute to the well-being and quality of life of all individuals. It is thus a logical tautology that occupation should be enabled for those at the end of life. Our present review examines current provision of these processes by Occupational Therapist, who can be much-valued members of multidisciplinary palliative care teams.

METHOD

Following a literature search and critical selection, 10 global papers were identified examining occupation and occupational therapy at the end of life in the acute, hospice, and community environments.

RESULTS

Universally, there appeared to be a dearth of therapists working in end-of-life care. Provision of palliative care in hospitals was found to be compensatory or rehabilitative. Hospice therapy emerged as pleasingly occupational, though the number of hospice places was disappointingly few. Community literature was sparse, so it proved challenging to draw definitive conclusions. Promising research refracted light on occupation at home; however, it also revealed stretched domiciliary services, where clients are not well informed about the potential scope of occupational therapy.

SIGNIFICANCE OF RESULTS

A "good death" involving a quality end-of-life experience is the foundational goal overarching all therapy and medicine in the provision of palliative care. Arguably, an occupation-focused approach provided by therapists meets client needs to enable meaningful experiences in the limited time left to them. Current occupational therapy practice environments are not necessarily achieving these goals in commensurate fashion. There is a need to promote the role of occupational therapy and circumscribe what therapists can offer. Further research is necessitated across all environments and future funding for therapist positions in palliative teams. End-of-life care can be complex and challenging; however, therapists can facilitate fulfillment of client-centered occupational goals. In engaging with personally constructed nuances of meaning, quality of life can be improved in those deserving of a significant and emotionally rich daily existence during their final days.

“Running Water Won't Freeze”: How people with advanced Parkinson's disease experience occupation

Objective:

Parkinson's disease (PD) is a progressive neurodegenerative condition often resulting in significant disability and impacting on one's ability to participate in an occupation. The present study aimed to explore how people with advanced Parkinson's disease experience the phenomenon of occupation in their daily lives in order to inform the practice of occupational therapy in palliative care.

Method:

Using a phenomenological approach, in-depth interviews were undertaken with a purposive sample of 10 people in the advanced stages of Parkinson's disease. These interviews were audiotaped, transcribed verbatim, and subsequently analyzed using a thematic content analysis approach. The study received approval from the relevant university ethics committee, as well as the research network of Parkinson's UK.

Results:

The experience of occupation emerged as being physical, psychological, social, and spiritual with related subthemes. Within each of these themes, participants described their experience of occupation that they valued and that were important to their daily lives. They also identified the strategies they employed to continue participating in certain occupations and described others they were no longer able to engage in and the impact of that loss.

Significance of Results:

Participants' experiences crossed the domains of palliative care and suggest that adopting a palliative care approach would enhance an enhanced quality of life, experienced in terms of meaningful and valuable occupation. Disruption to participation in occupation caused them distress and frustration, suggesting that access to occupation-focused therapy would significantly improve quality of life for people with PD. As there is a strong link between the ethos of occupational therapy and palliative care, it is proposed that there is a valuable role for occupational therapy intervention to play within palliative care.

Occupational Therapy for People Living with a Life-Limiting Illness: A Thematic Review

Introduction:

Little is known about occupational therapy practice for people with a life-limiting illness. This paper aims to review the available occupational therapy literature in order to develop a greater understanding of the role and practice trends of occupational therapists working in this area.

Methods:

A systematic search of literature published from 1975–2013 was conducted. Three hundred and fifty-five pieces of literature were located and screened for inclusion using a three-stage process. All literature that met the inclusion criteria was then analysed thematically.

Findings:

An in-depth review of 52 articles, three position statements, two key occupational texts, and one clinical guideline identified three themes in the literature. These themes comprised: (i) reframing practice: defining a palliative approach in occupational therapy; (ii) continuing occupational engagement despite loss; and (iii) preparing for practice when your client is dying: educational requirements of occupational therapists.

Conclusion:

Occupational therapy has an important role to play in the care of people with a life-limiting illness. However, knowledge gaps remain concerning the scope of the role and how best to engage clients in meaningful occupations at the end of life. Further education is required at the undergraduate level and for clinicians working in this area.

Impairment-driven cancer rehabilitation: an essential component of quality care and survivorship

Adult cancer survivors suffer an extremely diverse and complex set of impairments, affecting virtually every organ system. Both physical and psychological impairments may contribute to a decreased health-related quality of life and should be identified throughout the care continuum. Recent evidence suggests that more cancer survivors have a reduced health-related quality of life as a result of physical impairments than due to psychological ones. Research has also demonstrated that the majority of cancer survivors will have significant impairments and that these often go undetected and/or untreated, and consequently may result in disability. Furthermore, physical disability is a leading cause of distress in this population. The scientific literature has shown that rehabilitation improves pain, function, and quality of life in cancer survivors. In fact, rehabilitation efforts can ameliorate physical (including cognitive) impairments at every stage along the course of treatment. This includes prehabilitation before cancer treatment commences and multimodal interdisciplinary rehabilitation during and after acute cancer treatment. Rehabilitation appears to be cost-effective and may reduce both direct and indirect health care costs, thereby reducing the enormous financial burden of cancer. Therefore, it is critical that survivors are screened for both psychological and physical impairments and then referred appropriately to trained rehabilitation health care professionals. This review suggests an impairment-driven cancer rehabilitation model that includes screening and treating impairments all along the care continuum in order to minimize disability and maximize quality of life.