Process evaluation of the Cancer Home-Life Intervention: What can we learn from it for future intervention studies?

International consensus on occupational therapy interventions for people with palliative care needs: A European Association for Palliative Care Group Concept Mapping study

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.

Evaluation of an inpatient occupation-based group program using a process evaluation framework

INTRODUCTION

Occupation-based groups are used in inpatient rehabilitation to enhance delivery and intensity of intervention; however, little research is available to understand their effectiveness. The aim of this study was to examine the process of an occupation-based group to understand mechanisms and success factors.

METHODS

A mixed methods process evaluation using an evidence-based framework guided implementation and analysis. Participants were those involved in the 'LifeSkills' group run daily in an adult inpatient general rehabilitation ward. Quantitative administrative data, goal achievement outcome measures, group observations and qualitative semistructured interviews were conducted.

RESULTS

Thirty participants were recruited. Factors for success included consistency in group structure and support, using meaningful practise opportunities and facilitating a real-world experience. There was no significant relationship between patient outcomes and dose of training or patient demographics.

CONCLUSION

This evaluation contributes to a growing body of evidence for incorporating occupation-based approaches into rehabilitation and offers insights into practice implementation.

A resource-oriented intervention addressing balance in everyday activities and quality of life in people with advanced cancer: protocol for a feasibility study

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

Assistive devices among people living at home with advanced cancer: Use, non-use and who have unmet needs for assistive devices?

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.

Disability in Basic Activities of Daily Living Is Associated With Symptom Burden in Older People With Advanced Cancer or Chronic Obstructive Pulmonary Disease: A Secondary Data Analysis

CONTEXT

Managing activities of daily living is important to people with advanced cancer or chronic obstructive pulmonary disease (COPD). Understanding disability in activities of daily living may inform service planning.

OBJECTIVE

To identify the prevalence of disability in activities of daily living, associations and change over time, in older people with advanced cancer or COPD.

METHODS

Secondary analysis of International Access, Rights and Empowerment (IARE) studies in adults aged ≥65 years with advanced disease in the United Kingdom, Ireland, and United States, using cross-sectional (IARE I & II) and longitudinal (IARE II, 3 timepoints over 6 months) data. Measures included disability in activities of daily living (Barthel Index), symptom severity (Palliative Outcome Scale), and assistive device use (self-reported). Logistic regression was used to identify relationships between disability and age, sex, living alone, diagnosis, and symptom burden; visual graphical analysis explores individual disability trajectories.

RESULTS

One hundred fifty-nine participants were included (140 cancer, 19 COPD). Sixty-five percent had difficulty climbing stairs, 48% bathing, 39% dressing, and 36% mobilizing. Increased disability was independently associated with increased symptom burden (odds ratio, 1.08 [95% CI:1.02-1.15], P = 0.01) and walking unaided (z = 2.35, P = 0.02), but not with primary diagnosis (z = -0.47, P = 0.64). Disability generally increased over time but with wide interindividual variation.

CONCLUSION

Disability in activities of daily living in advanced cancer or COPD is common, associated with increased symptom burden, and may be attenuated by use of assistive devices. Individual disability trajectories vary widely, with diverse disability profiles. Services should include rehabilitative interventions, guided by disability in individual activities of daily living.

Occupations creating joy for people living with advanced cancer: A qualitative descriptive study

Introduction

For people living with advanced cancer, the possibilities for experiences of joy are seriously influenced by the consequences of the illness. Due to the limited expected lifetime, the need to support such experiences that may entail joy and contribute to quality of life are of importance. Research shows that people with advanced cancer experience quality of life through occupations they are able to perform and enjoy. The aim of this study was to describe which occupations contribute to joy for people living with advanced cancer and explore how they reflect upon these occupations during an occupational therapy intervention.

Methods

In total, 111 people with advanced cancer from the intervention group in a randomised controlled trial participated in the present study. Thirty-six of these participants were interviewed, and for 10 participants, this was combined with participant observations. A directed and a conventional content analysis were applied.

Results

148 occupations contributing to joy were categorised into self-care, leisure and productivity. Most occupations were placed into leisure (89%). Participants had three distinct approaches to occupations contributing to joy: Finding solutions to maintain occupations contributing to joy; having an all or nothing approach; and hoping to resume occupations contributing to joy.

Conclusion

This study found a wide range of occupations contributing to joy and shows the importance of focusing on enabling leisure occupations for people living with advanced cancer. The wide range of occupations as well as participants’ approaches to occupations may be useful to inform future interventions to enable enjoyment for people living with advanced cancer.