Occupational therapy in oncology palliative care for adolescents and young adults: Perspectives of Australian occupational therapists

INTRODUCTION

Palliative Care Australia suggests current needs (emotional wellbeing, understanding of cancers impact on relationships, everyday activities, and life milestones) for adolescent and young adults in palliative care are unmet due to a lack of age-specific palliative care facilities in Australia. This includes the provision of occupational therapy that can impact these unmet needs. Although the occupational therapy role in palliative care has been documented, little is known about existing occupational therapy services or occupational needs for young people with palliative care needs. The aims of this study were to obtain occupational therapists insights of working with this population in Australia regarding (1) gaps in palliative care services for this population; (2) facilitators and challenges to providing occupational therapy for this group; and (3) perceived occupational needs of young people living with a life-limiting cancer diagnosis.

METHODS

Using snowball sampling, an online survey was distributed to occupational therapists with experience working in palliative cancer care with adolescents and young adults. Available for 6 weeks, the survey included demographic, work history, and service delivery questions. Forced-choice questions were summarised descriptively, and content analysis was used to analyse free-text data.

RESULTS

Eleven completed surveys were returned. Overall, therapists perceived current palliative care services for this population within Australia to be lacking. Two gaps emerged: age-appropriate facilities and gaps in provision of psycho-social and occupational therapy services. Funding, lack of knowledge of the occupational therapy role, and professional confidence were highlighted as challenges to practice. Main occupational needs related to maintenance of as "normal" a life as possible: maintaining occupational role engagement, continuing connection with others, and being heard regarding their occupational needs.

CONCLUSION

Findings suggest a need for service changes, including custom-designed facilities, improved funding, training and mentoring, to support age-appropriate and occupation-focussed care for the young person in cancer-specific palliative care.

When Clients are Dying: Occupational Therapists’ Perspectives

Occupational therapists working with people who are terminally ill potentially face a contradiction between the principles and assumptions of rehabilitation-oriented practice and the needs and experiences of clients who are dying. This research investigated experiences of occupational therapists working with clients who are terminally ill to examine if such a contradiction existed and, if so, how it was managed in daily practice. Ten occupational therapists working with people who are terminally ill shared their perspectives through in-depth interview and participant observation. Data analysis followed grounded theory procedures. Nine conceptual categories were generated from the data: Making a Difference, Referral to Occupational Therapy, Assessing the Situation, Goal Setting, Building Against Loss, “Normality Within a Changed Reality,” Client Control, Supported and Safe Care, and Closure. Analysis of relationships between categories resulted in the development of a conceptual framework of occupational therapy practice with people who are terminally ill. The core phenomenon of the framework emerged as Affirming Life: Preparing for Death. Results indicate that occupational therapists manage this contradiction between their rehabilitation training and their work with people who are dying by reframing the process and outcomes of practice to acknowledge clients’ dual states of living and dying.

The Lost-Ness of Loss: A Reappraisal of Loss

The article explores the proposition that loss is a central, but neglected and taken-for-granted, concept within occupational therapy. A reappraisal of loss was stimulated by a module entitled ‘Loss and life-threatening conditions’ in the South Trent In-Service Diploma Course In Occupational Therapy. The student-negotiated curriculum is described. The evaluations highlighted the personal value and professional relevance of the concept of loss. These were confirmed during a staff development workshop for 37 experienced and expert therapists at Nottingham City Hospital. A framework that combines toss, mastery, mystery and occupation is offered as a professional model with practical implications. Encouragement is provided to re-evaluate and perhaps rediscover the pivotal place of loss within occupational therapy.

Has undergraduate education prepared occupational therapy students for possible practice in palliative care?

BACKGROUND

It has been argued that the unique nature of the occupational therapy role in palliative care (PC) warrants dedicated attention in undergraduate programmes to improve the confidence of occupational therapy graduates to work in this setting. Nevertheless, little is known about either the present PC education or the preparedness of graduates to work in this field. In addressing each of these issues, this study also sought information to guide the development of occupational therapy-specific undergraduate teaching resources.

METHODS

Survey information was gathered from two participant groups: (i) six occupational therapy schools from Australia and New Zealand and (ii) 24 occupational therapists employed in PC in Australia and New Zealand. Two different surveys were used, targeting issues specific to each of these two groups. Where possible, data were analysed quantitatively, whereas open-ended questions were interpreted thematically.

RESULTS

Occupational therapy schools reported 2-10 hours of PC-specific content and requested teaching resources specific to the occupational therapy role. Less than half of the clinicians (45.8%) recalled receiving undergraduate content in PC, and 75% reported having felt unprepared to work in this field. Clinicians who had received PC-specific content at university felt more prepared to work in this field than those who had not. Several recommendations for teaching PC were made.

CONCLUSIONS

The link between the extent of PC education received and perceived readiness to work in this field, together with the relatively small amount of dedicated undergraduate PC-specific content, supports the need to optimise teaching in this unique field.

An evaluation of the domiciliary occupational therapy service in palliative cancer care in a community trust: a patient and carers perspective

In the past 20 years there has been considerable growth in the provision of palliative care services. The shift in emphasis from hospice and hospital care to the development of community services has been significant. This enables people to be cared for at home and is in keeping with Government agenda. While this may be beneficial for the patient and fit in with the wishes of the family, it is likely to put heavy demands on the coping resources of individual carers. The views of service users are of paramount importance when discussing service evaluation and patient, family and carer empowerment. This research presents the findings of an evaluation of the domiciliary occupational therapy service provided for patients in the palliative stage of cancer care in North and West Belfast from the perspective of the patients and carers. For the purpose of this study, the palliative stage of cancer care is defined as the point from which the patient is no longer responsive to curative treatment, until death. A sample of 30 patients and their primary informal carers were selected using purposive sampling. A structured interview was carried out with both the patients and their carers to obtain views. Results suggest that although both patients and their carers value the service provided and report high levels of satisfaction, there are gaps identified in service provision and a lack of clear information among patients and their carers about the role of the occupational therapist and the range of services they can provide. There is a need to build upon the good work being done by domiciliary occupational therapists in the area of palliative cancer care and increase education and resources to ensure that a patient-centred, holistic, approach to care is used, addressing both the needs of the patient and their carers.

Journey of providing care in hospice: perspectives of occupational therapists

The purpose of this study was to explore the perspectives of occupational therapists with regard to their role in hospice and to examine whether occupational therapists experienced a conflict in supporting the dual status of living and dying for individuals with terminal illness. A qualitative analysis revealed the following themes: tuning in and comfort care, loss, working toward death, journey with patient, team player, use of occupational therapy, and dichotomous role. These themes demonstrated that occupational therapists played a significant role in hospice, helping individuals with terminal illness to live life fully and comfortably while facing death. The study found that occupational therapists used a holistic approach in their work by addressing the physical, social, emotional, and spiritual aspects of care.