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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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Figueiredo CDS, Giacomin KC, Gual RF, de Almeida SC, Assis MG. Death and Other Losses in the COVID-19 Pandemic in Long-Term Care Facilities for Older Adults in the Perception of Occupational Therapists: A Qualitative Study. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:795-811. [PMID: 35354414 PMCID: PMC8971964 DOI: 10.1177/00302228221086169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Long-term care facilities for older adults (LTCFs) were directly affected by the COVID-19 pandemic. This study aimed to discuss the perceptions of occupational therapists about deaths and other losses in LTCFs during the pandemic. This qualitative study is anchored in social phenomenology, and conducted in-depth interviews with eight occupational therapists who worked in LTCFs. Thus, two themes were generated after the Thematic Analyses: "The proximity of death" and "Losses associated with living and dying in a LTCF." In the first theme, the interviewees addressed the feeling of imminent death in the daily life of the LTCF, and feelings related to their own death, that of their family members and other older adults. In the second, the professionals highlighted three groups of losses: social, functional, and psychological/cognitive. These results highlighted the challenges faced by occupational therapists and can contribute to improve behavior and care for institutionalized older adults during the pandemic.
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Affiliation(s)
- Carolina de S. Figueiredo
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Karla C. Giacomin
- Geriatrician, Center for Studies in Public Health and Aging – NESPE, Fiocruz Minas - Municipal Health Department, Belo Horizonte, Brazil
| | - Ramon F. Gual
- Geriatrician, Conviver Complexo de Atenção ao Idoso, Belo Horizonte, Brazil
| | - Simone C. de Almeida
- Occupational Therapy Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marcella G. Assis
- Occupational Therapy Department, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Pino M, Jenkins L. Inviting the Patient to Talk About a Conversation They Had with Another Healthcare Practitioner: A Way of Promoting Discussion About Disease Progression and End of Life in Palliative Care Interactions. HEALTH COMMUNICATION 2024; 39:778-792. [PMID: 36908097 DOI: 10.1080/10410236.2023.2185579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Discussing disease progression is a core task in palliative care. This is especially important when there are indications that a patient considers their death as less imminent than the clinical team does. This article examines a communicative action that palliative medicine doctors use to address such discrepancies in knowledge and understanding of the patient's prognosis: inviting the patient to talk about the contents of a conversation they had with another healthcare practitioner. The study used conversation analysis to examine five consultations in which this action was identified. These were part of a larger data set of 37 consultations recorded in a large UK hospice and involving patients with palliative care needs, sometimes accompanied by family or friends, and palliative medicine doctors. Findings are that the action of inviting the patient to talk about a previous conversation creates an opportunity for patients to articulate what they know and understand about their disease progression - but without requiring them to do so. Discussing such sensitive matters is thus made a matter of 'opting in' (rather than 'opting out'). Doctors thereby avoid being interactionally accountable for directly initiating a potentially distressing topic. The article shows how the task of discussing disease progression and end of life is intertwined with the delicate management of patients' displayed states of awareness regarding their disease progression. The study thus has practical implications by documenting ways in which clinicians can help patients realign their expectations about such delicate matters.
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Affiliation(s)
- Marco Pino
- School of Social Sciences and Humanities, Loughborough University
| | - Laura Jenkins
- School of Social Sciences and Humanities, Loughborough University
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Perilla VML, Magalhães L, Pérez DKC, Olivero MMA, Cortes BDM, Montero YR, Arias VSA, Arias DRA. “O bicho, aquele pirralho” nos territórios indígenas colombianos: tecendo diálogos com a comunidade Kankuama em tempos de pandemia. CADERNOS BRASILEIROS DE TERAPIA OCUPACIONAL 2021. [DOI: 10.1590/2526-8910.ctoao2146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Este artigo tem como objetivo refletir sobre as experiências de afirmação da vida e preparação para a morte da comunidade colombiana indígena Kankuama, diante da pandemia e dos efeitos físicos, socioculturais, ecológicos e espirituais que fundamentam e impactam sua identidade, visibilidade, consciência e participação ocupacional. Por meio de pesquisa étnico-nacional colaborativa com base no pensamento indígena, o “Yarning” ou tecido foi utilizado para recuperar as narrativas de três kankuamos por meio de duas entrevistas semiestruturadas presenciais e uma virtual, gravadas e transcritas entre abril e agosto de 2020. As narrativas permitiram tecer reflexões vinculadas à luta pela preservação da própria dinâmica intercultural da saúde, reconhecendo elementos vinculados à sua história, além da ressignificação do vírus como fenômeno de aprendizagem do ser humano na relação com a Mãe Terra e com o território. O artigo também aborda os processos ocupacionais vinculados à morte, enfatizando os aprendizados da perda e da consciência do legado espiritual dos mais velhos, decanos e sábios para a interpretação e orientação das práticas mortuárias da passagem ao “Chundwa”. Resgatam-se as percepções que os Kankuamos possuem sobre a situação atual de saúde, conceitos de saúde e bem-estar, com base na Lei de Sé e sua relação com as ocupações relacionadas à morte, ao equilíbrio social, cultural e natural, que devem ser consideradas dentro da terapia ocupacional e da ciência ocupacional na América Latina.
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Batista MPP, Rebelo JE, de Carvalho RT, de Almeida MHM, Lancman S. Widow's perception of their marital relationship and its influence on their restoration-oriented everyday occupations in the first six months after the death of the spouse: A thematic analysis. Aust Occup Ther J 2019; 66:700-710. [PMID: 31657033 DOI: 10.1111/1440-1630.12609] [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] [Accepted: 08/18/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The death of a spouse greatly affects the survivor's emotions and may change one's everyday occupations, especially during recent bereavement. Considering the centrality of everyday occupations to occupational therapy practice, this research aimed to understand women's restoration-oriented everyday occupations within the first six months after the death of their spouse. METHODS This was a qualitative thematic analysis that applied a realistic method and a theoretical approach at the semantic level. Semi-structured interviews were conducted to understand the everyday occupations of widows after their husbands' deaths, emphasising those that were restoration-oriented, according to the dual process model of coping with bereavement framework. The analysis was conducted according to the phases expected to be conducted during a thematic analysis. RESULTS Fourteen widows with long-term marital relationships participated in this research. Their perceptions concerning their relationships with their spouses were an important aspect that influenced their everyday occupations. Women who qualitatively described their marital relationships in terms of attributes grouped by the researcher as lost and lonely also mentioned difficulty managing previously habitual occupations and changes in the meanings assigned to some of those occupations. These women mobilised unique strategies to address suffering and occupational changes during bereavement. Women who qualitatively described their relationships with attributes grouped by the researcher as free at last felt freedom after their husbands' deaths, which, according to the widows, brought happiness and feelings of peace and enabled them to engage in freely chosen occupations and to broaden their social networks. CONCLUSION Everyday occupations and their meanings can considerably change during widowhood. This study contributes to comprehending the uniqueness of responses to loss.
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Affiliation(s)
- Marina Picazzio Perez Batista
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Medical School, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Maria Helena Morgani de Almeida
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Medical School, Universidade de São Paulo, São Paulo, Brazil
| | - Selma Lancman
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Medical School, Universidade de São Paulo, São Paulo, Brazil
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Boa S, Duncan E, Haraldsdottir E, Wyke S. Mind the gap: Patients’ experiences and perceptions of goal setting in palliative care. PROGRESS IN PALLIATIVE CARE 2019. [DOI: 10.1080/09699260.2019.1672131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Sally Boa
- Strathcarron Hospice, Randolph Hill, Denny, Stirlingshire, UK
| | - Edward Duncan
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Erna Haraldsdottir
- Department of Education and Research, St Columba’s Hospice, Edinburgh, UK
| | - Sally Wyke
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Dawson S, Kristjanson LJ. Mapping the Journey: Family Carers’ Perceptions of Issues Related to End-Stage Care of Individuals with Muscular Dystrophy or Motor Neurone Disease. J Palliat Care 2019. [DOI: 10.1177/082585970301900107] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Progress in medical technology and treatment has resulted in more people with neurodegenerative conditions surviving for longer periods of time. This increased lifespan means that these individuals have a longer period of dependency on others, with a heightened need to maintain quality of life for both the individual and the family. Our paper reports on the findings of a study involving in-depth interviews with 16 carers to determine their perceived needs during the final stage of caring for someone with muscular dystrophy (MD) or motor neurone disease. Results suggest that the palliative care model has much to offer individuals with degenerative neuromuscular conditions and their families, but it is not yet recognized as an important part of care for young people with MD. Three major themes emerged in the analysis: reactions and responses, health system crossing points, reaching forward.
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Affiliation(s)
- Sky Dawson
- School of Nursing and Public Health, Edith Cowan University, Churchlands, Western Australia, Australia
| | - Linda J. Kristjanson
- School of Nursing and Public Health, Edith Cowan University, Churchlands, Western Australia, Australia
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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: 10] [Impact Index Per Article: 2.0] [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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Abstract
This article presents a scoping review of 74 papers from the peer reviewed literature dealing with occupational therapy in palliative care. Five themes emerged regarding the parameters of occupational therapy in palliative care. The themes include: the importance of valued occupations even at the end of life, an exploration of how occupations change over the trajectory of a terminal illness, the balance between affirming life and preparing for death, valued occupations might be doing, being, becoming, or belonging occupations and the emphasis of a safe and supportive environment as an essential dimension for effective palliative care. These five themes are combined to form a model to guide occupational therapy in palliative care. The model offers structure and direction for occupational therapists in order to offer an opportunity for clients in palliative care to flourish toward the end of their lives.
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Affiliation(s)
| | - Mary Ann McColl
- b School of Rehabilitation Therapy , Queen's University , Kingston , Ontario , Canada
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Treggalles K, Lowrie D. An exploration of the lived experience of professional grief among occupational therapists working in palliative care settings. Aust Occup Ther J 2018; 65:329-337. [PMID: 29797520 DOI: 10.1111/1440-1630.12477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM Occupational therapists who work in palliative care are frequently exposed to the experience of death and dying. Previous occupational therapy research has offered insight into factors that influence feelings relating to death and dying and associated coping strategies. However, existing literature is dated and has not specifically examined the concept of grief. This study addresses this gap in knowledge by exploring the lived experience of professional grief among occupational therapists working in palliative care settings. METHODS Semi-structured interviews were conducted with six Australian palliative care occupational therapists. The data were collected and analysed using an interpretive phenomenological approach. RESULTS Four interrelated themes were identified as core to the lived experience of professional grief among participants. These included; 'knowledge of self', 'giving permission for connections and feelings', 'filtering experience' and 'being present at work and at home'. CONCLUSION Considered in combination, these themes offer a guide for therapists to explore their own experience of and responses to professional grief and, in doing so, foster the development of personalised management strategies.
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Affiliation(s)
- Kelly Treggalles
- College of Healthcare Sciences, Division of Tropical Health and Medicine, James Cook University
| | - Daniel Lowrie
- College of Healthcare Sciences, Division of Tropical Health and Medicine, James Cook University
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Eva G, Morgan D. Mapping the scope of occupational therapy practice in palliative care: A European Association for Palliative Care cross-sectional survey. Palliat Med 2018; 32:960-968. [PMID: 29756556 PMCID: PMC5946674 DOI: 10.1177/0269216318758928] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
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.
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Affiliation(s)
- Gail Eva
- Department of Clinical Sciences, Brunel University London, London, UK
| | - Deidre Morgan
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Abstract
Occupational therapy possesses few mid-range substantive theories, particularly those that have been derived empirically or generated within the profession. Grounded theory offers a systematic and well recognised approach to study the richness and diversity of human experience, in order to generate relevant theory. This paper describes grounded theory, its theoretical orientation and its elements, and offers a critique of the approach. A selection of grounded theory studies related to occupational therapy and occupational science are reviewed to demonstrate the contribution that the approach has begun to make to, and the potential that the approach offers for, developing empirically derived occupational therapy theories.
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Hammill K, Bye R, Cook C. Workforce profile of Australian occupational therapists working with people who are terminally ill. Aust Occup Ther J 2016; 64:58-67. [DOI: 10.1111/1440-1630.12325] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Kathrine Hammill
- School of Science and Health - Occupational Therapy; Western Sydney University; Penrith New South Wales Australia
| | - Rosalind Bye
- School of Science and Health - Occupational Therapy; Western Sydney University; Penrith New South Wales Australia
| | - Catherine Cook
- School of Science and Health - Occupational Therapy; Western Sydney University; Penrith New South Wales Australia
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Jacques ND, Hasselkus BR. The Nature of Occupation Surrounding Dying and Death. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2016. [DOI: 10.1177/153944920402400202] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article presents the findings from a study intended to help occupational therapists better understand the meaning of occupation surrounding dying and death at a small residential hospice in the midwestern United States. Residents, their families, and hospice staff participated in a 6-month ethnographic study involving participant observation, interviews with staff, a group interview, artifact and document review, and journal keeping by the first author. Four domains of occupation were identified as elements of the dying experience: continuing life, preparation for death, waiting, and death and after-death. In the context of dying, both mundane and unique occupations took on new forms of significance to the residents, families, and caregivers. These findings contribute to our understanding of the nature and meaning of occupation and how occupation creates the good death.
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Abstract
BACKGROUND Client-centered care is the cornerstone of the hospice and includes family members and significant others as the client unit. There needs to be a conceptual shift away from "medicalizing" patients at the end of life to promoting their health and considering their well-being a shared responsibility. Using the hospice philosophy of client-centered care can inform and expand health-promotion occupational therapy practice, particularly for people at the end of life. OBJECTIVES This paper examines client-centered care at the end of life as that which enables engagement in meaningful occupation and promotes health and well-being until one dies. METHODS Constant comparison and thematic analysis is used for 12 interviews of hospice professionals. One of the themes, client-centered care, is discussed relative to the promotion of health and well-being at the end of life. RESULTS Client-centered care is deemed to be an important approach at the end of life. CONCLUSIONS/SIGNIFICANCE It is determined that client-centered care at the end of life is vital to promote quality of life, health, and well-being. Further research is indicated.
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Affiliation(s)
- Michael A Pizzi
- a Department of Occupational Therapy, School of Health Professions, Long Island University , Brooklyn, NY, USA
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Kilgour E, Kosny A, McKenzie D, Collie A. Interactions between injured workers and insurers in workers' compensation systems: a systematic review of qualitative research literature. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:160-81. [PMID: 24832892 DOI: 10.1007/s10926-014-9513-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Work-related injury is a major public health problem and a worker's recovery can be shaped by their interactions with employers, healthcare providers and the workers' compensation system. Most research on the effects of compensation has concentrated on examining outcomes rather than considering the compensation process itself. There has been little attention paid to the interactions between stakeholders and only recently has the client's view been considered as worthy of investigation. This systematic review aimed to identify and synthesize findings from peer reviewed qualitative studies that investigated injured workers interactions with insurers in workers' compensation systems. METHOD A search of six electronic library databases revealed 1,006 articles. After screening for relevance, 18 articles were read in full and a search of those bibliographies revealed a further nine relevant articles. Quality assessment of the 27 studies resulted in a final 13 articles of medium and high quality being retained for data extraction. RESULTS Included studies focused mainly on experiences of injured workers, many of whom had long term claims. Findings were synthesized using a meta-ethnographic approach. Six themes were identified which characterised the interactions between insurers and injured workers. The majority of interactions were negative and resulted in considerable psychosocial consequences for injured workers. Positive interactions were less frequently reported and included respectful, understanding and supportive communication and efficient service from insurers. CONCLUSION Findings from this synthesis support the growing consensus that involvement in compensation systems contributes to poorer outcomes for claimants. Interactions between insurers and injured workers were interwoven in cyclical and pathogenic relationships, which influence the development of secondary injury in the form of psychosocial consequences instead of fostering recovery of injured workers. This review suggests that further research is required to investigate positive interactions and identify mechanisms to better support and prevent secondary psychosocial harm to injured workers.
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Affiliation(s)
- Elizabeth Kilgour
- Institute for Safety Compensation and Recovery Research (ISCRR), Monash University, Level 11, 499 St Kilda Rd, Melbourne, VIC, 3004, Australia,
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Hammill K, Bye R, Cook C. Occupational Therapy for People Living with a Life-Limiting Illness: A Thematic Review. Br J Occup Ther 2014. [DOI: 10.4276/030802214x14151078348594] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Kathrine Hammill
- Lecturer, University of Western Sydney, School of Science and Health, Occupational Therapy, Penrith, New South Wales, Australia
| | - Rosalind Bye
- Director of Academic Programs, School of Science and Health, Occupational Therapy, Penrith, New South Wales, Australia
| | - Catherine Cook
- Adjunct Professor, University of Western Sydney, School of Science and Health, Occupational Therapy, Penrith, New South Wales, Australia
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Boa S, Duncan EAS, Haraldsdottir E, Wyke S. Goal setting in palliative care: A structured review. PROGRESS IN PALLIATIVE CARE 2014. [DOI: 10.1179/1743291x14y.0000000097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Costa A, Othero M. Palliative Care, Terminal Illness, and the Model of Human Occupation. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2012. [DOI: 10.3109/02703181.2012.743205] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ana Costa
- 1Faculdade de Medicina da Universidade do Porto, Portugal
| | - Marilia Othero
- 2Departamento de Medicina Preventiva da Faculdade de Medicina da Universidade de S. Paulo, Brazil
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Lala AP, Kinsella EA. A Phenomenological Inquiry into the Embodied Nature of Occupation at End of Life. The Canadian Journal of Occupational Therapy 2011; 78:246-54. [DOI: 10.2182/cjot.2011.78.4.6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background. Occupational therapists propose that occupation is a basic human need across the lifespan. However, there is limited understanding of how occupation contributes to the end-of-life experience. Purpose. The purpose of this study was to examine the embodied nature of occupation at end of life from the perspectives of Canadians 60 years of age or older who are diagnosed with a terminal illness. Methods. The study adopted a phenomenological methodological approach to conduct semi-structured interviews with eight participants. Findings. Six themes were identified. Participants described orientations toward occupations that involved: living with death, reworking everyday life, being guided by the will of the body, giving priority to relationships, attending to the small things, and engaging existential orientations. Implications. This study contributes to knowledge about occupation at end of life and offers a starting point to guide practice that is attentive to the lived dimensions of occupation at end of life.
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Keesing S, Rosenwax L. Is occupation missing from occupational therapy in palliative care? Aust Occup Ther J 2011; 58:329-36. [DOI: 10.1111/j.1440-1630.2011.00958.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Klein J, Liu L. Ageism in Current Practice: Experiences of Occupational Therapists. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2010. [DOI: 10.3109/02703181.2010.532904] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstracts. Br J Occup Ther 2010. [DOI: 10.1177/03080226100738s101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Halkett GKB, Ciccarelli M, Keesing S, Aoun S. Occupational therapy in palliative care: Is it under-utilised in Western Australia? Aust Occup Ther J 2010; 57:301-9. [DOI: 10.1111/j.1440-1630.2009.00843.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Warne KE, Hoppes S. Lessons in living and dying from my first patient: an autoethnography. The Canadian Journal of Occupational Therapy 2009; 76:309-16. [PMID: 19891301 DOI: 10.1177/000841740907600410] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study examines the challenges and rewards of a fieldwork student's first encounter with death in a clinical setting and describes occupational interventions that affirm the life of a client preparing for death. PURPOSE To explore meanings, challenges, and lessons of end-of-life care for an occupational therapy fieldwork student. METHODS A qualitative format, autoethnography, was used to develop a narrative that reveals the lived experience of a fieldwork student. FINDINGS. Findings include a description of what a fieldwork student was and was not able to accomplish in end-of-life care. The paper describes using self-care activities to normalize and cede control of end-of-life care to the client and developing a vision of how to help clients find closure. IMPLICATIONS The study carries implications for students and therapists working in end-of-life care. Therapists and educators can draw from this study to better understand and support new therapists when patients die.
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Affiliation(s)
- Katie E Warne
- Acute Rehabilitation Services, St. John Medical Center, Tulsa, OK 74104, USA
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Schleinich MA, Warren S, Nekolaichuk C, Kaasa T, Watanabe S. Palliative care rehabilitation survey: a pilot study of patients' priorities for rehabilitation goals. Palliat Med 2008; 22:822-30. [PMID: 18772213 DOI: 10.1177/0269216308096526] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rehabilitation in palliative care is often overlooked. Settings that do consider occupational or physical therapy for palliative care patients often consult to therapists with competing caseloads. Few therapists specialise in palliative care, but nearly all ask, 'What needs doing'? and 'How well am I doing that'? No existing instruments address their questions. The objective is to develop and test a questionnaire for identifying patient goals and priorities for rehabilitation in palliative care. A questionnaire representing 11 domains of the Canadian Model of Occupational Performance was designed and pilot tested at four palliative care sites. Each question reflected a typical rehabilitation intervention in palliative care. Patients were asked to rate how important each of these interventions was on a numerical rating scale (0, not important-10, extremely important). Open-ended questions captured verbatim comments regarding thoughts of rehabilitation. The questionnaire was tested for test-retest reliability with two interviews approximately 1 week apart. Forty patients participated in the first interview and 32 in the second. Eight of eleven domain sub-scores achieved an intra-class correlation coefficient of 0.6 or higher. The highest means were for the physical (8.2), institutional (7.8) and self-care (7.8) domains on the first interview and for the spiritual domain (7.9) on the second interview. Suggestions are provided to shorten the questionnaire and strengthen validity. This work furthers the understanding of the role of rehabilitation in palliative care. It also illustrates the feasibility of involving palliative care patients in research that contributes to setting standards and measuring quality of service.
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Affiliation(s)
- M A Schleinich
- Tertiary Palliative Care Unit, Grey Nuns Community Hospital, Edmonton, Alberta, Canada.
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Kealey P, McIntyre I. An evaluation of the domiciliary occupational therapy service in palliative cancer care in a community trust: a patient and carers perspective. Eur J Cancer Care (Engl) 2005; 14:232-43. [PMID: 15952967 DOI: 10.1111/j.1365-2354.2005.00559.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- P Kealey
- Palliative Care, Iveagh Buildings, Belfast BT12 6HF, UK.
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Cooper J, Littlechild B. A study of occupational therapy interventions in oncology and palliative care. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2004. [DOI: 10.12968/ijtr.2004.11.7.13362] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rahman H. Journey of providing care in hospice: perspectives of occupational therapists. QUALITATIVE HEALTH RESEARCH 2000; 10:806-818. [PMID: 11146860 DOI: 10.1177/104973200129118831] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
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.
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Affiliation(s)
- H Rahman
- Providence Everett Medical Center, Everett, Washington, USA
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