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Brose JM, Willis E, Morgan DD. Occupational adaptation for adults living with advanced cancer: A phenomenological longitudinal study. Aust Occup Ther J 2024; 71:52-63. [PMID: 37806961 DOI: 10.1111/1440-1630.12908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION People living with advanced cancer want to continue participating in their valued occupations amid cancer progression. However, increasing dependence and bodily deterioration challenge a person's ability to do so, thus requiring adaptation to how they engage in their occupations. Theoretical frameworks on the process of occupational adaptation often do not address the implications of progressive functional decline. METHODS A longitudinal phenomenological design was used to understand the lived experience of occupational engagement for working-aged adults living with advanced cancer. A semi-structured interview series explored participants' experience of occupational engagement and how this changed over time. Data were analysed thematically and mapped against the Model of Human Occupation (MOHO). FINDINGS Eight adults (40-64 years old) participated in 33 interviews over 19 months. Three themes were constructed from the data: ongoing adaptation through doing, the significance of volition in adaptation, and everyday life is contingent on my environment. Study findings demonstrate that the process of adaptation occurs through occupational engagement, is motivated by volition, and is affected by the environment. Volition and the environment play a more central role in occupational adaptation than occupational competency for the advanced cancer cohort. CONCLUSION Study findings further MOHO's theoretical conceptualisation of occupational adaptation by identifying the centrality of volition and the environment in the process of adaptation. For people living with advanced cancer, disease progression results in unremitting functional decline, thus rendering competency an unstable and untenable construct. Rather, this paper argues that occupational adaptation is facilitated by volition (i.e., the motivation behind the doing) and the environment, thus fostering a sense of identity and meaning at the end of life. Occupational therapists' awareness of the significance of volition and the environment can thus foster continued occupational engagement and meaning at the end of life for people living with advanced cancer.
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Affiliation(s)
- Julie M Brose
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Research Centre for Palliative Care Death and Dying (RePaDD), College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Eileen Willis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Deidre D Morgan
- Research Centre for Palliative Care Death and Dying (RePaDD), College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Smith KS, Kinsella EA, Moodie S, McCorquodale L, Teachman G. Mindfulness and therapeutic relationships: A phenomenological inquiry into paediatric occupational therapists' practices. Scand J Occup Ther 2023; 30:1441-1450. [PMID: 37256557 DOI: 10.1080/11038128.2023.2217670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/19/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND A growing body of literature points to the potential of mindfulness to support therapeutic relationships, and the importance of the therapeutic relationship when working with children and youth, yet little attention has been paid to this topic in occupational therapy. AIMS/OBJECTIVES The aim of this study was to inquire into occupational therapists' experiences of mindfulness in the therapeutic relationship with children and youth. MATERIALS AND METHODS Hermeneutic phenomenology was the methodological approach, with Heidegger's concepts of being-with and care as theoretical underpinnings of the study. Eight North American occupational therapists participated in semi-structured interviews that elicited first-hand accounts of mindfulness in the therapeutic relationship with children and youth. Interviews were transcribed verbatim and analysed using a phenomenological approach. RESULTS Four key themes were identified: fostering a safe space, enhancing presence, being authentic, and cultivating acceptance. CONCLUSIONS AND SIGNIFICANCE The findings offer insights regarding the potential affordances of mindfulness to support clinicians in the development of therapeutic relationships with children and youth. Further, this study highlights research priorities for future inquiry.
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Affiliation(s)
- Kirsten Sarah Smith
- Graduate Program in Health and Rehabilitation Sciences, University of Western Ontario, London, Canada
| | - Elizabeth Anne Kinsella
- Graduate Program in Health and Rehabilitation Sciences, University of Western Ontario, London, Canada
- Department of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Sheila Moodie
- Graduate Program in Health and Rehabilitation Sciences, University of Western Ontario, London, Canada
- National Centre for Audiology, University of Western Ontario, London, Canada
| | - Lisa McCorquodale
- Graduate Program in Health and Rehabilitation Sciences, University of Western Ontario, London, Canada
- School of Occupational Therapy, University of Western Ontario, London, Canada
| | - Gail Teachman
- Graduate Program in Health and Rehabilitation Sciences, University of Western Ontario, London, Canada
- School of Occupational Therapy, University of Western Ontario, London, Canada
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Guay M, Drolet MJ, Kühne N, Talbot-Coulombe C, Mortenson WB. What If Deliberately Dying Is an Occupation? Am J Occup Ther 2022; 76:23300. [PMID: 35709000 DOI: 10.5014/ajot.2022.047357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
In some legal and societal circumstances, people freely and capably plan, organize, and precipitate their own death. Drawing on published literature, we critically reflect on how deliberately ending one's own life fits with the current definitions of the concept of occupation. Using an occupational science and occupational therapy theoretical reflection, we argue that deliberately dying can for some people be considered a purposeful and meaningful occupation. Implications for such an occupational therapy practice are discussed: attending to the occupational needs of specific groups of people, reconsidering definitions and conceptual work, advocating for occupational justice in ending life activities, reflecting on ethical conundrums around self-harm activities within the scope of practice, and exploring deliberate death as a purposeful and meaningful occupation. Because deliberately dying is something that some people do, in this article we aim to open a dialogue within the field of occupational science and occupational therapy about this sensitive and potentially controversial issue.
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Affiliation(s)
- Manon Guay
- Manon Guay, OT, PhD, is Associate Professor, School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada;
| | - Marie-Josée Drolet
- Marie-Josée Drolet, OT, PhD, is Full Professor, Department of Occupational Therapy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Nicolas Kühne
- Nicolas Kühne, OT, PhD, is Full Professor, Department of Occupational Therapy, University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Claudia Talbot-Coulombe
- Claudia Talbot-Coulombe, OT, MSc, is Research Assistant, Research Center on Aging, Sherbrooke, Quebec, Canada
| | - W Ben Mortenson
- W. Ben Mortenson, OT, PhD, is Associate Professor, Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Lim GH, Yong C, Breen LJ, Keesing S, Buchanan A. Occupations of Terminally Ill Chinese Older Adults and Their Caregivers in Singapore: A Qualitative Exploratory Study. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221108288. [PMID: 35701184 DOI: 10.1177/00302228221108288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Occupations are everyday activities people do that bring meaning and purpose to life and is culturally shaped. This research aimed to explore the occupations of Chinese older adults living with a terminal illness and their caregivers in Singapore. Using a qualitative exploratory approach, 16 care recipient-family caregiver dyads were recruited from a local hospice provider. Semi-structured interviews were carried out and reflexive thematic analysis was employed. Three themes and seven subthemes described the challenges and changes to daily life faced by care recipients and caregivers as they adjusted to living with the terminal condition. Findings suggest that in a family-centric society, the occupations of care recipients are greatly impacted by their families. It is imperative to engage with family members in goal setting and intervention plans to facilitate therapy gains and carry-over into real life. These results may be applicable to other family-centric societies, but further research is required.
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Affiliation(s)
- Geck Hoon Lim
- Curtin School of Allied Health, Curtin University, Bentley, WA, Australia
- Health & Social Sciences, Singapore Institute of Technology, Singapore, Singapore
| | - Celine Yong
- Allied Health, Assisi Hospice, Singapore, Singapore
| | - Lauren J Breen
- School of Population Health, Curtin University, Bentley, WA, Australia
- Curtin enAble Institute, Curtin University, Bentley, WA, Australia
| | - Sharon Keesing
- Curtin School of Allied Health, Curtin University, Bentley, WA, Australia
| | - Angus Buchanan
- Curtin School of Allied Health, Curtin University, Bentley, WA, Australia
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Talbot-Coulombe C, Bravo G, Carrier A. Occupational Therapy Practice in Palliative and End-of-Life Care in Québec. Can J Occup Ther 2022; 89:201-211. [PMID: 35243918 PMCID: PMC9136369 DOI: 10.1177/00084174221084466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Claudia Talbot-Coulombe
- Claudia Talbot-Coulombe, Health Sciences Research Programs, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada. Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l’Estrie-Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
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The Complexities of Prescribing Assistive Equipment at the End of Life—Patient and Caregivers’ Perspectives. Healthcare (Basel) 2022; 10:healthcare10061005. [PMID: 35742056 PMCID: PMC9222988 DOI: 10.3390/healthcare10061005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 02/01/2023] Open
Abstract
Ongoing participation in valued and essential everyday activities remains a priority for people with advanced disease. This study sought to understand factors influencing patients with advanced disease and caregivers’ utilisation of assistive equipment that enable this participation. Employing a pragmatic approach, purposive sampling identified participants who were interviewed in their homes. A semi-structured interview guide was employed to elicit community dwelling patients’ and caregivers’ perspectives about assistive equipment utilisation. Recorded interviews were analysed inductively and themes were constructed from the data. Fourteen interviews were conducted with patients and caregivers. Patients had a range of cancers and COPD. Three empirically developed themes demonstrate the complexities associated with the use of assistive equipment at the end of life: 1. Enabling engagement in everyday activities; 2. Dependency—a two-way street; 3. The pragmatics of choosing, using or declining assistive equipment. Participants were motivated to use assistive equipment when it optimised their function, enabled participation and supported their values, roles and interests. Conversely, use of assistive equipment could be met with ambivalence as it represented deterioration or could cause conflict within relationships. Caregivers found assistive equipment made it easier for them to provide physical care. Skilled proactive assistive equipment prescription and training by allied health professionals enhanced patient and caregiver confidence and capacity to engage in everyday activities.
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Morgan DD, Taylor RR, Ivy M, George S, Farrow C, Lee V. Contemporary occupational priorities at the end of life mapped against Model of Human Occupation constructs: A scoping review. Aust Occup Ther J 2022; 69:341-373. [PMID: 35199343 DOI: 10.1111/1440-1630.12792] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/21/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION People with end-of-life care needs are seen in an increasingly diverse range of health and community settings. Opportunity for continued occupational participation is highly valued by people at the end of life. This scoping review sought to identify the priorities and preferences for participation at the end of life and to map findings using the model of human occupation. METHODS A search strategy informed by the research question was developed in collaboration with a research librarian. Data sources used were Ovid Medline(R), CINAHL, Ovid Emcare, Scopus, Web of Science and PsychInfo. Studies that focused on clinician perspectives, clinical care, grief and loss, did not clearly identify end-stage diseases, <18 years and written in languages other than English were excluded. FINDINGS Forty-four studies were included with a total of 1,070 study participants. Inductively developed themes were mapped against the model of human occupation constructs of volition (personal causation, values, interests), habituation (habits of occupational performance and routine), performance capacity and the lived body within the physical, social and occupational environment. The majority of findings sat within the construct of volition, particularly around sense of personal capacity, self-efficacy and values. At the end of life, people prioritise ongoing engagement in valued occupations even if participation is effortful. As disease progresses, opportunity to exert influence and control over this participation and engagement increases in importance. Personal causation plays an important role in the experience of occupational participation at this time. CONCLUSION This review provides important insights into the occupational priorities of people at the end of life and the importance of supporting agency and volition at this time. The model of human occupation and its client-centred focus offer a framework for a more robust examination of ways to enhance volitional capacity and enable occupational participation for people at the end of life.
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Affiliation(s)
- Deidre D Morgan
- Research Centre for Palliative Care, Death and Dying (RePaDD), College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Renée R Taylor
- Director, Model of Human Occupation Clearinghouse, Department of Occupational Therapy, University of Illinois, Chicago, Illinois, USA
| | - Mack Ivy
- Rehabilitation Services, MD Anderson Cancer Center, Manvel, Texas, USA
| | - Stacey George
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Caroline Farrow
- SA Health, Northern Adelaide Palliative Care Service, Adelaide, South Australia, Australia
| | - Vincci Lee
- Eastern Health, Box Hill Hospital, Box Hill, Victoria, Australia
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Kessner K, Hitch D. Development of an evidence-informed education package for occupational therapists for palliative and end of life care: promoting occupational justice. CADERNOS BRASILEIROS DE TERAPIA OCUPACIONAL 2022. [DOI: 10.1590/2526-8910.ctore23883117] [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
Abstract Introduction Death is inevitable, yet hospitals and health services continue to focus on life-sustaining practices despite clients presenting with clear decline related to life-limiting illness. Social and occupational injustice is common for clients receiving palliative or end-of-life care, as they experience increased occupational disengagement and disempowerment. A gap was identified in the Occupational Therapy department of a metropolitan Australian hospital regarding clinician skills, knowledge and confidence in working with these clients. Objective To describe the development of an evidence informed education package designed to support occupational therapists to provide the best possible quality of care and promote occupational justice for clients receiving palliative or end-of-life care. Method Consultation with key stakeholders and a review of existing resources including a skills audit, was conducted to identify current practice. A review of professional and grey literature was completed, and benchmarking with similar organisations provided a wider perspective on current Australian practice. Review of widely available educational resources were evaluated. Results Baseline data collection confirmed that promoting occupational and social justice for people requiring palliative or end-of-life care was under-recognised across the health service. Benchmarking identified significant variation in educational practices across similar Australian health services. The structure and content of a face-to-face clinical education session was formulated using evidence from the literature review and relevant available resources. There are plans to transfer this education package to an e-learning platform with evaluation built into the package to allow content to remain up to date. Conclusion Occupational Therapy clinicians are well placed to promote occupational and social justice for people requiring palliative or end-of-life care but require additional occupationally focused education to optimise their practice in this area.
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Morgan DD, Marston C, Barnard E, Farrow C. Conserving dignity and facilitating adaptation to dependency with intimate hygiene for people with advanced disease: A qualitative study. Palliat Med 2021; 35:1366-1377. [PMID: 34044651 DOI: 10.1177/02692163211017388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND People at the end of life experience increased dependence with self-care as disease progresses, including care with intimate hygiene. Dependence with intimate hygiene has been identified as a factor that may compromise dignity at the end of life. However, adaption to increased dependency and subsequent impact on dignity with intimate hygiene is an under-researched area. AIM This study sought to understand how people at the end of life experience dignity with intimate hygiene when function declines and how people adapt to increased dependence with intimate hygiene needs. DESIGN A qualitative design was employed using a hermeneutic phenomenological perspective which privileges participant perspectives. Findings were mapped against occupational therapy and dignity literature. SETTING/PARTICIPANTS Participants were people with advanced disease receiving inpatient or community palliative care. RESULTS Eighteen interviews were conducted with people about their experiences and perspectives of dignity with intimate hygiene. The following themes were constructed from the data: (1) There's a way of doing and a way of asking, (2) Putting each other at ease, (3) It's just how it is, (4) Regaining and retaining control. How people adjust to dependence with intimate hygiene is individually mediated. Patterns of occupational adaptation to increased dependence with intimate hygiene and practical implications for care are discussed. CONCLUSION Adaptation to increased dependence with intimate hygiene is facilitated by enabling moments of micro-competence and agency over how care is received. Carers play a pivotal role in compromising or conserving the dignity with intimate hygiene at the end of life.
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Affiliation(s)
- Deidre D Morgan
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Research Centre for Palliative Care, Death and Dying (RePaDD), Adelaide, SA, Australia
| | - Celia Marston
- Clinical Lead, Occupational Therapy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Research Lead, Occupational Therapy, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Elizabeth Barnard
- Department for Health and Wellbeing: SA Health, Northern Adelaide Local Health Network (NALHN), Adelaide, SA, Australia
| | - Caroline Farrow
- Department for Health and Wellbeing: SA Health, Northern Adelaide Palliative Service (NAPS), Northern Adelaide Local Health Network (NALHN), Adelaide, SA, Australia
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Figueiredo CDS, Ferreira EF, Assis MG. Death and Dying in Long-Term Care Facilities: The Perception of Occupational Therapists. OMEGA-JOURNAL OF DEATH AND DYING 2021; 87:177-193. [PMID: 34024180 DOI: 10.1177/00302228211019206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
End-of-life care in long-term care facilities for older adults requires numerous skills. However, many professionals, including occupational therapists, feel unprepared to deal with death and dyingand have difficulties to attend to the real needs of the older adults and their families.This is a qualitative study anchored in phenomenologywhich had the objective to understand the perception of occupational therapists regarding death and dying inlong-term care facilities. Data were collected through focus groups and analyzed by thematic content analysis. A total of 12 occupational therapists participated in this study, and two themeswere generated: "The Experience of Death and Dying" and "The Occupational Therapist's approach in Facing Death and Dying". These results may contribute to improvingthe care provided to older adults in the process of death and dying.
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Affiliation(s)
- Carolina de S Figueiredo
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Efigênia F Ferreira
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marcella G Assis
- Dentistry School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Bentz HH, Madsen SH, Pilegaard MS, Østergaard LG, Brandt Å, Offersen SMH, la Cour K. Occupations creating joy for people living with advanced cancer: A qualitative descriptive study. Br J Occup Ther 2021. [DOI: 10.1177/03080226211009419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Hannah Holt Bentz
- Department of Occupational Therapy, University College Absalon, Næstved, Denmark
| | | | - Marc Sampedro Pilegaard
- Occupational Science & Occupational Therapy, Research Unit for User Perspectives & Community‐based Intervention, Department of Public Health, University of Southern Denmark, Odense, Denmark
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative care, Odense University Hospital, Nyborg, Denmark
| | - Lisa Gregersen Østergaard
- Occupational Science & Occupational Therapy, Research Unit for User Perspectives & Community‐based Intervention, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Institute of Clinical Medicine, Aarhus University, Aarhus C, Denmark
| | - Åse Brandt
- Occupational Science & Occupational Therapy, Research Unit for User Perspectives & Community‐based Intervention, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Karen la Cour
- Occupational Science & Occupational Therapy, Research Unit for User Perspectives & Community‐based Intervention, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Peoples H, Nissen N, Brandt Å, la Cour K. Perceptions of quality of life by people with advanced cancer who live at home. Br J Occup Ther 2020. [DOI: 10.1177/0308022620976839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Cancer in advanced stages often results in a reduced ability to engage in occupations, which may influence quality of life. A growing number of people with advanced cancer receive palliative care at home and thus the home becomes the place where most of their everyday occupations occur. The purpose of this study was to explore, from an occupational perspective, how people with advanced cancer who live at home perceive quality of life. Method A qualitative descriptive design was employed, consisting of two consecutive interviews: a semi-structured interview and a subsequent photo-elicitation interview. Thematic analysis was used to explore the data. Ten participants took part in this study. Findings The analysis identified three interrelated themes: ‘quality of life during changing circumstances’; ‘striving to continue everyday life’ and ‘being independent and connected’. Conclusion The findings highlight the importance of everyday life continuity and ongoing changes and adjustments needed to maintain quality of life. However, due to the progressive nature of advanced cancer, the required adjustments may not always be possible. The findings furthermore show that loss of independence and increased dependence may lead to a new sense of interdependence and closeness with family and friends, which positively influences quality of life.
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Affiliation(s)
- Hanne Peoples
- Health Sciences Research Center, UCL, University of Southern Denmark, Odense, Denmark
| | - Nina Nissen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Åse Brandt
- Department of Public Health, General Practice, University of Southern Denmark, Odense, Denmark
- The National Board of Social Services, Odense, Denmark
| | - Karen la Cour
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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la Cour K, Gregersen Oestergaard L, Brandt Å, Offersen SMH, Lindahl-Jacobsen L, Cutchin M, Pilegaard MS. Process evaluation of the Cancer Home-Life Intervention: What can we learn from it for future intervention studies? Palliat Med 2020; 34:1425-1435. [PMID: 32611224 DOI: 10.1177/0269216320939227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Cancer Home-Life Intervention showed no significant effects, and examination of the processes affecting or inhibiting outcomes is relevant. AIM To evaluate the Cancer Home-Life Intervention for its processes of implementation, mechanisms of impact and contextual factors. DESIGN Process evaluation conducted alongside the randomised controlled trial, using quantitative and qualitative methods (ClinicalTrials.gov NCT02356627). The Cancer Home-Life Intervention is a tailored, occupational therapy-based programme. SETTING/PARTICIPANTS This study took place in participants' homes and at hospital. A total of 113 home-dwelling adults (⩾18 years) with advanced cancer who had received the Cancer Home-Life Intervention were included, together with five intervention-therapists. RESULTS All 113 participants (100%) received a first home visit; 32 participants (26%) received a second visit; and 4 participants (3%) received a third visit. Median number of delivered intervention components were 3 (interquartile range: 2; 4). Identified barriers for effect included unclear decision process for intervention dosage; participants' low expectations; participants' lack of energy; and insufficient time to adopt new strategies. The trial design constituted a barrier as the intervention could only be provided within a specific short period of time and not when relevant. Intervention components working to solve practical everyday problems, enhance enjoyment and increase a sense of safety were perceived as useful. CONCLUSION Future interventions can benefit from inclusion criteria closely related to the intervention focus and clear procedures for when to continue, follow-up and terminate intervention. Decisions about dose and timing may benefit from learning theory by taking into account the time and practice needed to acquire new skills.
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Affiliation(s)
- Karen la Cour
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| | - Lisa Gregersen Oestergaard
- DEFACTUM, Central Denmark Region, Aarhus, Denmark.,Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark.,The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Åse Brandt
- The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Sara Marie Hebsgaard Offersen
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Aarhus, Denmark
| | - Line Lindahl-Jacobsen
- The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark.,University College Absalon, Center for Nutrition and Rehabilitation, Sorø, Denmark
| | - Malcolm Cutchin
- Department of Health Care Sciences, Wayne State University, Detroit, MI, USA
| | - Marc Sampedro Pilegaard
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark.,The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
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Chow JK, Pickens ND. Measuring the Efficacy of Occupational Therapy in End-of-Life Care: A Scoping Review. Am J Occup Ther 2020; 74:7401205020p1-7401205020p14. [PMID: 32078513 PMCID: PMC7018467 DOI: 10.5014/ajot.2020.033340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Underutilization of hospice occupational therapy may be attributable to a lack of evidence on efficacy. OBJECTIVE To conduct a scoping review of occupational therapy outcome studies to ascertain how efficacy is captured in the literature. DATA SOURCES PubMed, CINAHL, MEDLINE, Scopus, Directory of Open Access Journals, Web of Science, OT Search, and Google Scholar. STUDY SELECTION AND DATA COLLECTION Search terms: hospice, palliative care, occupational therapy, rehabilitation, outcome measure, and assessment. Inclusion criteria: research studies in English, centered on adult hospice care, published between January 1997 and September 2017, and investigated occupational therapy efficacy with an outcome measure. Exclusion criteria: systematic reviews, participants not at terminal disease end stages, or intervention program reviews lacking differentiated occupational therapy outcomes. FINDINGS Seven articles met the inclusion criteria. Findings include frequent use of noncontrolled, quasi-experimental, prospective research designs; a focus on occupational performance; and no generally accepted hospice occupational therapy outcome measure. CONCLUSION AND RELEVANCE Outcome measures of participation in end-of-life occupations and environmental influences on occupational engagement are needed to effectively support occupational therapy practice and research with people who are terminally ill. WHAT THIS ARTICLE ADDS Occupational therapy in end-of-life care is growing in complexity yet remains low in utilization. This review adds insights into current practice and future research foci for the profession.
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Affiliation(s)
- Janice Kishi Chow
- Janice Kishi Chow, DOT, MA, OTR/L, is Occupational Therapist, Physical Medicine and Rehabilitation Services, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA, and Doctoral Candidate, School of Occupational Therapy, Texas Woman's University, Dallas;
| | - Noralyn Davel Pickens
- Noralyn Davel Pickens, PhD, OT, is Professor, School of Occupational Therapy, Texas Woman's University, Dallas
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Tavemark S, Hermansson LN, Blomberg K. Enabling activity in palliative care: focus groups among occupational therapists. BMC Palliat Care 2019; 18:17. [PMID: 30732615 PMCID: PMC6367774 DOI: 10.1186/s12904-019-0394-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 01/15/2019] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Sofia Tavemark
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-70182, Örebro, Sweden.,Örebro Municipality, Healthcare and Social Services, Örebro, Sweden
| | - Liselotte N Hermansson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-70182, Örebro, Sweden.,University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-70182, Örebro, Sweden.
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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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17
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Maersk JL, Cutchin MP, la Cour K. Identity and home: Understanding the experience of people with advanced cancer. Health Place 2018; 51:11-18. [PMID: 29501690 DOI: 10.1016/j.healthplace.2018.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/31/2018] [Accepted: 02/09/2018] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to explore how the identity of people with advanced cancer is influenced by their experiences of living at home. A total of 28 in-depth interviews were conducted with 22 people with advanced cancer and four spouses. Grounded theory guided the collection and analysis of data. Home tours and associated field notes augmented the interview data. The analysis revealed that support of participants' identity was reflected in their abilities to live and occupy the home during daily activities, and in the ways the home and objects functioned as referents to themselves and their past. Threats to their identity ensued as the home environment became unmanageable during daily activities and as homecare professionals and assistive devices entered the home. By supporting people with advanced cancer in maintaining daily activities in the home and reducing changes in the home caused by homecare it is possible to reduce loss of identity.
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Affiliation(s)
- Jesper Larsen Maersk
- University of Southern Denmark, Research Unit of General Practice, Research Initiative for Activity Studies and Occupational Therapy, JB Winsloews vej 9, 5000 Odense C, Denmark; University College Absalon, Department of Occupational Therapy, Parkvej 190, 4700 Naestved, Denmark; The Social and Health Academy, Vestensborg Alle 78, 4800 Nykoebing Falster, Denmark.
| | - Malcolm P Cutchin
- Wayne State University, Department of Health Care Sciences, 259 Mack Ave., Detroit, MI 48201, United States.
| | - Karen la Cour
- University of Southern Denmark, Research Unit of General Practice, Research Initiative for Activity Studies and Occupational Therapy, JB Winsloews vej 9, 5000 Odense C, Denmark.
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18
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Arntzen C. An Embodied and Intersubjective Practice of Occupational Therapy. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2017; 38:173-180. [DOI: 10.1177/1539449217727470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The literature on clinical reasoning tends to ignore the context and the interaction between patient and therapist. This article outlines a theoretical foundation for an extended mode of clinical reasoning in occupational therapy. Cognitive theories of human action, as well as narrative and instrumental approaches, provide an insufficient picture of the nature of clinical reasoning in occupational therapy practice. An embodied intersubjective clinical reasoning can function as an adjunct to traditional clinical reasoning in occupational therapy practice and is discussed through the concepts of the ambiguous body, incorporation of things, and the process of shared meaning-making. This mode of reasoning can help occupational therapy practitioners to be aware of how they influence the patient’s perception of body, self, and world. It can promote a better understanding of details in embodied performances and in the co-construction of meaning, positively influencing occupation, participation, and health.
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Affiliation(s)
- Cathrine Arntzen
- University of Tromsø, The Arctic University of Norway, Norway
- Division of Rehabilitation Services, University Hospital of North Norway, Tromsø, Norway
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Peoples H, Brandt Å, Wæhrens EE, la Cour K. Managing occupations in everyday life for people with advanced cancer living at home. Scand J Occup Ther 2016; 24:57-64. [PMID: 27578556 DOI: 10.1080/11038128.2016.1225815] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND People with advanced cancer are able to live for extended periods of time. Advanced cancer can cause functional limitations influencing the ability to manage occupations. Although studies have shown that people with advanced cancer experience occupational difficulties, there is only limited research that specifically explores how these occupational difficulties are managed. OBJECTIVE To describe and explore how people with advanced cancer manage occupations when living at home. MATERIAL AND METHODS A sub-sample of 73 participants from a larger occupational therapy project took part in the study. The participants were consecutively recruited from a Danish university hospital. Qualitative interviews were performed at the homes of the participants. Content analysis was applied to the data. RESULTS Managing occupations were manifested in two main categories; (1) Conditions influencing occupations in everyday life and (2) Self-developed strategies to manage occupations. SIGNIFICANCE The findings suggest that people with advanced cancer should be supported to a greater extent in finding ways to manage familiar as well as new and more personally meaningful occupations to enhance quality of life.
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Affiliation(s)
- Hanne Peoples
- a Department of Public Health, Research Unit for General Practice, The Research Initiative for Activity Studies and Occupational Therapy , University of Southern Denmark , Odense , Denmark
| | - Åse Brandt
- a Department of Public Health, Research Unit for General Practice, The Research Initiative for Activity Studies and Occupational Therapy , University of Southern Denmark , Odense , Denmark.,b The National Board of Social Services , Odense , Denmark
| | - Eva E Wæhrens
- a Department of Public Health, Research Unit for General Practice, The Research Initiative for Activity Studies and Occupational Therapy , University of Southern Denmark , Odense , Denmark.,c The Parker Institute, University Hospital Bispebjerg & Frederiksberg , Copenhagen , Denmark
| | - Karen la Cour
- a Department of Public Health, Research Unit for General Practice, The Research Initiative for Activity Studies and Occupational Therapy , University of Southern Denmark , Odense , Denmark
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20
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Hay ME, Connelly DM, Kinsella EA. Embodiment and aging in contemporary physiotherapy. Physiother Theory Pract 2016; 32:241-50. [DOI: 10.3109/09593985.2016.1138348] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Melissa E. Hay
- Health & Rehabilitation Sciences, University of Western Ontario, London, ON, Canada
| | - Denise M. Connelly
- School of Physical Therapy, University of Western Ontario, London, ON, Canada
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Verikios D, Hitch D, Andriske L. Achieving occupational goals with the TAPit: A case study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.4.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: The Touch Accessible Platform for Interactive Technology (TAPit) is an interactive learning station, with a large touch screen providing access to the Internet and other resources. The aim of this study was to investigate the physical, psychosocial and functional impact of the TAPit on an individual living with spinal cord injury. Methods: This study employed a mixed methods case study design. Quantitative data was analysed descriptively, and both quantitative and qualitative data was classified according to the dimensions. Results: The introduction of the TAPit to the participant addressed aspects of doing, being, becoming and belonging, and had an immediate and successful impact for her, as she achieved two long-held and meaningful goals during a short trial. Strengths and limitations for the TAPit were identified in regards to people with spinal cord injury, along with directions for future development. Conclusions: This case study provides the first evidence about the effectiveness of the TAPit as an item of assistive technology for people with spinal cord injury, including participant perspectives on its use. This study demonstrates its potential as a device to support people to be able to participate in meaningful activities and occupations and that the provision of suitable adaptations and apps are the key to its success.
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Affiliation(s)
- Debbie Verikios
- Clinical Lead Occupational Therapist, Trauma Rehabilitation, Barwon Health, Geelong, Victoria, Australia
| | - Danielle Hitch
- Senior Lecturer, Deakin University, Geelong, Victoria, Australia
| | - Larissa Andriske
- Clinical Lead Occupational Therapist, Neurology, Barwon Health, Geelong, Victoria, Australia
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23
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Marston C, Agar M, Brown T. Patients’ and caregivers’ perceptions of occupational therapy and adapting to discharge home from an inpatient palliative care setting. Br J Occup Ther 2015. [DOI: 10.1177/0308022615586417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Celia Marston
- Lecturer, Monash University, Melbourne, Victoria, Australia and Senior Occupational Therapist, Department of Palliative and Supportive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Meera Agar
- Director of Palliative Care, Department of Palliative Care, Braeside Hospital, HammondCare, Sydney, New South Wales, Australia
- Conjoint Associate Professor, South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Senior Lecturer, Discipline of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
| | - Ted Brown
- Associate Professor, Department of Occupational Therapy, Monash University, Melbourne, Victoria, Australia
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Morgan DD, Currow DC, Denehy L, Aranda SA. Living actively in the face of impending death: constantly adjusting to bodily decline at the end-of-life. BMJ Support Palliat Care 2015; 7:179-188. [DOI: 10.1136/bmjspcare-2014-000744] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 03/17/2015] [Accepted: 06/23/2015] [Indexed: 11/03/2022]
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"It's not about treatment, it's how to improve your life": The lived experience of occupational therapy in palliative care. Palliat Support Care 2015; 14:225-31. [PMID: 26073536 DOI: 10.1017/s1478951515000826] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES A key aim of palliative care is to improve the quality-of-life of people with a life-threatening illness. Occupational therapists are well positioned to contribute to this aim due to their broad range of interventions, client-centeredness and focus on occupation. However, there is a limited understanding of how occupational therapy contributes to the end-of-life experience, which is crucial to providing optimal care. The aim of this study is to investigate the lived experience of occupational therapy in palliative care for people with a life-threatening illness. METHOD A hermeneutic interpretive phenomenological approach was adopted. Semi-structured interviews were conducted with eight participants recruited from inpatient and outpatient sectors of a specialist palliative care hospital in Sydney, Australia. RESULTS The two themes developed from participant responses were: (1) occupational therapy provides comfort and safety and (2) trusting the occupational therapist to know what is needed. SIGNIFICANCE OF RESULTS This study gives insight into the ways in which people with a life-threatening illness experience occupational therapy in palliative care. In addition, it provides a starting point to guide practice that is attentive to the needs of people with a life-threatening illness at end-of-life, thus enhancing client-centered care.
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Abstract
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.
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“Running Water Won't Freeze”: How people with advanced Parkinson's disease experience occupation. Palliat Support Care 2014; 13:1363-72. [DOI: 10.1017/s1478951514001357] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective: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.
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Hitch D, Pépin G, Stagnitti K. In the footsteps of Wilcock, Part two: The interdependent nature of doing, being, becoming, and belonging. Occup Ther Health Care 2014; 28:247-63. [PMID: 24694178 DOI: 10.3109/07380577.2014.898115] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The four dimensions of occupation developed by Wilcock in the Occupational Perspective on Health-doing, being, becoming, and belonging-have evolved. Although the inter-relationships between the dimensions have been explored by clinicians and researchers to some degree, the reciprocal and multidimensional nature of these relationships are rarely explicitly addressed. This article will present a critical analysis of the relationships and interaction between doing, being, becoming, and belonging, initially in dyads and then in a multidimensional way. The article proposes provisional understandings of how they combine and influence each other in occupational engagement. Six observations are made on the dimensions of occupation, along with a discussion of the impact of their interrelationships on research and practice.
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Affiliation(s)
- Danielle Hitch
- Occupational Science and Therapy, Deakin University , Geelong , Australia
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Hitch D, Pépin G, Stagnitti K. In the footsteps of Wilcock, Part one: The evolution of doing, being, becoming, and belonging. Occup Ther Health Care 2014; 28:231-46. [PMID: 24689506 DOI: 10.3109/07380577.2014.898114] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This article will present a critical analysis of the four dimensions of occupation, doing, being, becoming and belonging, and propose clearer understandings of the terms. The concepts have developed and evolved since Wilcock first introduced them as main constructs of Occupational Perspective of Health (OPH), with doing and being receiving the most comprehensive development. However, the concepts of becoming and belonging remain underdeveloped. Given the complex nature of occupation, this comprehensive analysis of each dimension adds greater depth to our understanding, and provisional definitions of each term are provided to guide their ongoing development.
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Affiliation(s)
- Danielle Hitch
- Occupational Science and Therapy, Deakin University , Geelong , Australia
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Hammell KRW. Belonging, occupation, and human well-being: An exploration. The Canadian Journal of Occupational Therapy 2014; 81:39-50. [DOI: 10.1177/0008417413520489] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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White KM. Occupational therapy interventions for people living with advanced lung cancer. Lung Cancer Manag 2013. [DOI: 10.2217/lmt.13.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Occupational therapists are an integral part of the lung cancer multidisciplinary team, focusing on interventions to assist continued participation in activities that are valued as meaningful for the individual patient. The interventions occupational therapists utilize play a vital role in the management of refractory symptoms for people living with advanced lung cancer. Core interventions, such as energy conservation, anxiety management, home assessments, assistive equipment, technological devices and breathlessness management, are employed by occupational therapists to optimize function and enable participation in chosen, everyday activities, and will be reviewed in this paper.
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Affiliation(s)
- Kahren M White
- Clinical Specialist Oncology & Palliative Care, PO Box 6089 Marrickville South, NSW 2204, Australia
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