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The Role of OT in Hospice and Palliative Care

The Role of OT in Hospice and Palliative Care. Janice Kishi Chow, MA, OTR/L Palo Alto VA Hospice and Palliative Care Center April 23, 2013. Objectives. What is hospice and palliative care? What role does OT play?. Hospice. Non-curative comfort care Psychosocial support

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The Role of OT in Hospice and Palliative Care

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  1. The Role of OT in Hospice and Palliative Care • Janice Kishi Chow, MA, OTR/L • Palo Alto VA Hospice and Palliative Care Center • April 23, 2013

  2. Objectives • What is hospice and palliative care? • What role does OT play?

  3. Hospice • Non-curative comfort care • Psychosocial support • Life expectancy is less than 6 months • Affirms life • Accepts death as a normal process • Neither hastens or postpones death

  4. Palliative care • “Palliare” : to cloak • Non-curative, comfort care • Arose from modern hospice care • Symptom management for those not terminally ill • Provided at an stage of an illness or disease • In conjunction with curative treatments • Segues into hospice care

  5. Impact of Hospice and Palliative Care • Misconception that hospice and palliative care hastens death • Journal of Pain and Symptom Management, March 2007 • Hospice patients lived mean average of 29 days longer • CHF: +181 days • New England Journal of Medicine, August 2010 • Early palliative care of Lung CA: 2.7 months longer

  6. Possible Factors thatContribute to Survival • Weakened patients avoid risks of over-treatment • Hospice care can improve monitoring and treatment • Psychosocial support may lessen burden of care, increase desire to live, and prolong life • Early management of symptoms may stabilize disease • Stability may prolong life

  7. Role of OT in Hospice and Palliative Care • Maximize occupational engagement • Decline is dynamic • Modification and adaptation • Support the grieving process

  8. Tom* • 47 year old male veteran • Metastatic rectal cancer (dx’d 4 mo. prior) • Chemo, XRT • Stage 4 coccyx ulcer • Severe hip, back and ulcer pain • BLE strength grossly 2-/5 *Name changed

  9. Tom’s goals • Pain relief • Full recovery • Improve strength • Transfer into a wheelchair • Go outside with his family • Walk

  10. Themes • Decreased insight vs. Faith • Poor endurance vs. Denial • Poor rehab potential vs. “Rehab moments”

  11. Treatment • Edge of bed activities • Pre-functional AAROM • Retrograde massage • Theraputty exercises • Psychosocial support

  12. Wheelchair Fitting • Tilt-in-Space Recliner w/c • Cushion with gel insert • 22” hand rims • Front brakes • Family education

  13. Maximizing Function • Dynamic sitting balance activities • Cooking activity • ADL retraining Ham and Cheese Crescent roll

  14. Cancer Dying Trajectory Health Status 12 11 10 9 8 7 6 5 4 3 2 1 0 Months Before Death Hallenbeck, J. L. Palliative Care Perspectives. 2003, Oxford University Press.

  15. Cancer Dying Trajectory Functional Plateau Health Status Sudden decline (probable pulmonary embolism or sepsis) 12 11 10 9 8 7 6 5 4 3 2 1 0 Months Before Death Hallenbeck, J. L. Palliative Care Perspectives. 2003, Oxford University Press.

  16. Chuck* • 75 year old male veteran • Palliative care admission • H/o CHF and COPD • Retired truck driver • Married with children and grandchildren • Recurrent short stays over 2 years * Name changed

  17. Chuck’s goals • Symptom management (SOB, fatigue) • Maximize function • Maximize time with family

  18. Treatment • Energy conservation • Adaptive equipment • Power mobility • Psychosocial support

  19. Sine-wave Dying Trajectory Health Status 12 11 10 9 8 7 6 5 4 3 2 1 0 Months Before Death Hallenbeck, J. L. Palliative Care Perspectives. 2003, Oxford University Press.

  20. Conclusion • Hospice and Palliative Care • Non-curative comfort care and psychosocial support • Alleviates pain and suffering • Improves quality of life

  21. Conclusion • Role of OT • Maximizes occupational engagement • Support grieving clients

  22. Practical Application • Palliative Care Consult • Symptom management • Facilitate discharge planning • Medical and psychosocial support • End of life discussions

  23. References • Addington-Hall, J. M. & Higginson, I. J. (2001). Introduction. In Addington-Hall, J. M. & Higginson, I. J. (Eds.), Palliative Care for Non-cancer Patients. New York: Oxford University Press. • Connor SR, Pyenson B, Fitch K, Spence C, Iwasaki K. (2007). Comparing hospice and nonhospice patient survival among patients who die within a three- year window . Journal of Pain Symptom Management. 33(3):238-46. • Hallenbeck, J. L. Palliative Care Perspectives. 2003, Oxford University Press. • Ternel, J.S., Greer, J.A., Muzinkansky A., Gallagher, R.N., Admane, S., Jackson, V. A., Dahlin,, C. M., Blinderman, C. D., Jacobsen, J., Pirl, W. F., Billings, J. A., & Lynch, T. J. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine. 363(8):733-42. • World Health Organization (WHO). Cancer: palliative care. Retrieved April 16, 2013 from http://www.who.int/cancer/palliative/en/

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