Occupational Therapy in Palliative Care

1. Occupational Therapy in Palliative Care Elaine Stokoe OT January 2008

2. Rehabilitation Stages(Dietz,1981) • Preventative – anticipation of potential disability to lessen severity • Restorative – return to pre-morbid status without significant handicap • Supportive – support through decline of progressive but stabilised disease to remain as functional as possible & retaining an element of choice & control • Palliative – assist in symptom control & in advanced stages preventing complications through positioning, pressure care & prevention of contractures.

3. The OT Role • The OT role is to inform, support, facilitate, & enable opportunities for patients to perform activities in order to promote function, quality of life, the realisation of potential & the retention of valued roles within the family. • The OT’s specific concern is with the client’s experience of illness or disability and how impairment affects function in the physical, cognitive, emotional, spiritual & social domains of life. (Creek, 2003)

4. The OT Role in Palliative Care Rehabilitation • Not restoration to a former condition & status but ‘ a recomposition of life’ using the OT process to help to build the client’s life to a manageable level (Bateson, 1990) • Focuses on supportive and palliative stages.

5. Functional Issues ENVIRONMENTAL • Physical – internal/external stairs/steps, access to toilet & bathing, premises unsuitable for adaptation. • Bio-physiological – feels unable to cope, lacks confidence to return home, feels a burden, not wanting outside help or environment altered. • Socio-cultural – relatives/carers/patients not wanting to face care at home, not considering any difficulties/ unable to accept help, not wanting to alter routines, family dynamics, psychiatric or emotional problems

6. Functional Issues • Self maintenance – impaired independence in ADLs • Productivity – loss of role/ personal satisfaction • Leisure – unable to participate • Sensory skills – pressure problems, pain, shortness of breath, balance, co-ordination & safety • Inter-personal - communication / relationships • Intra-personal – Anxiety, depression, denial • Cognitive – memory, concentration, problem solving, coping

7. OT Interventions • Physical – assessment of home environment, provision of equipment, adaptations, manual handling • Bio-psychological – increasing confidence by reinforcing capabilities, falls prevention, increasing awareness of practical/safety issues, liaison with carers • Socio- cultural – MDT working to look at the practical realisation of patients goals & level of professional support needed including consideration of families’ concerns.

8. OT Interventions 2 • Self maintenance – assessment of ADLs & activity tolerance, identification of support requirements, advice on pacing & energy conservation. • Productivity – role adjustment, re-establishment of self esteem • Leisure – activities within changed capabilities • Motor – Assessment of abilities & adaptation of activity & environment, practise of safe transfer methods, lifestyle management

9. OT Interventions 3 • Sensory – establishment of safe environment by reviewing risk • Inter-personal – encourage patients’ communication & understanding by family & carers (often on environmental visits) • Intra-personal – relaxation, anxiety management, pacing with patient • Cognitive – assessment of cognitive abilities & looking at alternative coping mechanisms

10. What next? As palliative care is concentrating more on supporting patients in the community, the role of the OT in hospice & day care is expanding. By focussing on the analysis of activity and the concept of the patient’s ‘wellness’ the OT is able to improve quality of life through the promotion of abilities and addressing disabilities particularly with regard to self maintenance, productivity and leisure. (Cooper, 1997)

11. References • Bateson, M.C. (1990). Composing a Life. New York: Plume • Cooper, J. (1997). Occupational Therapy in Oncology and Palliative Care. • Creek, J. (2003). Occupational Therapy defined as a complex intervention. College of Occupational Therapists. • Dietz, J.H.(1981). Rehabilitation Oncology. New York: John Wiley