Occupational Therapy in Palliative Care Elaine Stokoe OT January 2008

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.

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)

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.

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

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

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.

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

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

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)

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