1. Specialist Palliative Care Occupational Therapist
SPECIFIC STRATEGIES USED BY H.C.P.s IN THE MANAGEMENT OF CANCER RELATED FATIGUE
Jackie Pottle
Specialist Palliative Care Occupational Therapist
Central Trust

2. Content Research study for an M.A . degree Aim of research Methodology
Results
Implications for future practice

3. Fatigue - what is it?
“Fatigue is a subjective , unpleasant symptom which incorporates total body feelings ranging from tiredness to exhaustion, creating an unrelenting overall condition which interfers with the individuals’ ability to function to their normal capacity”
Ream and Richardson, 1996

4. Philosophy
“Before beginning a Hunt, it is wise to ask someone what you are looking for before you begin looking for it.”

5. CRF at palliative stage of illness, story so far.....
multi causal and multi dimensional symptom
‘ not easy to define , to decide what causes it or to effectively manage it’ (Lindqvist 2004)
Severity of fatigue as a symptom
‘ most troublesome symptom’ in 25% cases (Hoerkstra et al 2007)
Prevalent between 60 – 90 % cases ( Munch et al 2005, Barnes and Bruera,2002)
Found to compromise Q.of life, affecting well being, daily activities,relations with family and friends
(Porock et al 2000, Curt et al 2000,)

6. Story so far (cont) HCPs : Recognition of importance of fatigue
Underestimation of extent
Variabilty in assessment and management
Patients :Belief that Drs will initiate discussion
- Levels of subjective distress are greater than objective measures
- Poor recognition of receiving treatment
In advanced Ca , fatigue is intertwined with recognition of death.

7. Aims of research To identify the HCPs :-
level of knowledge of management of CRF
Specific methods of managing CRF
Approach to effective management of CRF
To recommend educational guidance for future use

8. Qualitative research Why qualitative ? Method used :purposive sampling
12 semi-structured interviews,(30 minutes duration)
4- Medics Questions
4- AHPs Case studies
4- Nurses

9. Results :analysis of texts
Interviews transcribed
Thematic analysis according to grounded theory approach( see Denscombe 2007 pg 297)
External sources to verify data collected

10. THEORY CONCEPTS HYPOTHESIS f b e c d Qualitative data CATEGORIES
CODE A f b e c d
Qualitative data

11. RESULTS: Themes identified
Series of hypotheses and concepts :-
Informal assessment including key components of CRF is undertaken by HCPs
HCPs recommend a variety of strategies
HCPs follow a supportive, reflective approach to management of CRF
Management is led by patient and carers’ needs
An inclusive team approach is followed

12. Concepts
The progression of CRF can be a tool to discuss end of life issues
HCPs require education on the management of CRF

13. Description of strategies for the management of CRF
Provision of information*
Graduated physical exercise programme
Adjustment of aspiration*
Relaxation techniques
Description of strategies for the management of CRF
Provision of self awareness tools
Use of support networks
Emotional support*
Provision of disabilty equipment
Acknowledgemnt /recognition of existence of fatigue*
Stress mangement eg prioritisation/pacing of ADL

14. Discussion of concept 1
Certain strategies (as expected) eg exercise/relaxation,energy conservation
Lack of specific details of each strategy
Strategies are not easily packaged or place within pathways
Some strategies not recognised eg *
Challenge of patients not recognising strategies but this also applies to some HCPs.
‘Inevitable , unimportant and untreatable’ (Stone et al 2000) – “ can’t do bugger all about it “

15. Concept2 :Fatigue can be used as a tool to discuss end of life issues
Appropriate and sensitive use of fatigue as a tool to discuss deterioration
Appears to be inevitability and untreatable aspect about fatigue with its close association with death but can still be a tool to allow discussion
Challenge of supporting both patient/ carers but also some HCPs with this.

16. Development of overall theories
Theory 1 : Variable , patient led strategies to manage CRF at palliative stage are implemented by HCPs
Theory 2 :HCPs approach towards the management of CRF at palliative stage is a key aspect of its effectiveness.

17. The pot of honey
“ sometimes the more you think, the more there is no real answer”

18. Implications for future practice
Knowledge-
HCP to raise topic with patients.
Informal assessment is acceptable but can dimimish importance of topic
Important to patients to have fatigue acknowledged- even as part of symptom cluster

19. Future practice Strategies
Development of collection of broad ideas of various types of strategies
Information on current research on effectiveness of interventions
Approach
Education on acceptability of realistic,suportive approach and not solution focused

20. Future developments National research RCT in Oxford
Locally -development of workshop/ information package -OT led
but offers of assistance by any other team members gratefully received!

22. REFERENCES
Ream E& RichardsonA(1996)Fatigue :a concept analysis.Int .J Nursing Stud.33(5)
LindqvistO.WidmarkA, Brigit H(2004)Meanings of thePhenomenon of fatigue as narrated by 4 patients with Cancer in palliatve care. Cancer Nursing Vol 27,no3:
Hoerkstra J,Verooj-Danser J(2007)The added value of assessing the most troublesomesymtom in patients with cancer in the palliative phase.Patient Education and counselling,65(2)223-9
Munch Tn, Zhang T< WilleyJ, Palmer J, Bruera (2005)Journal of palliative Medicine Dec8(6):1144-9
Barnes E,Bruera (2002)Fatigue in patients with advanced cancer:a review. International Journal of gynecological Cancer 12 :
Denscombe M(2007)The Good Research Guidefor small scale social researchprojects:Buckingham:Open University Press