Role of Occupational Therapy in Palliative and Hospice End-of-Life Care

Definition

Palliative Care – An interdisciplinary team approach for people with serious or life-threatening illnesses to enhance the quality of life. The goal is to provide pain relief, comfort, symptom management, support systems, including psychological and spiritual care along with medical treatment.

Quick Facts

• Clients may receive palliative care for months to years, depending on the stage of the disease process.^[1]Guo, Y., & Shin, K.Y. (2005). Rehabilitation needs of cancer patients. Critical Reviews in Physical and Rehabilitation Medicine, 17(2), 83–99. doi:10.1615/CritRevPhysRehabilMed.v17.i2.10
• Occupational therapy practitioners do play a role on the palliative and hospice care team.
• Their role includes identifying the occupations that are meaningful to clients and addressing barriers to such occupations.
• OTs consider the physical, psychosocial, and behavioral health needs of the client.

Occupational Therapy Intervention

There is a misconception that clients with terminal conditions are not appropriate for occupational therapy services.^[2]Benthall, D. & Holmes, T. (2011). End-of-life care: Facilitating meaningful occupations. OT Practice, 16 (9), 7-10.

The goal of occupational therapy services in end-of-life care is to optimize the quality of life and well-being of clients through engagement in occupations.^[3]Pizzi, M. (2010). Promoting wellness in end-of-life care. In M. Scaffa, M. Reitz, & M.

Occupational therapists provide a unique service that enables function, comfort, safety, autonomy, dignity and social participation in occupations.^[4]WFOT. (2016). Position Statement: Occupational Therapy in End of Life Care.

OTs also provide a resource to the team by supporting the roles of the client in function with regard to their body system, skills, abilities, roles, relationships, and valued occupations.^[5]Thompson, B. (1991). Occupational therapy with the terminally ill. In J. Kiernat (Ed.), Occupational therapy and the older adult (pp. 324–337). Gaithersburg, MD: Aspen.

Outcome Measures

Due to the progressive nature of end-of-life and dying, occupational performance outcomes are expected to decrease throughout the intervention period.

• COPM
• Goal Attainment Scaling
• Functional Assessment of Chronic Illness Therapy-Spiritual Scale

Activities of Daily Living

• Dressing
• Bathing and Showering
• Functional mobility

Instrumental Activities of Daily Living (IADLs)

• Meal preparation
• Home management
• Health management (Now its own occupation)
• Religious or spiritual activities

Rest and Sleep

• Promoting rest and sleep

Leisure

• Client-centered
• Holistic

Psychosocial/Behavioral Health

• Client
• Family and friends

Occupational Therapy Approaches

• Task and activity analysis
• Modification of activiies
• Adapting the environment
• Minimizing potential barriers
• Maximizing strengths
• Meaningful to the client, family, and cultural context
• Providing relief for pain and suffering
• Improving the quality of life
• Provide caregiver training
• Maintaining a sense of control in one’s life^[6]Christiansen, 1999; Egan & DeLaat, 2003, Singer, Martin, & Kelner, 1999; Vrkljan & Miller-Polgar, 2001
• Using social contacts as a strength to prevent isolation^[7]Enes, 2003; Gourdji et al., 2009; Hunter, 2008; Lyons et al., 2002; Singer et al., 1999; Steinhauser et al., 2000
• Contribute to the search for finding meaning and purpose in life and one’s relationships (spirituality) ^[8]AOTA, 2008; Chochinov & Cann, 2005; Egan & DeLaat, 1997; Lin & Bauer-Wu, 2003; Pizzi & Briggs, 2004; Prince- Paul, 2008; Unruh, Smith, & Scammell, 2000

Research and OT Practice

• OTs who are sensitive to the client and their occupational profile can facilitate their ability to transmit purposeful legacies.^[9]Hunter, E. G. (2008). Legacy: The occupational transmission of self through actions and artifacts. Journal of Occupational Science, 15(1), 48–54. The Role of Occupational Therapy in End-of-Life … Reference List
• No widely established outcome measure is used in this setting. However, the COPM is often recommended for use. Further research is needed to determine of the validity of the COPM in end-of-life care.^[10]Cooper, J., & Kite, N. (2015). Occupational therapy in palliative care. In E. Cherny, M. Fallon, S. Kaasa, R. K. Portenoy, & D. C. Currow (Eds.), Oxford textbook of palliative medicine (pp. … Reference List
• Outcome measures should address the physical environmental effects on occupational engagement. Dying may be viewed as taboo and family members may alienate a person by avoiding them from end-of-life conversations.^[11]Costa, A., & Othero, M. (2012). Palliative care, terminal illness, and the Model of Human Occupation. Physical and Occupational Therapy in Geriatrics, 30, 316–327. … Reference List

Takeaway

• The scope of occupations in end of life in research has been shown to be primarily focused on self-care (ADLs, IADLs).
• People with a terminal illness often value being able to engage in such activities and routines.
• However, they also value occupations that are specific to end of life.
• These include addressing relationships, reworking life to accommodate the illness, legacy building, life review, finding closure, putting affairs and final arrangements in order.^[12]Eriksson, L., Oster, I., & Lindberg, M. (2016). The meaning of occupation for patients in palliative care when in hospital. Palliative and Supportive Care, 14, 541–552. … Reference List^[13]Peoples, H., Brandt, A., Wæhrens, E. E., & la Cour, K. (2017). Managing occupations in everyday life for people with advanced cancer living at home. Scandinavian Journal of Occupational Therapy, … Reference List
• Occupational therapy can benefit from expanding its influence and value as a profession in end-of-life care beyond self-care occupations.
• Dying can shape occupational needs and OTs can provide. service to the client by exploring their roles and interests across multiple contexts.
• Overall, occupational therapy is an effective service in end-of-life care but more outcome measures can be used to research how dying affects the various components (depending on the frame of reference used).