Occupational therapists

How occupational therapists address palliative care 

Helping people with a life-limiting illness to engage with activities or occupations that are both essential and meaningful to them and, in doing so, fostering a sense of ability, dignity, and control.

Scope of practice

Occupational therapists (OTs) support people of all ages and abilities to engage in activities or occupations that they find meaningful. Occupation refers to self-care or personal care, work-related or domestic activities, or leisure activities. Occupational therapy assessments seek to understand what occupations are important to the client, any current issues they may have in doing them, and understanding the client’s goal(s). Occupational therapy interventions may include modifying an activity or an environment, education and advice about services, and prescriptions for assistive equipment where required. [1-3]

OTs may have roles of advanced or extended practice or scope of practice which reflect a level of expertise within or beyond the established contemporary scope of practice. [3-5]

Role in palliative care

Palliative care provides a support system for people living with a life-limiting condition to live as actively as possible, with dignity, for as long as possible. It is active and supportive care that seeks to maximise quality of life. [6] It is useful well before death and not limited to care of the dying. [7]

In helping people with palliative care needs, an OT: [7-13]

• assesses a person’s functional ability within practical everyday contexts in order to enable occupational engagement wherever possible as function declines
• is led by the person’s symptoms and their sense of what is important to them to co-create realistic goals and expectations with the person in the face of impending death within the context of a therapeutic relationship
• assists with the management of symptoms such as anxiety, fatigue, breathlessness and pain through assessment, education, relaxation techniques, counselling, task redesign and equipment prescription
• assesses and treats dyspnoea (difficulty breathing) with supported body positioning and other strategies such as breathing techniques, energy conservation techniques and use of handheld fans within the context of everyday function
• assesses for and prescribes complex seating and wheelchairs as required, as well as prescribing pressure relieving devices such as cushions and mattresses where required
• assesses and develops strategies to help people manage cognitive changes that impact participation in everyday activities; these changes may be due to ageing, medical treatment or disease specific changes such as cerebral metastases or frontotemporal dementia (MND)
• assists the person to maintain or improve independence within their own home or place of care of their choice through assessment, education, environmental modifications and planning for future needs
• encourages and facilitates engagement in purposeful or pleasurable activities such as hobbies or leisure pursuits to enhance quality of life
• may retrain the person in personal or domestic activities using either a change of technique or appropriate equipment
• supports the person’s capacity to attend to affairs and develop a legacy
• liaises within the care team to promote best outcomes
• provides support, education and training to informal carers about manual handling within the home context in order to reduce risk of injury
• may be involved in lymphoedema management, additional qualifications required.

OTs may work in palliative care as only part of their role or have a palliative care caseload with a specialist role. This may be a member of a multidisciplinary team or a sole practitioner.

The scope of occupational therapy palliative care interventions across Europe has been mapped in a cross-sectional survey. [14]

The RACGP aged care clinical guide (Silver Book 2019) recognises the role of allied health professionals in team care arrangements for a proactive person-centred approach to palliative care. [15] Palliative Care Australia also recognises the importance of access to information and support from a diverse range of allied health services for patients, families and carers. [16]

The role of allied health in palliative care is to provide the person with as much therapy time as possible. The goal of allied health in palliative care is around maintaining and improving functional ability. There may be a blurring of roles across allied health professions in palliative care more than in other care contexts.

Practice support

Useful evidence-based information and resources on rehabilitative palliative care are available from Hospice UK.

Using evidence

Although OTs are familiar with evidence and evidence-based practice through their training and continuing professional development (CPD), keeping up to date can be time-consuming.

CareSearch provides the tools to help find and use palliative care evidence. This includes PubMed searches on a multitude of topics and sections dedicated to Searching for Evidence and Using Evidence in Practice.

For support in applying evidence in practice, check out the Journal Club Basics page on CareSearch which provides information on the benefits of and practical pointers in setting up or joining a journal club.

The International Centre for Allied Health Evidence at University of South Australia has a number of resources to support translation of evidence into practice.

Guidelines

Codes and guidelines to provide guidance to the occupational therapy profession developed by The Occupational Therapy Board of Australia are freely accessible.

Occupational Therapy Australia has published position papers: Occupational Therapy in Palliative Care (555kb pdf) (August 2015) and Occupational Therapy in Oncology (553kb pdf) (August 2015). [13,17]

The Palliative Care Service Development Guidelines 2018 (340kb pdf) provides an overview of OT (as part of allied health) in palliative care. [16]

Guidelines for the role of OT in cancer and end-of-life care have been developed in USA, Canada and UK. [11,18]

Resources for Patients, Carers and Families

OTs have an important role in supporting patients, carers and their families with information. The CareSearch Resources for Patients, Carers and Families provides links to useful information including fact sheets and printable resources OTs can download and share.

Occupational Therapy Australia has published a booklet 'Helping you live until you die - A guide for people with a life-limiting illness, their family and friends'

Education

The National Palliative Care Strategy 2018 lists as a priority the ability of medical, nursing and allied health graduates to identify and address people’s palliative care needs (Priority 2.1, p15). [19] This is also highlighted for the acute sector in the Guiding Principles of the National Consensus Statement: essential elements for safe and high-quality end-of-life care which also recognises the importance of the role of an interdisciplinary team. [20]

Courses

CareSearch lists a collection of Palliative Care eLearning resources for allied health for independent learning.