The Role of Occupational Therapy in Palliative Care

Summary

This lecture explores the vital role of occupational therapy in adolescent palliative care, challenging preconceived notions and emphasizing the importance of a holistic approach. It discusses the wide range of conditions and settings where therapists work, focusing on improving quality of life for patients and their families. The lecture also highlights the unique contributions of occupational therapists, such as facilitating engagement in meaningful daily activities and supporting patients' physical, emotional, and social needs. It underscores the significance of individualized care, interdisciplinary collaboration, and the therapist's role in helping patients achieve their goals and maintain their chosen occupations, even as they face life-limiting illnesses.

Takeaways

• 🌟 Occupational therapy in palliative care aims to improve the quality of life for individuals facing life-threatening illnesses and their families.
• 👥 The interdisciplinary team in palliative care includes a variety of healthcare professionals such as doctors, nurses, physiotherapists, and social workers.
• 🏥 Occupational therapists may work in diverse settings including hospitals, hospices, and community-based services.
• 🔍 The World Health Organization defines palliative care as an approach to improve quality of life, addressing physical, psychosocial, and spiritual aspects of the person.
• 🏠 End-of-life care and hospice care are distinct; hospice care is for those with a life-limiting illness and may involve symptom control and family support.
• 📈 Palliative care should be initiated early to allow for well-planned and managed end-of-life care, supporting both the individual and their family.
• 🤝 Occupational therapists support individuals to continue or start new occupations, focusing on what is meaningful to them and their life goals.
• 🧘‍♂️ The holistic approach of occupational therapy considers the person's motor, emotional, cognitive, and sensory aspects to help them engage in their chosen occupations.
• 👨‍⚕️ Occupational therapists work closely with adolescents, addressing issues like body image, self-identity, and sexuality, which are particularly relevant during this life stage.
• 🌱 The 'On Track' program at Peter MacCallum Cancer Center is an example of a service that assists adolescents with cancer to return to productive occupations like work or school.

Q & A

What is the primary focus of this lecture on occupational therapy in palliative care?

The lecture focuses on the role of occupational therapy in adolescent palliative care, aiming to challenge perceptions and highlight the potential, possibilities, and rewards of working in this area.

How does the lecture suggest changing preconceived ideas about palliative care?

The lecture encourages participants to list three words that come to mind when thinking of palliative care and revisit these at the end of the week to see if their perceptions have changed.

What is the interdisciplinary team involved in palliative care according to the lecture?

The interdisciplinary team may include medical staff, general practitioners, nurses, palliative care nurses, physiotherapists, chaplains, social workers, and speech pathologists.

What is the broad age range of individuals involved in palliative care as mentioned in the lecture?

The age range spans from premature neonatal babies in special care units to older adults with advanced dementia.

How does the World Health Organization define palliative care as per the lecture?

According to the WHO, palliative care aims to improve the quality of life for individuals facing life-threatening illnesses, their families, and carers, addressing physical, psychosocial, spiritual, and emotional aspects, and managing symptoms like pain.

What is the difference between end-of-life care and hospice care as discussed in the lecture?

End-of-life care can include both hospice and palliative care during the end stage of life, while hospice care is for those with a life-limiting illness and may focus on symptom control and support for the family.

Why is it important for occupational therapists to understand the term 'palliative care'?

Understanding the term helps occupational therapists to focus on the holistic well-being of the person, including symptom management and improving quality of life, rather than just treating the illness.

What role does the American Occupational Therapy Association suggest for occupational therapists in palliative care?

The AOTA suggests that occupational therapists should facilitate engagement in daily life, helping individuals with life-limiting conditions to continue or start new occupations.

How does the lecture describe the unique role of occupational therapists in palliative care?

Occupational therapists have a unique role as they consider all aspects of a person, including motor, emotional, cognitive, and sensory aspects, to help individuals with life-limiting conditions resume, continue, or start new occupations.

What are some of the settings where occupational therapists might work with individuals nearing the end of life?

Occupational therapists might work in surgical or medical units in hospitals, hospices, community-based services, palliative care services, and rehabilitation services.

What are some of the interventions that occupational therapists provide in palliative care as mentioned in the lecture?

Interventions can include pain management, relaxation training, sleep assistance, education advice, structuring the person's day, and environmental adaptations to support meaningful occupations.

Outlines

00:00

💡 Introduction to Occupational Therapy in Adolescent Palliative Care

This paragraph introduces the lectorial, focusing on the role of occupational therapy in palliative care, particularly for adolescents. It highlights the importance of understanding common perceptions about palliative care and encourages the audience to reflect on their values, beliefs, and settings in which they might work. The section emphasizes that palliative care is about improving the quality of life for people of all ages, from infants to older adults, and touches on the range of conditions that might require this care.

05:01

🏥 Importance of Early Palliative Care and Occupational Therapy’s Role

This section stresses that palliative care should be initiated early, allowing for better planning and support for both patients and their families. Occupational therapists help individuals maintain daily life activities, support family involvement, and enable patients to continue their chosen occupations. It emphasizes that occupational therapists work in diverse settings such as hospitals, hospices, and community services, collaborating with various healthcare professionals.

10:03

👥 The Holistic Approach of Occupational Therapy in Palliative Care

Occupational therapy in palliative care is unique in its holistic approach, focusing on the motor, emotional, cognitive, and sensory aspects of the individual. The therapist helps patients engage in meaningful activities, whether resuming old occupations or starting new ones, as part of preparing for the end of life. The section also touches on the emotional impact of working with dying patients and the interdisciplinary nature of care.

15:04

🎯 Supporting Adolescents and Their Individual Needs

This paragraph focuses on the occupational therapist's role in understanding adolescents’ personal goals and body image issues. Special attention is given to addressing the emotional and physical changes related to cancer treatment, such as hair loss or amputation. The therapist must treat adolescents as adults, allowing them to express their priorities and goals without the influence of their parents.

20:06

🧠 Reflecting on Attitudes Toward Death in Palliative Care

The final paragraph encourages professionals to reflect on their own values, emotions, and attitudes toward death and dying. It emphasizes the dynamic and ever-changing nature of palliative care, where flexibility is crucial. The section also highlights the importance of supporting individuals and families through the emotional challenges of end-of-life care, acknowledging the privilege of working in this field, and viewing death as a unique and meaningful occupation.

Keywords

💡Palliative Care

Palliative care is a specialized medical field focused on providing relief from the symptoms and stress of serious illnesses, improving the quality of life for both the patient and their family. In the video, it is emphasized that palliative care is not just for end-of-life scenarios but can be initiated earlier to plan and manage end-of-life care, supporting not only physical symptoms but also emotional and spiritual well-being.

💡Occupational Therapy

Occupational therapy (OT) is a healthcare profession that helps people of all ages participate in the activities of everyday life. In the context of the video, OT in palliative care aims to enable patients to continue their normal or chosen occupations, adapting environments and tasks to support their functional abilities and maintain their quality of life.

💡Adolescent Palliative Care

Adolescent palliative care specifically addresses the needs of younger patients receiving palliative care, focusing on their unique developmental and emotional stages. The video discusses the importance of this specialized care, highlighting the work of occupational therapists like Olivia Doug in helping adolescents continue their daily life activities and cope with treatments that affect their body image and self-identity.

💡Interdisciplinary Team

An interdisciplinary team is a group of professionals from different fields who work together to provide comprehensive care. In palliative care, this team may include doctors, nurses, occupational therapists, physiotherapists, social workers, and chaplains. The video underscores the importance of this collaborative approach to address the diverse needs of patients and their families.

💡Quality of Life

Quality of life refers to an individual's overall well-being and satisfaction with life. In the video, improving the quality of life is central to palliative care, aiming to support patients physically, emotionally, socially, and spiritually, as well as managing symptoms like pain.

💡End-of-Life Care

End-of-life care encompasses the medical and personal care given to patients in the final stages of a terminal illness. The video clarifies the distinction between end-of-life care and hospice care, noting that the former can include both palliative and hospice care, focusing on comfort and support for patients nearing the end of their lives.

💡Hospice Care

Hospice care is a type of end-of-life care for patients with a terminal illness, often provided in a residential hospice or at home. The video explains that hospice care may be sought for symptom control or to address functional needs and family coping, though it may not cover the entire end stage of life.

💡Functional Decline

Functional decline refers to the loss of ability to perform activities of daily living. In the video, occupational therapists work to prevent functional decline by adapting environments and tasks, ensuring patients can continue their chosen occupations and maintain their independence for as long as possible.

💡Person-Centered Care

Person-centered care is an approach to healthcare that focuses on the individual's needs, preferences, and values. The video emphasizes the importance of this approach in palliative care, tailoring interventions to meet the unique needs of each patient and involving them in decision-making about their care.

💡Spirituality

Spirituality in the context of healthcare refers to the personal beliefs and values that give meaning and purpose to life. The video mentions that occupational therapists consider the spiritual aspect of patients, acknowledging its importance in overall well-being and quality of life.

💡Cultural Sensitivity

Cultural sensitivity is the ability to understand and respect cultural differences when providing care. The video highlights the importance of being aware of and respecting cultural and spiritual factors in palliative care, ensuring that care is delivered in a manner that is respectful and appropriate for each patient's background.

Highlights

The lecture focuses on the role of occupational therapy in adolescent palliative care.

It challenges preconceived notions about palliative care to reveal its potential and rewards.

The lecture discusses the interdisciplinary team and various settings where occupational therapists work.

It emphasizes the importance of working with a range of conditions and age groups in palliative care.

The World Health Organization's definition of palliative care is explored, highlighting quality of life improvement.

The differences between end-of-life care, hospice care, and palliative care are clarified.

Occupational therapists support individuals to continue their normal or chosen occupations.

The lecture highlights the importance of a person-centered and holistic approach in occupational therapy.

It underscores the significance of listening to individuals' narratives and life stories.

The lecture discusses the need for flexibility and adaptability in palliative care practice.

The role of occupational therapists in managing symptoms and enhancing the environment for patients is detailed.

The lecture stresses the importance of acknowledging and respecting individuals' wishes and values.

It explores the significance of meaningful occupations and daily routines in palliative care.

The lecture addresses the challenges of working with families and aligning their wishes with those of the patient.

It discusses the importance of cultural and spiritual factors in palliative care.

The lecture provides examples of how occupational therapists can support individuals at different life stages.

It introduces Olivia Doug, an occupational therapist specializing in working with adolescents.

The lecture concludes with a reflection on personal values and attitudes towards death and dying.

Transcripts

welcome to this lectorial

which is focusing on the role of

occupational therapy in palliative care

and in particular

focusing on adolescent palliative care

in this lecture we're looking at your

perceptions

perhaps

well-held or ingrained values relating

to palliative care

and

looking at changing some of those

to enable you to see the

huge potential

possibilities of and rewards and working

in this area

we're also looking at the

interdisciplinary team that you might be

working with the types of settings and

different conditions

of people you might be working with as

well as the types of interventions and

exploring

with olivia doug

at ontrack peter mack the sorts of

things that she feels are important

particularly working with adolescents

so looking at what you think when you

immediately

think of palliative care

think of three words that come to mind

perhaps write those down and revisit

those at the end of this week and see

whether or not you've changed your mind

about

the myths or the preconceived ideas that

you might have had

working in palliative care

also think about

what sort of settings an occupational

therapist might work with people

nearing end of life

and the types of conditions and perhaps

ages that those people might be with

see if you can list at least five

settings or

so just to give you a little bit of help

we're thinking about the types of

conditions

of people you might be working with you

can see from this slide that there is a

whole range of different conditions

obviously cancer is probably the one

that springs most to mind for most

people

however there are

all ages

involved in palliative care

from

your premature neonatal babies

in a special

care unit

right up to people that

older adults

with advanced dementia

so this slide indicates that there is a

whole range of

age groups as well as a whole range of

different conditions

from

perhaps progressive neurological

conditions

hiv

chronic conditions such as renal disease

or cardiac disease

as well as congenital

so when we talk about

palliative care

as occupational therapists i think it's

useful to understand the term

so on this slide is a term from the

world health organization

and the crucial parts of this

definition is improving quality of life

including both the

person who may be

facing the life-threatening illness as

well as their their family and carers

and

the other aspect of this definition

that's useful is looking at

the physical psychosocial

spiritual

aspects of the person and also emotional

i would add

as well as

looking at symptom management such as

treatment of pain so looking really at

the

the whole person

and

so when we talk about end-of-life care

and hospice care it's important to

be aware of the differences that these

two terms mean

so end-of-life care

can encompass both hospice and and

palliative care during the

the end stage of life

while hospice care

the person has a life limiting illness

however

the person may be admitted to a hospice

for symptom control

or to organize

perhaps issues such as

how the family is coping with some of

the functional needs

but the person may not necessarily be

admitted for the entire length of of

their end stage of of life

however a lot of people do

choose to to

die in a hospice and because of the type

of surrounding which isn't generally a

non-clinical surrounding

so palliative care often it's thought of

the palliative care is

only initiated when the person

is extremely

ill or very near to to die

but it

can be and and should be initiated

earlier on

so that the person's

end of life care can be well planned and

managed and particularly family and

carers well supported

so occupational therapists working in

palliative care services as well as in

other sorts of settings

provide a valuable role in supporting

families and also the person to perhaps

plan

choose

and enable that person to continue their

normal occupations or chosen occupations

so this is a quote from the american

occupational therapy association

their position statement on palliative

care which

indicates that

our main role is about facilitating

engagement in daily

life or i would say usual

so where do we work we work in a lot of

different settings ranging from

surgical or medical units in a hospital

perhaps to a hospice to community-based

services

palliative care services but also

community health and other

more rehabilitation services and

commonly

there are more occupational therapists

working in oncology rehabilitation

we work with a variety of different

health professionals ranging from

specialist medical staff general

practitioners

nurses palliative care nurses

physiotherapists

people providing particularly

spirituality and and counselling

services such as chaplains social

workers

speech pathologists who may be looking

at the person's communication and

so what's special about occupational

therapy in this area

well i think it's a

rather unique role and it's something

that's quite rewarding and

because we look at all the aspects of

the person

both their motor their

emotional their cognitive

and

sensory aspects

we're helping the people

we're working with who have life

limiting conditions

resume

continue

or

even start new occupations

and enabling people to

live

and participate in their occupations of

their choices is pretty special

we don't just look at

symptom management such as pain or

fatigue

we also look at

enhancing the environment and

so as i mentioned we might be assisting

a person to return to a previous or old

occupation

that they still want to perform

or we may be looking at new occupations

so things that people want to start that

perhaps

are on the list of things that they

wanted always to do during their life

we work particularly around i think

enabling people to do the things they've

always wanted to do

in preparation for their end of life

it may be around

making a video that might be shown at

their funeral

getting their

life in order

having the social

outings and family outings

that they want to do

prior to to dying

spirituality and which is one of the

core things in the person and

so as occupational therapists

we look at the environment and consider

how we can enhance the environment both

at a physical social or

cultural level

to enable the person to

participate or engage in their chosen

occupations

we certainly look at the person

or personal factors

such as

functional decline

anxiety

mobility problems

fatigue

so those things that are impacting upon

the person's

so our core values of being occupational

therapists

position ourselves very well within a

palliative care service or

in a service that is working with people

who may be

at the end of their lives

certainly i've mentioned before the

person-centered or holistic approach is

is very important

and being able to tailor

interventions

uh

and and our service to ensure that we're

meeting the needs of of individuals

is some particularly important

also

being with

people listening um

people's narratives their life stories

are very very important in this in this

stage

and

being able to listen and

work towards this person's goals

is i think a truly great honor and

something that

it's

also i think particularly important to

acknowledge and appreciate that

everyone is dying

some just dying sooner than others

but it's something that we all face our

mortality

is is very apparent to us with people

who are nearing the end

it

takes a i think an interdisciplinary

approach to deliver the best possible

care to these people

and one that is respectful of people's

wishes where they're at

some people may

not be ready

to accept that they're dying and may

have be having

difficulties coming to terms with that

working with people to

ensure that the given the right service

at the right time

and that the people around them are also

respected and

so

as mentioned we're particularly

interested in meaningful occupations and

rather than just sort of see palliative

care as

tucking the person away in the corner

keeping them comfortable keeping them

pain-free

our

view is very much that we want people to

live life to the fullest right to the

very end so things like daily routines

are very important

often

having worked with a lot of people who

have had cancer

seeking some sort of normality and going

back to doing their normal occupations

has been very very important to them

people often reprioritize their goals

and and direction life directions when

they know that their time is limited

so

assisting people to

do the things that they want to do at

that particular time is very important

to them and and often to family although

there can be can be some conflict

between what the family want and what

the person wants

and that's

working through those with with everyone

involved

um and certainly um being aware of

cultural and and spiritual factors um

that the person

so how do we practice well

like in any area

developing a

therapeutic relationship

with the person but also with their

carers or family members is important

gaining information from just talking

with the person understanding where

they're at

what their wishes are

and

the sorts of occupations that are

important to them is important to us as

well not just focusing on their deficits

or the things that they've lost but also

perhaps identifying their strengths and

using their abilities and strengths to

perhaps overcome some of those deficits

as mentioned before identifying the

carers needs so they may

perhaps feel quite in the dark about

what's happening

and may need some education and support

they may be at a different stage in

terms of accepting things

so

supporting carers is is essential

particularly if the person

wishes is to

die at home or

they want to do things that

may require quite a lot of assistance

and support

as occupational therapists we do a lot

of task analysis and

during the period of palliative care

particularly

towards the end

things are not

static there are

dynamic they're changing

therefore

constantly re-evaluating task

analysis

so what sort of interventions

all and many we

have to be very flexible in how we

provide

interventions

depends on where the person is at at

that particular time

working in conjunction with the other

interdisciplinary team members is

important and communication with them is

vital

we may pay

very much a education role in at times

look at relieving symptoms such as pain

and

shortness of breath

that may be important at other times

planning days to overcome

fatigue

and being able to do the things that

people want to do

and maybe providing assistance

organizing assistance to do

other occupations that they wouldn't

have been able to do

if they had fatigue problems

environmental adaptations

is also very important particularly

again if we're going to support carers

for the person to die at home and

or enable the person to continue to

access environments where their

meaningful occupations are taking place

and probably in particular preventing

functional decline so as i mentioned

before it's not about just making the

person comfortable but ensure

i'm just giving you a few examples now

of

different ways that we might

interact with people in various

stages of life

so for the older adult

being able to perhaps go on a holiday or

die at home may be the goal

whereas a child

being able to

play

in a hospital ward normalizing perhaps a

hospital ward

and enabling social interaction with

their friends or brothers and sisters

for adolescents it may be

going to a concert maybe having an

outing with their friends

and

that may be seen as their

biggest priority

whereas an adult it may be more around

involving the

family so olivia is an occupational

therapist who graduated from la trobe

and she's been working at peter mccallum

cancer center for some time now and

recently she

commenced

in a program called on tracker peter

mack working predominantly with

adolescence

and it's a statewide service that goes

centered at peter mac but goes right

across victoria

it consists of a number of other health

professionals and also education and

vocational consultants

with the

aim or the

priorities of the service

particularly on productive occupations

such as assisting the person to return

to work or school or university

and it may be

not necessarily viewed as palliative

care maybe assisting someone who may

have

had a tumor in their femur who's had

their leg amputated and then subsequent

treatment to that maybe around assisting

them to return to school

so

they work

within peter mccallum but also right

across the state with community base

so when i asked olivia about her role a

few things came to mind and the first

one was around using a screening tool to

identify the

the issues or the priorities for the

person

she may be involved in doing work side

or school visits or even doing home

visits

they look both at productive occupations

and also self-care occupations

however

leisure leisure occupations

unfortunately

due to time constraints this may not be

a high priority

although it may be high priority for the

person

getting the person home particularly

from

a surgical

or a unit

hospital unit in patient unit may be a

priority

and resuming normal occupations and

so the sorts of things olivia does

on a regular basis may be around pain

management and relaxation training that

may be to address anxiety assists with

sleeping

or general coping

lots of work in around education advice

around structuring

the person's day

encouraging them sometimes to push

themselves rather than

be the lounge lizard or

just stay in bed

encouraging them to get up get going so

that they're main maintaining

functional ability and preventing that

decline that will impact

so just a couple of things that olivia

did mention and one is

even though the person is an adolescent

treat them as an adult and really

encourage them to make their own

decisions

so

they may have

their family and carers around them

however

she felt it was important to

usually talk to them without their

parents there

because they

more inclined to tell you what is really

important to them

and what are their

goals and priorities

working with adolescents

there's often some particular things

around

body image

which is important and

self-identity which is forming

during adolescence

so

cancer-related treatments such as

chemotherapy or radiotherapy can impact

upon

things like

hair loss

the person can lose a lot of muscle bulk

but also if they're on things like

steroids for things like cystic fibrosis

then they may have a lot of weight gain

and obviously things like amputation

will

disrupt

body image greatly as well

often overlooked is things like

sexuality issues which for adolescents

is

is a major

priority and

again

talking to the person by themselves

rather than with their parents will

elicit some of those issues

and

i think the other thing

that's important working with this

age group

is

is knowing that they're seeking answers

they're looking for guidance

however

so coming to the conclusion of this

lectorial i think it's important to

reflect on

your own

values your own

emotions and attitudes towards

death and dying

so being aware of those

being in tune with where you're at

is essential if you're working with

people who are

nearing the end of their lives

working through perhaps some emotional

issues

being respectful of other people's

values

and choices

seeing that it's a real privilege to

work with people in this space

needing

recognizing the need to be flexible this

is

ever-changing and very very dynamic

so

what may be appropriate for this moment

may not be appropriate in a few hours

time so

seeing it that is

it's not one size fits all and it's

certainly

uh the one thing will not necessarily be

the same throughout the whole period of

end of life

it'll sometimes be very distressing

to

see

people upset

to even to face your own mortality

i think

is is quite challenging

but there are some

some i think very special times and and

very

uh rewarding times working with people

in and also seeing dying as as a unique

occupation and

it's very special to work with people to

give them the sort of

so this is just a list of

references that i've used in preparing

this

i would really encourage people to use

some of the references

relating to palliative care australia

and there is some great resources on the

website pcc for you

which has been

for a number of years now developing up

resources for undergraduate health

students

so

again i would really encourage