The Role of Occupational Therapy in Palliative Care
Summary
TLDRThis 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
💡 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.
🏥 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.
👥 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.
🎯 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.
🧠 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.
Mindmap
Keywords
💡Palliative Care
💡Occupational Therapy
💡Adolescent Palliative Care
💡Interdisciplinary Team
💡Quality of Life
💡End-of-Life Care
💡Hospice Care
💡Functional Decline
💡Person-Centered Care
💡Spirituality
💡Cultural Sensitivity
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
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