Occupational Therapy and Palliative Care

Occupational Therapy and Palliative Care

1. Occupational Therapy Palliative Care

2. Occupational Therapy A client-centered health profession concerned with promoting health and well being through occupation. T he primary goal of occupational therapy is to enable people to participate in the activities of everyday life . O T’s achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement ’

3. Occupational Therapy W e assist our clients to reach goals, we assess the occupational performance deficits and determine barriers to goals they have identified as important, including intimacy

4. Occupational Therapy Optimizes quality of life and promotes occupational performance over the course of disease progression through participation in meaningful occupations, via comprehensive assessment and intervention Promotes adaptation and coping with the challenges associated with life limiting illness, by reframing occupational goals and expectations in the face of impending death Supports capacity to attend to affairs and the development of legacy

5. Occupational Therapy Assists with management of symptoms such as fatigue, breathlessness and pain through assessment, education, counselling, task redesign and equipment prescription Provides support to the person to remain in/return to the place of care of their choice through assessment, intervention and care co-ordination

6. Occupational Therapy Provides expert assessment of the person’s ability to manage safely within their own home. Targeted interventions, such as education and environmental modifications address identified goals. The occupational therapist’s understanding of the illness enables planning for future needs

7. Occupational Therapy Provides expert liaison within the care team to promote best outcomes Provides support, education and training to informal caregivers to reduce risk of injury, negative experiences and complex bereavement. The informal caregiver role can be challenging, generating anxiety and stress in an already uncertain situation

8. WHO Definition of Palliative Care : An approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual .

9. WHO Definition of Palliative Care: A ffirms life and regards dying as a normal process. I ntends neither to hasten or postpone death. I ntegrates the psychological and spiritual aspects of patient care. O ffers a support system to help patients live as actively as possible until death. U ses a team approach to address the needs of patients and their families, including bereavement counselling.

10. Palliative Care Vison and Occupational Therapy P rovide holistic care, which includes the physical, spiritual, social and psychological dimensions of personhood. ‘... P alliative care is not only about people dying peacefully; it is about helping people to live until they die.’ O T is to provide holistic approach that works to address goals and needs to get the best possible quality of life in order to achieve a ‘good death’ whilst concentrating on the core of – Occupation

11. Role Occupational Therapist Inpatient assessment, review , discharge planning Coordination of care Consults Active management with the service

12. Inpatient Team Medical + Nursing + Allied health + Advanced Recreation Officer + Admin Role Symptom assessment and multidisciplinary intervention Discharge planning and coordination with community team & NGOs Rehabilitation of function/deconditioning Terminal Care

13. Community Team Medical +Nurses + OT + SW + PT + Allied Health Assistant + Admin Role : H ome visits O utpatient Clinics C onsultancy S ymptom management at home P artnership with NGOs, private hospitals and other services S upporting patients’ choice of care setting H ospital avoidance

14. Palliative Care Children and Adults The patient has progressive, life limiting or life threatening disease (malignant and/or non malignant ) E.g . cancer, neuro-degenerative conditions, end stage cardiac, respiratory, renal

15. Role of Occupational Therapy in Palliative Care “They acknowledge the inevitability of death, the loss of function and the ongoing drive to be as active as possible for as long as possible ” ” Occupational therapists help to optimize the individual’s function, promote dignity and support participation in essential and valued activities . Consistent with palliative philosophy, interventions are developed in consultation with people with life-limiting conditions and their circles of support to live and die in the place of their choosing”.

16. Occupational Therapist Assist With H ome Environment (Minor mods, set up, equip) E quipment prescription R eview of occupational performance in the home F uture planning and expected deterioration G oal setting L ymphedema management I dentification of other needs and advocacy or referral E.g. PT, SW, DT, SP D ischarge planning E.g. from hospital I ntervention and education of patient/ carer /family ( fatigue and energy conservation, breathing, relaxation, pressure care, manual handling, memory, sleep hygiene)

17. Assessment - Occupational Performance Care Planning- Psychosocial care H ome assessment E quipment provision D ischarge planning Symptom Management - Equipment provision P ressure care F atigue management P ain and breathlessness M aintaining occupational performance R ehabilitation

18. Care Planning; Psychosocial A cknowledgement and validation of the patient’s difficulties and threatened existence can be powerful. T his requires active listening and a preparedness to be uncomfortable, to sit with someone while they cry, to discuss intimacy, spiritual and existential issues. A cceptance , empathy and encouragement are important. C are for the C arers and family is important. They too need validation and encouragement.

19. Symptoms a Person Experience P ain F atigue L oss of intimacy B reathlessness N ausea W eight loss A nxiety +/- depression E dema ( swelling) W ounds C ognitive changes S leeplessness F unctional deterioration

20. Pain “ P ain is what the patient says it is, existing where and when the patient says it does .” P ain can be an expression of emotional and spiritual distress as well as a physical symptom B est treated through a combination of pharmaceutical and non-pharmaceutical interventions

21. Fatigue Some signs of fatigue are: F eeling tired, weary or exhausted even after sleeping L acking energy to do your regular activities H aving trouble concentrating, thinking clearly, or remembering F eeling negative, irritable, impatient, or unmotivated L acking interest in normal day-to-day activities S pending less attention on personal appearance S pending more time in bed or sleeping

22. Intimacy Sexuality : ‘capacity for sexual feeling; a persons sexual orientation or preference, sexual feeling ’ Intimacy is defined as - ‘a close, familiar, and usually affectionate or loving personal relationship with another person or group’ or a ‘close or warm’ friendship or understanding’.

23. Intimacy Interventions Therapeutic touch Active listening Education Positioning Energy conservation Pain management

24. When a person is dying F eeling the need to review their life … F inish things off… F eelings of loss of control… M eaning of life & mortality & death… M aking and maintaining connections with others… R e-instating lost relationships… M anaging the health care system … F eelings of loss of self… F eelings of loss of function… L ooking at achievements… L ooking at relationships… R eflecting on love shared… C hanges in roles… U ncertainty… U se one of the OT models to help you assist them to set goals .

25. Home Assessment for End of Life Care C hallenging but highly rewarding N eed to understand prognosis/disease progression C arers take the opportunity to ask all manner of questions C hoose the room for delivery of care

26. Home Assessment for End of Life Care Interventions include ; Counselling , education, exploration of issues relating to Carer fatigue and degree of risk the individual/family are prepared to accept P rescription of equipment (hosp. bed, transporter commode, hoist wheelchair, pressure care equipment, call systems)

27. Client Needs and how we really address their needs A ssessment W e ask them C ollaboration E nablement P roblem Solving E nvironmental Adaptation U sing therapy as a therapeutic tool E nd of Life Goal Setting

28. Client Needs and how we really address their needs Goal setting H ow do we establish the priorities? W hat is your most important plan? W hat is going on for you right now? B e brave and ask the hard questions Collaboration : B alance the person’s and family’s aspirations with realistic expectations H elp the person and family to achieve their aspirations wherever possible

29. Client Needs and how we really address their needs Just right balance: R ecognizing deterioration & predicting changes, Acknowledge the important relationship between symptom + feelings + ability to function Enablement : S ometimes people need to be given permission not to have to do things O ffer support to patients by helping them re-determine realistic goals. N ormalize Reframe and redefine plans/wishes/needs

30. Client Needs and how we really address their needs Therapy : C reative therapy strengthens ‘connections to life’. Therefore looks at personal experiences of engaging in creative activities A range of creative activities offered should be adjusted through activity analysis of function, Benefits: ↑ energy, ↓ pain & opportunity to express emotions/explore & understand own feelings & ↑ sense of self-identity.

31. Client Needs and how we really address their needs Therapy : C reative therapy strengthens ‘connections to life’. Therefore looks at personal experiences of engaging in creative activities A range of creative activities offered should be adjusted through activity analysis of function, Benefits: ↑ energy, ↓ pain & opportunity to express emotions/explore & understand own feelings & ↑ sense of self-identity.

32. Through Occupation We… C onceptualize the world D efine ourselves L earn about ourselves C are for ourselves C onnect with others D emonstrate our love and concern for others C ontribute to society C onnect with the spiritual E xercise choice D emonstrate our individuality E xperience master

33. Through Occupation We… C onceptualize the world D efine ourselves L earn about ourselves C are for ourselves C onnect with others D emonstrate our love and concern for others C ontribute to society C onnect with the spiritual E xercise choice D emonstrate our individuality E xperience master