Enhancing Palliative Care through Occupational Therapy

• Defining Occupational Therapy in Palliative Care

• Enhancing Quality of Life in Palliative Care

• Using the Canadian Practice Process Framework in Occupational Therapy for Palliative Care

• Occupational Therapy Interventions in Palliative Care

• Distinguishing Between Palliative Care and End-of-Life Care

• Palliative Care: Online Tools and Resources

Defining Occupational Therapy in Palliative Care

When we talk about healthcare, certain professions like doctors and nurses probably spring to mind first. However, there are many other health professionals involved in a patient's care, especially in a complex field like palliative care. Among these lesser-recognized but equally vital professionals are occupational therapists. Occupational therapists have unique expertise in enhancing daily function and quality of life, making them an essential part of the palliative care team, ensuring that patients maintain independence and engage in meaningful activities even in their final stages of life.

To understand occupational therapy in palliative care, let's first unpack what each term means:

• Occupational Therapy: This is a type of healthcare where professionals, known as occupational therapists, help individuals of all ages to live their lives to the fullest while being able to cope with health-related challenges. They promote health and well-being through the 'occupation', or meaningful, everyday activities. This could be anything from helping a person safely use their kitchen appliances to assisting a child with disabilities to participate fully in school activities.

• Palliative Care: This is a particular form of medical care that focuses on relieving the symptoms and stress of serious illness. The goal isn't to cure the disease but to improve the quality of life for both the patient and their family. Occasionally, it is provided alongside curative treatment as well.

Enhancing Quality of Life in Palliative Care

Improving the quality of life goes beyond just easing symptoms or extending life. It encompasses essentials like ensuring a patient's comfort, upholding their dignity, catering to their emotional and psychological well-being, and addressing their social and spiritual desires (Kaasa & Loge, 2003). Occupational therapists are dedicated to upholding the self-respect and autonomy of their patients, empowering them to retain as much control over their daily activities as possible. Let's examine further how occupational therapists enhance a client's overall well-being.

"In the journey of palliative care, occupational therapy ensures every moment is lived with purpose and meaning."

Focus on Comfort: Often, the primary goal isn't to cure but to provide comfort and

support. Effectively managing symptoms that may cause discomfort, such as pain, fatigue, or breathlessness, allows the client to experience as much comfort as possible.

Preserving Dignity: Serious illnesses can often rob individuals of their ability to do daily tasks independently, negatively affecting their self-esteem. Occupational therapists help preserve the dignity and self-worth of individuals, allowing them to maintain control over their lives as much as possible. Occupational therapists help clients perform tasks that may be causing some difficulty, from self-care routines like dressing or eating to more complex activities like cooking or driving.

Promoting Emotional and Psychological Well-being: Palliative care understands that individuals are more than their disease. Addressing emotional and psychological needs, reducing stress and anxiety, and providing necessary mental health support promote well-being.

Supporting Social and Spiritual Needs: Quality of life involves social connections and spiritual beliefs. Occupational therapists aim to support these aspects, ensuring the individual feels connected, understood, and at peace. Occupational therapists facilitate meaningful interactions and engagement with family, friends, and the community and provide a safe space for individuals to explore and express their spiritual concerns.

Benefiting Families and Caregivers: Enhancing a patient's quality of life also has a positive impact on their families and caregivers. It can reduce the stress and burden of care, provide peace of mind, and improve the family dynamic. When a patient is more stable and contented, families can focus on creating meaningful memories together rather than being overwhelmed by the demands of care.

Client-Centred and Holistic Care: Occupational therapists follow a client-centred approach, meaning they view each patient as a unique individual with specific needs, desires, and life experiences. This is combined with a holistic view, where they consider all aspects of a person’s well-being – physical, emotional, psychological, social, and spiritual. A client-centred, holistic approach has numerous benefits. It respects the autonomy and individuality of each patient, allowing them to feel heard and understood. It can also increase satisfaction with care, as the patient feels their unique needs and wishes are being considered and addressed. When patients are involved in their care decisions, and the care they receive aligns with their values and interests, it can add a profound sense of meaning. They’re not just passively receiving care; they're actively participating in managing their lives (Kielhofner, 2008).

(Kaasa & Loge, 2003)

Using the Canadian Practice Process Framework in Occupational Therapy for Palliative Care

Assessing and treating patients doesn't always follow a one-size-fits-all method; it often varies based on individual needs. One approach we haven't touched upon on our website is the Canadian Practice Process Framework (CPPF). This framework is versatile and applicable across various occupational therapy fields or settings. The Canadian Practice Process Framework is a distinctive, structured approach used by occupational therapists in Canada to guide their practice from the initial point of contact with a client to the conclusion of therapy. Rooted in the values of client-centred care, the CPPF delineates clear stages in the therapy process, ensuring a systematic and thorough approach to care (Townsend & Polatajko, 2013).

The CPPF is all about putting patients first, making sure their needs and wishes are the main focus. This framework allows occupational therapists to work closely with patients, building trust and understanding. This way, they can give the best care possible, aiming to improve the patient's comfort and quality of life during their final days.

CPPF: Structured framework for client-centered OT interventions.

Let’s look at the eight steps that guide the occupational therapy process:

1. The process begins with Enter/Initiate, where the occupational therapist establishes contact with the palliative patient. This phase involves understanding the context of the patient's request and establishing initial rapport. This step is critical as it sets the tone for the subsequent stages of care and ensures that the patient feels heard, respected, and understood.

2. Next comes Set the Stage. During this stage, the therapist and patient form a partnership, and there is a mutual understanding of roles, responsibilities, and expectations. Informed consent and confidentiality parameters are also discussed. Both parties gain clarity on their roles, what they can expect from one another, and the responsibilities they each hold.

3. The Assessment/Evaluation phase follows. Here, the occupational therapist conducts a thorough evaluation of the patient’s abilities, needs, and challenges. They gather relevant information to understand the patient's daily routines, goals, and meaningful activities, all within the context of their palliative status.

4. With the assessment complete, the Agree on Objectives and Plan phase ensues. The therapist collaborates with the patient and possibly their caregivers or family to define realistic goals and establish a comprehensive intervention plan. This mutual agreement ensures the plan aligns with the patient's values and aspirations.

5. The Implement Plan step is where the devised interventions are carried out. This could involve making tangible changes to the patient's environment, ensuring it's both safe and conducive to their well-being. Skill training might be introduced, equipping the patient with new techniques or strategies to handle daily tasks more efficiently and comfortably. Additionally, the therapist might offer valuable education, providing the patient with knowledge about their condition and ways to cope.

6. Subsequent to implementation is Monitor and Modify. Given the nature of palliative conditions, where patients’ health and needs can shift over time, it's imperative for the occupational therapist to maintain an ongoing evaluation of the interventions in place. This isn't a passive process; the therapist actively observes, listens, and collaborates with the patient, ensuring that the interventions remain relevant and effective. Feedback from the patient becomes invaluable here, offering firsthand insights into what's working and where there might be room for improvement.

7. The Evaluate Outcome phase of the CPPF focuses on reviewing and measuring the effectiveness of the interventions. Here, occupational therapists work alongside patients to review the goals set at the onset of the therapy, measuring the extent of their achievement. They delve into understanding the tangible and intangible impacts of the interventions: Has mobility improved? Has the pain been managed more effectively? Are daily activities now more feasible and enjoyable? How have these interventions enriched the patient's overall quality of life?

8. The Conclude/Exit phase signals the end of the formal therapeutic relationship. As this phase unfolds, the therapist takes time to reflect upon and recognize the progress made throughout the therapy sessions and to ensure a smooth transition post-therapy. The primary aim is to ensure that patients and their loved ones feel confident, informed, and empowered as they step into the next chapter of their care journey.

(Townsend & Polatajko, 2013)

Occupational Therapy Interventions in Palliative Care

In palliative care, occupational therapists don't just focus on easing symptoms like pain or anxiety; they also look at how these symptoms impact a person's day-to-day activities. For example, someone struggling with breathlessness might find it hard to do things like take a shower or get dressed. Similarly, a patient dealing with pain may have difficulty doing their laundry or preparing meals. Occupational therapists step in to help bridge this gap, assisting patients in finding ways to engage in meaningful tasks while managing their symptoms.

"When curing is not the end goal, occupational therapy makes living the focus."

Below is a compilation of frequent challenges palliative patients face, accompanied by brief intervention strategies for each:

• Pain: Chronic or acute pain can severely limit a person's ability to perform daily tasks or participate in activities they enjoy.

• Fatigue: A pervasive sense of tiredness can be debilitating, affecting the patient's energy levels and endurance for activities. Possible inventions may include environmental modifications, activity pacing, joint protection strategies, activity modification, and the use of adaptive or assistive devices.

• Shortness of Breath: Respiratory issues can hinder basic activities, from speaking to moving around. For those facing respiratory challenges, occupational therapists might suggest paced breathing techniques during activities and the use of adaptive equipment to minimize exertion, ensuring tasks are completed with minimal breathlessness. They can also educate on energy conservation methods and efficient ways to organize daily routines to reduce the strain on the respiratory system.

• Cognitive Changes: Memory problems, confusion, or other cognitive impairments can affect a person's ability to follow routines or engage in meaningful tasks. Occupational therapists can introduce memory aids and compensatory strategies, such as visual prompts or electronic reminders, to assist with daily tasks. They can also modify activities to match the individual's cognitive level.

• Mood Fluctuations: Depression, anxiety, and other emotional challenges can influence motivation, participation, and overall well-being. Occupational therapists can implement relaxation techniques, mindfulness exercises, and graded activity scheduling to address emotional challenges while offering strategies to promote participation in meaningful and mood-lifting activities.

• Decline in Physical Mobility: This could be due to muscle weakness, joint issues, or other physical ailments, impacting the ability to move around, transfer, or maintain balance. Occupational therapists can provide exercises to strengthen muscles, recommend assistive devices to aid movement and offer strategies to transfer and maintain balance in various environments safely.

• Decreased Dexterity: Fine motor skills might be compromised, affecting tasks like buttoning clothes, writing, or eating. Occupational therapists can introduce adaptive equipment, such as button hooks or weighted pens, and provide fine motor exercises to enhance hand coordination and grip strength.

• Difficulty with Self-Care: Challenges in activities of daily living (ADLs) like bathing, dressing, and grooming. Interventions may include teaching compensatory techniques, recommending adaptive devices like long-handled sponges or dressing aids, and modifying the environment to facilitate independence in ADLs.

• Sensory Changes: Alterations in vision, hearing, or other senses can influence how a person interacts with their environment. Occupational therapists might recommend adaptive tools such as magnifiers or amplification devices and suggest environmental modifications like increased lighting or contrasting colour schemes to aid interaction and navigation.

• Environmental Challenges: Difficulties navigating the home environment due to physical barriers, stairs, or potential hazards. Occupational therapy innervations can include home safety assessments to identify barriers and hazards and then recommend modifications such as installing grab bars, ramps, or stairlifts to ensure safer and more accessible living spaces.

• Medication Management Issues: Remembering to take medications, understanding their side effects, or managing multiple prescriptions can become a challenge. Occupational therapists can introduce medication management strategies such as using pill organizers, setting up alarms or reminders, and providing education on potential side effects to ensure consistent and safe medication intake.

• Spiritual or Existential Distress: Struggling with questions about meaning, purpose, or the end of life. Occupational therapists can facilitate life review activities, create spaces for reflection and meaning-making, and collaborate with spiritual care providers to address patients' spiritual and existential concerns.

• Social Isolation: As health declines, some individuals may withdraw or struggle to maintain social connections. Potential interventions may include introducing adaptive communication tools, facilitating participation in group activities or community events, and educating families on strategies to encourage social engagement.

(Talbot et. al., 2022; Tavemark et. al, 2019)

It's important to remember that not all palliative patients face the same challenges. The abovementioned issues are merely examples that an occupational therapist might encounter when working with this population. Every person's journey is unique, and what one patient experiences might differ from another. Occupational therapists should approach each patient individually, understanding that the challenges highlighted are possibilities, not certainties.

"Where life's timeline may be uncertain, occupational therapy crafts moments that matter."

Distinguishing Between Palliative Care and End-of-Life Care

Note that palliative care and end-of-life care are distinctive. Palliative care and end-of-life care are both specialized approaches to healthcare, but they differ in their focus and timing. Palliative care is a comprehensive approach that aims to improve the quality of life for patients facing serious illnesses, regardless of their prognosis. It focuses on managing symptoms, providing emotional support, and enhancing overall well-being. End-of-life care, on the other hand, specifically caters to individuals in the final stages of a terminal illness or those nearing death.

Palliative Care: Online Tools and Resources

Pallium Canada:

• Website: pallium.ca

• They offer a series of webinars on topics relevant to palliative care approach across care settings, especially during the COVID-19 pandemic. These webinars cover a range of topics like providing home-based palliative care with Personal Protective Equipment (PPE), managing symptoms in COVID-19 patients, and reorganizing palliative care services during the pandemic. Over 25 free webinars are available, created by more than 65 subject matter experts, and are accessible to healthcare professionals across Canada.​

Ontario Palliative Care Network:

• Website: ontariopalliativecarenetwork.ca

• Provides a toolkit for healthcare professionals to identify patients who would benefit from palliative care earlier in their illness trajectory, and recommends tools that can be used to determine when to introduce palliative care​.

Get Palliative Care:

• Website: getpalliativecare.org

• Offers resources such as articles, videos, podcasts, webinars, and a glossary to help understand palliative care. They also provide links to various other resources, and a directory to find palliative care providers in your area.

Palliative care: Resources - Canada.ca:

• Website URL: www.canada.ca

• Description: This webpage provides a list of national and provincial/territorial resources in Canada for palliative care, including organizations and associations dedicated to palliative care and hospice services across different regions in Canada.

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