When Clients are Dying: Occupational Therapists’ Perspectives

Occupational therapists working with people who are terminally ill potentially face a contradiction between the principles and assumptions of rehabilitation-oriented practice and the needs and experiences of clients who are dying. This research investigated experiences of occupational therapists working with clients who are terminally ill to examine if such a contradiction existed and, if so, how it was managed in daily practice. Ten occupational therapists working with people who are terminally ill shared their perspectives through in-depth interview and participant observation. Data analysis followed grounded theory procedures. Nine conceptual categories were generated from the data: Making a Difference, Referral to Occupational Therapy, Assessing the Situation, Goal Setting, Building Against Loss, “Normality Within a Changed Reality,” Client Control, Supported and Safe Care, and Closure. Analysis of relationships between categories resulted in the development of a conceptual framework of occupational therapy practice with people who are terminally ill. The core phenomenon of the framework emerged as Affirming Life: Preparing for Death. Results indicate that occupational therapists manage this contradiction between their rehabilitation training and their work with people who are dying by reframing the process and outcomes of practice to acknowledge clients’ dual states of living and dying.

Occupational Therapy and Cancer Rehabilitation

The occupational therapy literature and oncology rehabilitation literature were examined to determine the extent of occupational therapy involvement in the treatment of cancer patients. There has been a development of occupational therapy services for many such patients. It is in the areas of terminal care, post-surgical treatment and paediatric oncology that the occupational therapy role has been most extensively documented. Directions for future occupational therapy practice are made.

The Art of the Possible …

As an optional part of her training a recently qualified American Occupational Therapist undertook a placement in terminal care at St. Luke's Nursing Home in Sheffield. The author provides an objective account of this experience which complements an article by Mrs. Ann Holland published in December 1981.

Occupational Therapy for People Living with a Life-Limiting Illness: A Thematic Review

Introduction:

Little is known about occupational therapy practice for people with a life-limiting illness. This paper aims to review the available occupational therapy literature in order to develop a greater understanding of the role and practice trends of occupational therapists working in this area.

Methods:

A systematic search of literature published from 1975–2013 was conducted. Three hundred and fifty-five pieces of literature were located and screened for inclusion using a three-stage process. All literature that met the inclusion criteria was then analysed thematically.

Findings:

An in-depth review of 52 articles, three position statements, two key occupational texts, and one clinical guideline identified three themes in the literature. These themes comprised: (i) reframing practice: defining a palliative approach in occupational therapy; (ii) continuing occupational engagement despite loss; and (iii) preparing for practice when your client is dying: educational requirements of occupational therapists.

Conclusion:

Occupational therapy has an important role to play in the care of people with a life-limiting illness. However, knowledge gaps remain concerning the scope of the role and how best to engage clients in meaningful occupations at the end of life. Further education is required at the undergraduate level and for clinicians working in this area.

Journey of providing care in hospice: perspectives of occupational therapists

The purpose of this study was to explore the perspectives of occupational therapists with regard to their role in hospice and to examine whether occupational therapists experienced a conflict in supporting the dual status of living and dying for individuals with terminal illness. A qualitative analysis revealed the following themes: tuning in and comfort care, loss, working toward death, journey with patient, team player, use of occupational therapy, and dichotomous role. These themes demonstrated that occupational therapists played a significant role in hospice, helping individuals with terminal illness to live life fully and comfortably while facing death. The study found that occupational therapists used a holistic approach in their work by addressing the physical, social, emotional, and spiritual aspects of care.

Adult hospice day care

This article describes the concept of adult hospice day care, argues that programs of adult hospice day care can be an important adjunct to home care and inpatient care, and provides a concrete illustration of ways in which a typical program of adult hospice day care might be implemented.

Occupational Therapy in Adult Bone Marrow Transplantation

Bone marrow transplantation (BMT) is a relatively new and complicated procedure for patients with a range of malignant and non-malignant disorders, including aplastic anaemia, leukaemia and severe combined immunodeficiency syndrome. To date, there has been little discussion of the occupational therapist's role in BMT. This article outlines six stages of BMT, and discusses occupational therapy assessment, treatment and long-term follow-up in order to highlight the contribution occupational therapy may make in the care of these patients.

Perspectives on the pain of the hospice patient

Behind the physical disfigurement and emotional ravages of advanced malignancy, it is the pain of cancer that is most dreaded. Severe biological pain is experienced by fewer than half of patients dying from cancer. Hospice physicians have the expertise to control the pain of those cancer patients who do experience it. The cancer patient may experience other forms of pain that can be equally devastating: pain of isolation, pain of abandonment, and pain of loss of role. It is important for the occupational therapist working in a hospice setting to understand all aspects of pain management, and the occupational therapy treatment strategies which can improve the quality of life and perception of pain for the hospice patient. Through presentation of case studies, the authors illustrate applications of occupational therapy assessments and interventions in respect to two hospice patients. The occupational therapy treatment strategies effected an improvement in the quality of life for these patients and consequently their perception of pain of loss of role. Occupational therapists, as part of the hospice team, play an important part in giving patients an opportunity to live out their lives in as dignified and purposeful a manner as their disease permits.