Role of the Speech-Language Pathologist in Palliative Hospice Care

In reviewing the literature, there are few articles describing the role of the speech-language pathologist in hospice. Communication impairments can impact upon the hospice team's ability to provide symptom control and supportive psychosocial care, and diminish the patient's ability to guide the decision making process and maintain social closeness with family. Swallowing difficulties may result in discomfort for patients and concern from caregivers. Patient care provided by the speech-language pathologist can align with the framework of the World Health Organization's components of palliative care. Four primary roles of the speech-language pathologist in hospice can be described. (1) To provide consultation to patients, families, and members of the hospice team in the areas of communication, cognition, and swallowing function; (2) To develop strategies in the area of communication skills in order to support the patient's role in decision making, to maintain social closeness, and to assist the client in fulfillment of end-of-life goals; (3) To assist in optimizing function related to dysphagia symptoms in order to improve patient comfort and eating satisfaction, and promote positive feeding interactions for family members and (4) To communicate with members of the interdisciplinary hospice team, to provide and receive input related to overall patient care. Further development of the speech-language pathologist as a participating member of the hospice interdisciplinary team would support the overall goal of providing quality care for patients and families served by hospice.

The utilization of physical therapy in a palliative care unit

BACKGROUND

In the supportive oncology and palliative care settings, rehabilitation interventions are often overlooked and underutilized, despite high levels of functional disability in these patients. As a result, little is known about the utilization or effectiveness of rehabilitation interventions in palliative care populations.

OBJECTIVE

To assess the utilization of physical therapy (PT) in a hospital-based palliative care unit, to characterize functional disabilities in patients who received PT, and to identify factors related to functional improvement following a course of PT.

METHODS

Retrospective chart review of 100 patients (mean age 70 years, 97% male) discharged from the Milwaukee Veterans Hospital Palliative Care unit over 15 months. Activities of daily living (ADL) performance scores were recorded on admission, at 2 weeks, and at completion of the PT program and correlated with demographic and disease-related variables.

RESULTS

Thirty-seven patients received a formal PT assessment, and 18 patients underwent PT. The most common functional disabilities in patients who received PT were deconditioning, pain, imbalance, and focal weakness. Ten patients demonstrated improvement in ADL function at 2 weeks. Six patients completed the course of PT. Albumin was significantly correlated with functional improvement. When controlling for albumin, patients with diagnosis of dementia were more likely to show improvement in functional status than patients without a dementia diagnosis.

CONCLUSION

PT assessment and utilization were uncommon in this group. When utilized, PT benefited 56% of patients. Factors related to functional improvement following a PT course were a higher albumin level and a diagnosis of dementia. Prospective trials of PT in palliative care patients are needed to better define response rate and predictors of response.

Palliative care in chronic psycho-geriatrics: a case-study

In this case-study the relevance of psycho-social interventions for providing palliative care in the terminal phase of life of psycho-geriatric patients with functional-psychiatric co-pathology is described. The know-how, interventions and facilities such as available in a reactivation unit in a 'psychiatric-skilled' Dutch nursing home, were highly relevant to tune palliative care to the needs and abilities of the patient. The application of the four main-dimensions of the method of Dynamic System Analysis (particularly Cognitive functions, Psychological functions, Social context and Biology) can stimulate professionals to use an integral perspective both to the psycho-social needs of terminal psycho-geriatric patients and their relatives and to the biological aspects. To establish the value of the DSA method for providing palliative care to psycho-geriatric patients with functional-psychiatric co-pathology scientific research is recommended to determine the prognostic profile of patients who benefit most from an actual palliative care program.

Exploring rehabilitation within lymphoedema management

A review of the literature reveals rehabilitation to be a complex concept. Rehabilitation is more than a global term used to encompass the different types of therapy employed to reduce the effects of disability or chronic illness; it is a philosophical approach which provides a framework for care. This framework promotes an environment in which the individual is enabled to attain his/her own ideal of health. The concept of rehabilitation is explored within the mainstream management of lymphoedema to identify implications for improving practice. Areas in which lymphoedema therapists could strive to achieve a more rehabilitative approach to care include: implementing an organized and standardized approach to lymphoedema management, improving interdisciplinary working, developing the holistic scope of care, and acknowledging the central importance of the patient and family in clinical practice. Adopting a rehabilitative approach to lymphoedema management will help to promote greater patient satisfaction with treatment.