the role of ot in hospice and palliative care
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The Role of OT in Hospice and Palliative Care. Janice Kishi Chow, MA, OTR/L Palo Alto VA Hospice and Palliative Care Center April 23, 2013. Objectives. What is hospice and palliative care? What role does OT play?. Hospice. Non-curative comfort care Psychosocial support - PowerPoint PPT PresentationTRANSCRIPT
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The Role of OT in
Hospice and Palliative Care
Janice Kishi Chow, MA, OTR/LPalo Alto VA Hospice and Palliative Care Center
April 23, 2013
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Objectives
•What is hospice and palliative care?
•What role does OT play?
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Hospice
•Non-curative comfort care
•Psychosocial support
•Life expectancy is less than 6 months
•Affirms life
•Accepts death as a normal process
•Neither hastens or postpones death
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Palliative care•“Palliare” : to cloak
• Non-curative, comfort care
• Arose from modern hospice care
• Symptom management for those not terminally ill
• Provided at an stage of an illness or disease
• In conjunction with curative treatments
• Segues into hospice care
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Impact of Hospice and Palliative
Care• Misconception that hospice and palliative care hastens death
• Journal of Pain and Symptom Management, March 2007
• Hospice patients lived mean average of 29 days longer
• CHF: +181 days
• New England Journal of Medicine, August 2010
• Early palliative care of Lung CA: 2.7 months longer
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Possible Factors thatContribute to Survival
• Weakened patients avoid risks of over-treatment
• Hospice care can improve monitoring and treatment
• Psychosocial support may lessen burden of care, increase desire to live, and prolong life
• Early management of symptoms may stabilize disease
• Stability may prolong life
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Role of OT in Hospice and Palliative
Care
•Maximize occupational engagement
•Decline is dynamic
•Modification and adaptation
•Support the grieving process
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Tom*
•47 year old male veteran
•Metastatic rectal cancer (dx’d 4 mo. prior)
•Chemo, XRT
•Stage 4 coccyx ulcer
•Severe hip, back and ulcer pain
•BLE strength grossly 2-/5
*Name changed
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Tom’s goals
•Pain relief
•Full recovery
•Improve strength
•Transfer into a wheelchair
•Go outside with his family
•Walk
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Themes
•Decreased insight vs. Faith
•Poor endurance vs. Denial
•Poor rehab potential vs. “Rehab moments”
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Treatment•Edge of bed activities
•Pre-functional AAROM
•Retrograde massage
•Theraputty exercises
•Psychosocial support
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Wheelchair Fitting
•Tilt-in-Space Recliner w/c
•Cushion with gel insert
•22” hand rims
•Front brakes
•Family education
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Maximizing Function
•Dynamic sitting balance activities
•Cooking activity
•ADL retraining
Ham and Cheese Crescent roll
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Cancer Dying Trajectory
12 11 10 9 8 7 6 5 4 3 2 1 0
Months Before Death
Health Status
Hallenbeck, J. L. Palliative Care Perspectives. 2003, Oxford University Press.
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Cancer Dying Trajectory
12 11 10 9 8 7 6 5 4 3 2 1 0
Months Before Death
Health Status
Hallenbeck, J. L. Palliative Care Perspectives. 2003, Oxford University Press.
Functional Plateau
Sudden decline(probable pulmonary embolism or sepsis)
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Chuck*
•75 year old male veteran
•Palliative care admission
•H/o CHF and COPD
•Retired truck driver
•Married with children and grandchildren
•Recurrent short stays over 2 years
* Name changed
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•Symptom management (SOB, fatigue)
•Maximize function
•Maximize time with family
Chuck’s goals
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Treatment
•Energy conservation
•Adaptive equipment
•Power mobility
•Psychosocial support
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Sine-wave Dying Trajectory
12 11 10 9 8 7 6 5 4 3 2 1 0
Months Before Death
Health Status
Hallenbeck, J. L. Palliative Care Perspectives. 2003, Oxford University Press.
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Conclusion
•Hospice and Palliative Care
•Non-curative comfort care and psychosocial support
•Alleviates pain and suffering
•Improves quality of life
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Conclusion
•Role of OT
•Maximizes occupational engagement
•Support grieving clients
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Practical Application
•Palliative Care Consult
•Symptom management
•Facilitate discharge planning
•Medical and psychosocial support
•End of life discussions
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References
• Addington-Hall, J. M. & Higginson, I. J. (2001). Introduction. In Addington-Hall, J. M. & Higginson, I. J. (Eds.), Palliative Care for Non-cancer Patients. New York: Oxford University Press.
• Connor SR, Pyenson B, Fitch K, Spence C, Iwasaki K. (2007). Comparing hospice and nonhospice patient survival among patients who die within a three- year window . Journal of Pain Symptom Management. 33(3):238-46.
• Hallenbeck, J. L. Palliative Care Perspectives. 2003, Oxford University Press.
• Ternel, J.S., Greer, J.A., Muzinkansky A., Gallagher, R.N., Admane, S., Jackson, V. A., Dahlin,, C. M., Blinderman, C. D., Jacobsen, J., Pirl, W. F., Billings, J. A., & Lynch, T. J. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine. 363(8):733-42.
• World Health Organization (WHO). Cancer: palliative care. Retrieved April 16, 2013 from http://www.who.int/cancer/palliative/en/