Funded from Macmillan Cancer Support, this is a three year project which began in 2012, looking at the addition of an Occupational Therapist and Physiotherapist to an already established Hospital Palliative Care Team of nurses, doctors, social worker, pharmacist and complementary therapist. This is in addition to the already existing team of ward based OTs and PTs.
Inspiration for the project came from complex patient discharges. The team wanted to explore what difference there would be by having an OT and PT educated specifically to a specialist palliative care approach. Working alongside the Clinical Nurse Specialists as part of the Hospital Palliative Care Team, the OT and PT can assess patients’ needs and devise management plans.
The role of an Occupational Therapist and Physiotherapist within a Hospital Pallative Care Team:
An impact assessmentSt. John’s Hospital Palliative Care Team,
Rosemary Cairns, CNS; Suzanne Young, CNS; Lesley Goodman, PT; Michelle Lennox, OT; Kate Henriksen, Consultant; Charlie Hall, Specialty Doctor; Fiona Bankier, Complementary Therapist; Lynn Bennett, Pharmacist; Anne Spiers, Social Worker.
TRIGGER FOR PROJECT
I want home, like everyone else.
No one is listening to me and I don’t want to talk
about the future
Patient with complex needs
We can’t do that!!
I don’t know whatto say to her She’s putting
up barriersThe family
won’t manage
Common staff concerns
CORE SKILLS
Functional assessmentBreathlessness management
Fatigue managementCore discharge planning
Mobility assessmentRehabilitation
Equipment provision
ENHANCED SKILLS
Symptom assessment (basic)Advanced communication skills
CBT TrainingPsychological support
Complex discharge adviceAdvance care planning
Preference for place of care, deathDiscussions around DNACPRDisease trajectory awareness
SPICT tool and prognostication awarenessSpecialist rehabilitation
Advisory roleEducational role
PATIENT
PainPsychological distressCognitive impairment
Poor mobilityTwo storey house/Downstairs living
Bathroom upstairsUncertain future
Complex communication issues
STAFF
Can’t do thisShe won’t engage
She doesn’t really want homeWill she be safe?She’s not realistic
Redressing the balanceSpecialist OT and physiotherapist project started
OT & PT skills
I feel listened to
I feel I can cope
I have choices
Teaching Sessions
Research
Advicefor
peers
ReflectionShadowing
Training Courses
FocusGroups
Education and evaluation along the way
Medical Photography Services, St. John’s Hospital, Livingston. August 2014.
Both the OT and PT brought a wealth of knowledge and experience to the service and in turn they have gained an enormous amount; for example, enhanced communication skills to enable advance care planning discussions, thinking ahead and recognising the individual needs of patients to a specialist level. A key role is to liaise with generalist OTs and PTs and provide advice to support complex palliative care patients.
By identifying with their colleagues in their respective profession, the OT and PT have been able to provide education sessions that may be much more powerful than if delivered simply by the nursing team.
Both the OT and PT are now studying towards the Graduate Certificate in Palliative Care.
