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.