Faull et al. (1998) position an occupational therapist as a health care professional that plays a vital role in the maximization of “patient’s potential for safe independent living” (p. 21). However, the patients of palliative care form a specific category of “patients with end-stage disease” (Twycross, 2003, p. 7). This specificity accounts for the necessity of a complex approach to patient rehabilitation where a team of healthcare professionals is involved, occupational therapists among them. Thus, one of the primary skills necessary for a newly graduated occupational therapist is the skill of communication and cooperation with other health care professionals, such as physiatrists, physical therapists, rehabilitation psychologists, social workers, etc. (Morrison et al., 2003, p. 143).
Supporting team approach to rehabilitation of palliative care patients, Watson et al. (2005) stress the necessity of an occupational therapist’s ability to set realistic goals for the patient, which will be “feasible and structured” (p. 644). Thus, a newly graduated occupational therapist should possess the skill of realistic goal-setting and planning. Cooper and Littlefield (2004) performed a study of occupational therapy interventions in oncology and palliative care and, focusing on patient contact activities performed by occupational specialists, they also stress the importance of goal setting (p. 330). McIntyre and Atwal (2005), p.70, suggest the use of the SMART framework in arriving at realistic goals for patients in palliative care. The SMART framework for goal setting in palliative care involves the goals set are specific, measurable, achievable, realistic, and timely regarding occupational performance. A key element here is a collaboration with the patients in arriving at goal setting. However, before the goal-setting exercise, a measurement of the baseline has to be made, which acts as the foundation of where the patient is and where the patient can be expected to be after the planned intervention. This makes assessment skills and planning skills important to an occupational therapist. In addition communicative skills to build rapport with the patient and collaborative skills to arrive at a mutually agreeable intervention plan to improve performance essential to an occupational therapist. Finally, in connection with goal setting monitoring skills are also needed to evaluate the progress of the planned intervention (McIntyre and Atwal, 2005, p.70).
Along with goal setting, the researchers stress the overall ability of an occupational therapist to perform an assessment, such as the one done during initial interviews, besides, home assessments and perceptual assessments are included (Cooper & Littlefield, 2004, p. 330). An occupational specialist should have theoretical knowledge and practical skills of symptom control provision, such as relaxation, fatigue, anxiety, breathlessness management (Cooper & Littlefield, 2004, p. 330). In addition to the provision of symptom control in these areas, a key area of symptom control is pain alleviation. Symptom control of pain from the disease processes and side effects of the treatments like chemotherapy, medication, and radiotherapy usually falls under the ambit of the medical and nursing professionals in the team providing palliative care. Palliative care patients, however, experience two other kinds of pain consisting of pain that comes from extended bed rest or period of inactivity and the pain that develops from loss of role or helplessness. These are the key areas of pain alleviation that an occupational therapist requires skills in. The occupational therapist can educate the care providers on better positioning of the patient the appropriate techniques associated with transferring and positioning of the patient. This requires instructional communication skills in an occupational therapist. The occupational therapist plays an important supportive role in elevating the pain from helplessness. Death hovers on the near horizon and patients in palliative care feel pain from the useless condition that they are in. Supportive strategies that provide meaningful activity help in alleviating this kind of pain. These meaningful activities can involve creative activities, wherein patients can express themselves. Skills in evaluating the pain experienced by the patients and developing support strategies are thus essential to an occupational therapist (Lewis, 2003, p. 85).
Occupational therapists should provide palliative care patients with equipment (Cooper & Littlefield, 2004, p. 330) and adaptation (Kealey & McIntyre, 2005, p. 237). Patients in palliative care grow weaker and in addition to symptom control, the use of equipment is extremely helpful. Local home health services and insurance companies are the common sources for such equipment, procuring of which can be assisted by occupational therapists (Higginson & Gass, 2004, p.1293). According to Connor (2009), p.34, it is “occupational therapists that teach the patient and family to use special devices”. Occupational therapists should have excellent communication skills since communication is greatly valued by patients and the caregivers of patients, as the study conducted by Kealey & McIntyre (2004) established. Communicative and training skills are thus essential skills for an occupational therapist to be successful in providing palliative care, which is reflected in Toth-Cohen (2000), p. 509, pointing out that occupational therapists should transcend from their traditional roles to providing support and training for care givers.
Occupational therapists should provide emotional support and advice on stress management (Kealey & McIntyre, 2004, p. 329). Patients in palliative care and the caregivers face severe emotional stress. This emotional stress arises from the condition of the patient and the needs that keep changing and the realization this is a one-way road with time the essential controller. The patient and the caregivers have to be assessed for the emotional and stress support requirements and the appropriate emotional and stress support coordinated by the occupational therapist. This places the need for occupational therapists to be emotionally strong and with skills to assess and handle the emotional needs of patients and the caregivers (Aitken & Aitken, 2009, p.7).
Literary References
Aitken, A. M. & Aitken, (2009). Community Palliative Care: The Role of the Clinical Nurse Specialist. West Sussex, United Kingdom: John Wiley & Sons Ltd.
Connor, S. (2009). Hospice and Palliative Care: The Essential Guide. Second Edition. Madison Avenue, New York: Routledge
Cooper, J., & Littlefield (2004). Interventions in oncology and palliative care. International Journal of Therapy & Rehabilitation. 11(7), 329-333.
Faull, C., Carter, Y., & Woof R. (1998). Handbook on Palliative Care. Main Street, MA: Wiley-Blackwell.
Higginson, I. J. & Gass, D. A. (2004). Palliative Care. Oxford: Oxford University Press.
Kealey, P., & McIntyre I. (2005). An evaluation of the domiciliary occupational therapy service in palliative cancer care in a community trust: A patient and carers perspective. European Journal of Cancer Care, 14, 232-243.
Lewis, C. S. (2003). Elder care in Occupational Therapy. Thorofare, New Jersey: Slack Incorporated.
McIntyre, A. & Atwal, A. (2005). Occupational Therapy With Older People. Oxford: Blackwell Publishing Ltd.
Morrison, R.S., Meier, D.E., Capello, C. (2003). Geriatric Palliative Care. Melbourne: Oxford University Press.
Toth-Cohen, S. (2000). Role Perceptions of Occupational Therapists Providing Support and Education for Caregivers of Persons with Dementia. American Journal of Occupational Therapy, 54(5), 509-515.
Twycross, R.G. (2003). Introducing Palliative Care. Abington, OX: Radcliffe Publishing.
Watson, M.S., Lucas, C., & Hoy A. (2005). Oxford Handbook on Palliative Care. Melbourne: Oxford University Press.