This weeks #OTalk is on the topic of “Occupational Palliative Rehabilitation” and will be hosted by Jennifer Woods of the HIV, Oncology and Palliative care RCOT Specialist Section (@Rcotsshopc).

Here is what Jennifer had to say…

Occupational Therapists have a unique role in supporting people through illness and any resulting disability through their dual training and their holistic and client-centred approach to maximising patient’s engagement in meaningful activities.

“Around half a million people die in England each year, of whom almost two thirds are aged over 75. The large majority of deaths at the start of the 21st century follow a period of chronic illness such as heart disease, cancer, stroke, chronic respiratory disease, neurological disease or dementia.” End of Life Care Strategy 2008 pg.9

The main change to this trend in the last decade is that dementia has moved to become the leading cause of death and cancer as a cause of death becoming less prevalent (National Office for Statistics 2015).

The combination of an aging population, better diagnosing and a wider range of treatment options mean that more people than ever are living with cancer (Refs, Ref), and other potentially progressive conditions considered to have a palliative and end of life stage. Macmillan estimated that the number of people living with cancer in 2015 was 2.5 million, rising to 4 million by 2030 (Macmillan 2015). The number of people living with heart failure is 900,000 with 30% to 40% of these dying within one year (British Heart Foundation 2017).

The impact of this is that throughout a patient’s journey they can often find themselves transitioning from various generalist services to specialist services.

Due to the consequences of cancer and it’s associated treatment often leading to symptoms such as pain, fatigue, communication difficulties, cognition, continence, breathlessness and altered body image, this group are often referred to specialist level palliative care services. However such symptoms are also reflected in the majority of conditions that are progressive but conversely the vast majority of these do not trigger referral to specialist level palliative care providers. The current dichotomy is that many Cancer patients will be referred to specialist palliative or supportive care cancer services regardless of whether the presenting needs can be supported with simple interventions and self-management from a non-specialist occupational therapist. However anecdotally, more recently people are increasingly being referred to palliative care services simply because ‘palliative’ is mentioned. Again regardless of presenting symptom needs.

This raises questions of if and when people should be referred to Occupational Therapists in Palliative Care and Occupational Palliative Rehabilitation.

Triggers for palliative care

Table 1. Number and percentage of patients identified for palliative care and referred to specialist palliative care, and median time before death

	Cancer (n=200)	Organ failure (n=170)	Frailty and/or dementia (n=160)	All trajectories (n=530)
No. identified on the palliative care register (PCR)	149	32	32	213
% of all patients identified for palliative care	75%	19%	20%	40%
Median time identified on the PCR before death (weeks)	7.3	13.4	2.4	6.6
No. referred for specialist palliative care (SPC)	137	18	8	163
% of all patients referred for SPC	69%	11%	5%	31%
% of patients on the PCR referred for SPC	92%	56%	25%	77%
Median time referred for SPC prior to death (weeks)	5.3	5.2	2.0	4.9

The Royal College of Occupational Therapist’s HIV, Oncology and Palliative Care specialist section want to explore the following:

Who’s responsibility is palliative care / occupational palliative rehabilitation?
What skills do Occupational Therapists have to meet the needs of these patient groups?
When (if at all) would Occupational Therapists refer on to a specialist Occupational Therapist in Palliative Care?
What training have Occupational Therapists had in palliative care and complex symptom management?