Occupational Therapy in Oncology and Palliative Care E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 414

Veröffentlichungsjahr: 2013

Beschreibung

Now in its second edition, this is the only book on occupational therapy in oncology and palliative care. It has been thoroughly updated, contains new chapters, and like the first edition will appeal to a range of allied health professionals working with patients with a life-threatening illness.

The book explores the nature of cancer and challenges faced by occupational therapists in oncology and palliative care. It discusses the range of occupational therapy intervention in symptom control, anxiety management and relaxation, and the management of breathlessness and fatigue.

The book is produced in an evidence-based, practical, workbook format with case studies. New chapters on creativity as a psychodynamic approach; outcome measures in occupational therapy in oncology and palliative care; HIV-related cancers and palliative care.

Leseprobe

Contents

List of Contributors

Foreword

Preface

REFERENCES

Acknowledgements

Introduction

REFERENCES

1 What is Cancer? 1

CLASSIFICATION OF TUMOURS

INCIDENCE

AETIOLOGICAL FACTORS

SYMPTOMS

INVESTIGATIONS

TREATMENTS/INTERVENTIONS

ACTION POINTS

REFERENCES

RECOMMENDED READING

2 Challenges Faced by Occupational Therapists in Oncology and Palliative Care

EXPLORING SELF-MOTIVATION

FOCUSING CARE ON THE PERSON WITH CANCER

COMMUNICATION

BREAKING BAD NEWS

TIME MANAGEMENT

CONFLICT

LOSS

GRIEF

CULTURAL ISSUES

SUMMARY

ACTION POINTS

REFERENCES

3 Occupational Therapy Approach in Symptom Control

PROBLEM-SOLVING APPROACH

FEEDING PROBLEMS, INCLUDING DRY MOUTH AND ANOREXIA

PAIN

INSOMNIA

SWOLLEN LEGS, INCLUDING LYMPHOEDEMA

NAUSEA AND VOMITING

CONSTIPATION, DIARRHOEA AND URINARY PROBLEMS

CONFUSION

RADIATION-INDUCED BRACHIAL PLEXOPATHY (RIBP)

SPINAL CORD COMPRESSION

SUMMARY

ACTION POINTS

REFERENCES

RECOMMENDED READING

4 Occupational Therapy in Anxiety Management and Relaxation

WHAT IS ANXIETY?

WHAT IS STRESS?

THE EMERGENCY RESPONSE

PHYSICAL SYMPTOMS OF ANXIETY AND STRESS

COGNITIVE SYMPTOMS OF ANXIETY AND STRESS

BEHAVIOURAL SYMPTOMS OF ANXIETY AND STRESS

OCCUPATIONAL THERAPY INTERVENTION IN ANXIETY AND STRESS MANAGEMENT

SUMMARY

ACTION POINTS

REFERENCES

SUGGESTED READING

5 Occupational Therapy in the Management of Breathlessness

WHAT IS BREATHLESSNESS?

ASSESSMENT

OCCUPATIONAL THERAPY ROLE IN THE MANAGEMENT OF BREATHLESSNESS

PROBLEM-SOLVING APPROACH OF OCCUPATIONAL THERAPY

SUMMARY

ACTION POINTS

REFERENCES

RECOMMENDED READING

6 Occupational Therapy and Cancer-Related Fatigue

CAUSES OF FATIGUE IN CANCER

SYMPTOM CLUSTERS

PATTERNS OF FATIGUE IN CANCER

EFFECTS OF CANCER-RELATED FATIGUE

ASSESSING FATIGUE IN CANCER

OCCUPATIONAL THERAPY AND THE MANAGEMENT OF CANCER-RELATED FATIGUE

EDUCATION

PHARMACOLOGICAL INTERVENTIONS

GRADED ACTIVITY AND EXERCISE

ENERGY CONSERVATION

STRUCTURED PSYCHOLOGICAL SUPPORT

RELAXATION AND STRUCTURED SLEEP

COGNITIVE REHABILITATION

SUMMARY

ACTION POINTS

REFERENCES

7 Client-centred Approach of Occupational Therapy Programme - Case Study

PERSONAL, FAMILY, SOCIAL AND MEDICAL HISTORY

OCCUPATIONAL THERAPY ASSESSMENT METHODS

RESULTS AND IDENTIFICATION OF STRENGTHS AND PROBLEMS

PSYCHOSOCIAL ISSUES

PROFESSIONAL ISSUES

OCCUPATIONAL THERAPY PROGRAMME

PRIORITIZED PROBLEM LIST

GOAL OF INTERVENTION

SELECTION, ANALYSIS AND APPLICATION OF ACTIVITIES

ACTIVITY ANALYSIS

ACTIVITY: COOKING SPAGHETTI

SUMMARY AND RECOMMENDATIONS

REFERENCES

8 Occupational Therapy in Paediatric Oncology and Palliative Care

PAEDIATRIC PALLIATIVE CARE

WHEN PALLIATIVE CARE BEGINS

IMPACT ON THE PARENTS AT REFERRAL OF A LIFE-LIMITED CHILD

IMPACT ON THE REFERRED CHILD

IMPACT ON THE SIBLINGS

THE ROLE OF THE OCCUPATIONAL THERAPIST

ASSESSMENT

THE MAIN AIMS OF OCCUPATIONAL THERAPY IN PALLIATIVE CARE

COPING MECHANISMS

WHEN A CHILD IS DYING

WELL-BEING OF THE THERAPIST

SUMMARY

ACTION POINTS

REFERENCES

SUGGESTED FURTHER READING

9 Occupational Therapy in HIV-related Cancers and Palliative Care

HIV AND AIDS

HIV-RELATED CANCERS

OTHER HIV-RELATED CANCERS

OTHER HIV-RELATED LIFE-LIMITING CONDITIONS

MEDICATION, ADHERENCE AND PAIN MANAGEMENT ISSUES

REFERENCES

10 Occupational Therapy in Neuro-oncology

CENTRAL NERVOUS SYSTEM TUMOURS

CLASSIFICATIONS

SIGNS AND SYMPTOMS

INVESTIGATIONS

MEDICAL TREATMENTS

SIDE-EFFECTS OF TREATMENTS

OCCUPATIONAL THERAPY ASSESSMENT

OCCUPATIONAL THERAPY INTERVENTION

EVALUATION OF INTERVENTION

CASE STUDIES

SUMMARY

ACTION POINTS

REFERENCES

RECOMMENDED READING

11 Occupational Therapy in Hospices and Day Care

OCCUPATIONAL THERAPY MODEL

MOTOR SKILLS

SENSORY SKILLS

COGNITIVE SKILLS

INTRAPERSONAL SKILLS

INTERPERSONAL SKILLS

SELF-MAINTENANCE

PRODUCTIVITY

LEISURE

DAY CARE

ACTION POINTS

REFERENCES

12 The Use of Creativity as a Psychodynamic Activity

THE PSYCHODYNAMIC APPROACH

ASSESSMENT

THE THERAPEUTIC RELATIONSHIP

USING COUNSELLING SKILLS

COMMUNICATION ISSUES

NARRATIVE

CREATIVE ACTIVITIES

ARTWORK

CONSTRAINTS

DOING AND BECOMING – A TRANSITION

SPIRITUALITY – IS IT ADDRESSED CREATIVELY?

REFERENCES

13 Measuring Occupational Therapy Outcomes in Cancer and Palliative Care

OUTCOME MEASURES

THE NATURE OF OUTCOMES IN CANCER AND PALLIATIVE CARE: IMPROVEMENT VERSUS DETERIORATION

MULTIPROFESSIONAL TEAMWORKING AND OUTCOMES

ORGANIZATIONAL ISSUES

OCCUPATIONAL THERAPISTS’ IDEAS ON OUTCOMES

PATIENTS’ PERCEPTIONS OF OUTCOMES

INITIAL CONSIDERATIONS ON MEASURING OUTCOMES

SOME POSSIBLE OCCUPATIONAL THERAPY MEASURES

WESTCOTES INDIVIDUALISED OUTCOME MEASURE (WIOM)

ASSESSMENT

ESTABLISHING PRIORITIES

A GOAL VERSUS AN INTERVENTION PLAN

ADDING IT ALL TOGETHER

SUMMARY

REFERENCES

RECOMMENDED READING

Appendices

Appendix 1

Appendix 2

Appendix 3

Appendix 4

Appendix 5

Appendix 6

Appendix 7

Appendix 8

Appendix 9

Appendix 10

Appendix 11

Appendix 12

Appendix 13

Appendix 14

Appendix 15

Appendix 16

Appendix 17

REFERENCES

Glossary

Glossary-Abbreviations

Index

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Library of Congress Cataloging-in-Publication Data

Occupational therapy in oncology and palliative care / edited and co-written by Jill Cooper. – 2nd ed.

p. ; cm.

Includes bibliographical references and index.

ISBN-13: 978-0-470-01962-7 (alk. paper)

ISBN-10: 0-470-01962-X (alk. paper)

1. Cancer – Palliative treatment. 2. Occupational therapy.

[DNLM: 1. Neoplasms – therapy. 2. Neoplasms – complications. 3. Occupational

Therapy – methods. 4. Palliative Care – methods. QZ 266 O15 2006] I. Cooper, Jill.

RC271.P33O23 2006

616.99′406 – dc22

2005030099

A catalogue record for this book is available from the British Library

ISBN-13

978-0-470-01962-7

ISBN-10

0-470-01962-X

DEDICATED TO PETER, JOYCE AND STANLEY

Contributors

Helen Barrett BA (Hons), BSc (Hons), OT

Senior Occupational Therapist, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, UK SM2 5PT

Kathryn Boog BSc (Hons), OT

Senior Occupational Therapist, St Columba’s Hospice, Boswall Road, Edinburgh, UK EH5 3RW

Anne Bostock DipCOT, OT

Senior Occupational Therapist, Sue Ryder Care – Leckhampton Court Hospice, Leckhampton Court, Church Road, Leckhampton, Cheltenham, UK GL53 0QJ

Will Chegwidden BSc OT (Hons), OT

Senior Occupational Therapist, The Royal London & St Bartholomew’s NHS Trust, London, UK E1

Jill Cooper DipCOT, DMS, OT

Head Occupational Therapist, The Royal Marsden NHS Foundation Trust, Fulham Road, London, UK SW3 6JJ

Derek Doyle MD, OBE

Retired Consultant in Palliative Medicine, Senior Editor of The Oxford Textbook of Palliative Medicine, Vice President and Honorary Vice Chair of the National Council for Palliative Care

Shelley Ellis BSc (Hons), OT

Senior Occupational Therapist, Great Oaks Dean Forest Hospice and community, The Gorse, Coleford, Gloucestershire, UK GL16 8QE

Gail Eva BSc (OT)(Hons), MSc, OT

Team Leader Hospital and Community Palliative Care, Sir Michael Sobell House Hospice, Churchill Hospital, Headington, Oxford, UK OX3 7LJ

Camilla Hawkins DipCOT, LHMC, MScOT, OT

Senior Occupational Therapist, Mildmay Hospital, London, UK E1

Gemma Lindsell BA (Hons), DipCOT, OT

Senior Occupational Therapist, The Royal Marsden NHS Foundation Trust, Fulham Road, London, UK SW3 6JJ

Daniel Lowrie BHSc (OT), OT

Lecturer/practitioner Occupational Therapist, The Royal Marsden NHS Foundation Trust, Fulham Road, London, UK SW3 6JJ

Sara Mathewson BSc(Hons), OT

Senior Occupational Therapist in Palliative Care, Gloucester Royal Hospital NHS Foundation Trust, Great Western Road, Gloucester, UK GL1 3NN

Lilias Methven DipCOT, OT

Senior Occupational Therapist, Gloucester Royal Hospital NHS Foundation Trust, Great Western Road, Gloucester, UK GL1 3NN

Claire Tester DipCOT, PGDip, OT

Senior Occupational Therapist, Rachel House Children’s Hospice, Avenue Road, Kinross, UK KY13 8FX

Julie Watterson BSc (Hons), OT

Senior Occupational Therapist, Prospect Hospice, Moormead Road, Wroughton, Swindon, Wilts, UK SN4 9BY

Foreword

The death of Dame Cicely Saunders (in July 2005), the charismatic visionary behind the Hospice Movement, brought home to many of us both the importance of what she advocated and the remarkable, worldwide acceptance of the principles of palliative care. From modest beginnings in 1967 there are now, in 2005, more than 8000 palliative care services worldwide, more than 20 academic professorial chairs, countless undergraduate and postgraduate qualifications available, and more than 300 multiprofessional research projects on the go at any one time. In the United Kingdom alone there are 217 in-patient palliative care units, 356 community palliative care services, 258 day care units and 83 hospital palliative care teams.

At the heart of each one, whatever the type of service, are the patients and their loved ones. Each hopes for cure or if cure is unrealistic, for a life worth living, a life that they and they alone can say has ‘quality’. It may not be a long life, any more than it might resemble their life before their illness but, for them, it is a life worth living – a life with as little dependency on others as possible, a life without suffering, a life with smiles and happy times shared with family and friends preferably in their own homes.

Palliative care provision has burgeoned, as we have seen, but it has changed in other ways since the first edition of this book. No longer is it primarily concerned with oncology patients. Today hospital palliative care teams can expect to be invited to see patients with advanced cardiac, respiratory, neurological and even infectious conditions. No longer will most be in the far advanced stages of illness. Some may still be under their care a year or more later, still spending much of their time at home.

Oncology has changed, almost as dramatically as has palliative care. With earlier referrals, more sophisticated investigations and new drugs many malignancies can be controlled for years – not cured but controlled sufficiently for patients and carers to have every reason to talk about quality rather than quantity of life. No longer is there a false dichotomy between oncology care and palliative care as was once the case. Oncology teams now offer good palliative care and see that as part and parcel of their work. The two disciplines for whom this book is written now recognize that neither can work in isolation, that they share aims and many skills, and that they can and must work together respecting the training, the skills and the contributions of the other.

The society in which we live and work is also changing, perhaps quicker and more radically than many of us would wish. No matter how much people say that when the time comes they would like to die at home, studies are showing that this is seldom achieved. No matter how much family doctors and community nurses would like to care for the terminally ill at home, this is becoming ever more difficult because of their workload, inadequate resources, and unsatisfactory out-of-hours cover. Cover of the chronically ill and aged is suffering. Resources for care, whatever the condition, are being directed more towards cure than long term or palliative care. ‘Hard’ research attracts more funding than ‘soft’ research into such things as feelings, spiritual needs, needs of relatives, stress of the carers and quality of life. Some would go so far as to say that since the first edition of this book we have moved back to being more interested in the pathology than in the person with that pathology, vehemently as most would deny that.

What cannot be denied is that occupational therapy has grown as a discipline and grown in importance and is certain to continue on that road. It is not an optional extra in today’s care team, whether in hospital or community. Today, the occupational therapist is an indispensable, integral member of each team but the value of her/his contribution will largely rest on the adequacy of her training, her well-informed understanding of the work and contributions of other disciplines, and sensitivity to the nature of changes in our society. The challenges of this work are truly enormous but so too are the rewards.

I commend this new edition as a major contribution to better care for people at one of the most frightening times of life. No greater challenge and no greater rewards can any of us ever have than caring for those on their final, often very long and lonely, road of life.

Dr Derek DoyleHon. Vice Chairman National Council for Palliative CareJuly 2005

Preface

The second edition of this book aims to explore further occupational therapy for persons with life-threatening and life-limiting illnesses. The most common diseases that most occupational therapists will encounter are cancer and heart disease, as well as other conditions, which are classified under the umbrella term of palliative care, such as HIV/AIDS, neurological and congenital illnesses. The fundamental principles of occupational therapy in oncology and palliative care still apply and this edition will discuss and examine treatment programmes and approaches that have been developed with evidence-based practice.

Specific solutions may still not exist for all specific problems. Individual coping mechanisms are required for people whether they have physical, psychological or psychosocial difficulties so the occupational therapist needs to refine their core and problem-solving skills and analyse each case as it arises.

Working with individuals who have cancer or are at the palliative stages of a disease involves considering their ability to survive and, if the illness is terminal, assessing how to facilitate them and their carers in achieving optimum quality of life in their remaining time. This second edition focuses on suggested occupational therapy interventions that can be adapted to suit different work settings and environments.

The first chapter revisits the basic terminology for cancer and palliative care interventions, treatments, side effects and related issues. This is followed by a discussion of the principles of occupational therapy in this clinical area, first in general terms and then with specific reference to more complex issues. Subsequent chapters discuss more specific symptoms and approaches as well as exploring the use of creativity as a psychodynamic activity and examining palliative care far more broadly, particularly in paediatrics. The examples of treatment programmes are a consensus of expert practitioners throughout the UK and are designed to be used and adapted to suit individual requirements, work settings and requirements.

This second edition aims to underpin clinical practice with evidence-based information wherever possible and should be used to support practice development and used as a workbook format. In some scenarios, the individuals receiving treatment are referred to as clients; at other times, they are referred to as patients. This depends on the health care setting.

Various political influences, particularly in the United Kingdom, have occurred since the publication of the first edition in 1997 including the NHS Cancer Plan (DoH, 2000) and NICE Guidelines for Supportive and Palliative Care (NICE, 2004) and these continue to recognize the value of occupational therapy in this clinical area.

Jill CooperRoyal Marsden NHS Foundation Trust

REFERENCES

DoH (2000) The NHS Cancer Plan: A plan for investment, a plan for reform, Department of Health, London.

NICE (2004) Improving Supportive and Palliative Care for Adults with Cancer: The Manual, National Institute for Clinical Excellence, London.

ACKNOWLEDGEMENTS

I wish to thank the following for permission to use copyright material:

Bloomsbury Publishing plc for

Figure 1.1

: ‘Common symptoms and signs of cancer’ reproduced here in Chapter 1. Tobias, J. and Eaton, K. (2001)

Living with Cancer,

Bloomsbury, London.

M.A. Healthcare Ltd for

Figure 2.1

: ‘Breakdown of all occupational therapy activity’ reproduced here in Chapter 2. Cooper, J. and Littlechild, B. (2004)

International Journal of Therapy and Rehabilitation,

11 (7).

College of Occupational Therapists for extract from HOPE (2004)

Occupational Therapy Intervention in Cancer,

College of Occupational Therapists, London, reproduced here in Chapter 3.

Elsevier Limited for extract from Oliver, K. and Sewell, L. (2002) in

Occupational Therapy and Physical Dysfunction,

5

th

edn (eds. A. Turner, M. Foster and S.E. Johnson), Churchill Livingstone, Edinburgh, reproduced here in Chapter 5.

Oxford University Press for

Figure 8.1

: ‘Model of curative and palliative care relationships’ reproduced here in Chapter 8. Goldman, A. and Schuller, I. (2001)

Palliative Care for Non-cancer Patients

(eds J. Addington-Hall and J. Higginson), Oxford University Press, Oxford.

I would also like to thank:

the staff and patients of The Royal Marsden NHS Foundation Trust, with whom it is always a pleasure and honour to work;

my fellow occupational therapists in HOPE (Occupational Therapy Specialist Section in HIV/AIDS, Oncology, Palliative Care and Education) with whom I am very proud to have worked on various projects.

I wish to thank specifically:

Helen Barrett, Phil Canning, Charlie Ewer-Smith, Chervonne Hopkinson, Gemma Lindsell, Daniel Lowrie, Andrea Mitchell, Sarah Patterson, Astrid van Dijken, Jo Bray and Barbara Littlechild, all of whom have contributed so much to various subjects covered in this book.

In addition, I wish to thank:

Kathy Thompson, Nicki Thompson, Diane Strange, Paul Armitage, Gill Skilton and Douglas Guerrero for their kind support and help in specific areas. Also Steve Park, Assistant Professor of Occupational Therapy at Pacific University, Oregon, for the information drawn from his lectures 1998–1999 used in Chapter 13.

Introduction

This edition refers to occupational therapy in the treatment of conditions such as cancer and others requiring palliative care and also aims to encompass other illnesses than cancer that result in a chronic debilitating condition or non-curable disease and which might be life-threatening. The occupational therapist assesses and analyses functional problems in any illness irrespective of the origin of the disease, but it is the diagnosis and prognosis that affects the intervention and urgency with which the occupational therapy service is needed. Occupational therapists aim to maintain the people whom they are treating at their optimum independence and quality of life. This is carried out preferably in their own homes by controlling symptoms and providing home-care support together with training for the carers. Intervention occurs from the early stages of health promotion to the more advanced stages when disability and illness have become more severe and chronic. A holistic, client-centred approach is needed, which is constantly reassessed according to the needs of the individuals and their carers. The fundamental areas in which occupational therapy contributes include:

assisting clients with activities for the treatment of physical dysfunction;

retraining clients in personal and domestic activities that are necessary for daily living;

assessing seating needs and prescribing wheelchairs and pressure relieving cushions;

retraining clients in order to help them with cognitive and perceptual dysfunction;

splinting to prevent deformities and control pain;

making home assessments;

referring to and liaising with social services for ongoing home assessment and provision of equipment;

helping with lifestyle management including investigating hobbies and leisure pursuits;

providing advice on and education about relaxation techniques;

aiding breathlessness management;

aiding management of fatigue and energy conservation;

providing support and education for carers;

assisting with psychological adjustment and goal-setting related to loss of function.

In order to establish rapport and introduce the occupational therapy service to clients, the occupational therapist can make them aware of the services that are available, even if those services are not required immediately. If clients know what is available and where to obtain it they can make use of appropriate services at a later date as and when necessary. This avoids needless struggle and avoids the occupational therapy intervention occurring at a time of crisis, when it could be called upon earlier, thus preventing the crisis from happening.

As the assessment of each client covers many aspects of life it is necessary for an occupational therapist to establish a good rapport with the individual. Even the simplest of interactions can raise numerous issues. It may be that all the occupational therapist does is provide a padded bathboard to help an individual wash comfortably. The ramifications of this include:

giving clients the choice of when to bathe rather than them having to wait for a carer;

reducing anxiety;

promoting self-esteem;

maintaining dignity

enabling privacy

avoiding being dependent on others;

providing safety.

The range of services available to individuals with cancer, or any life-threatening illness, continues to change dramatically and there is now firm emphasis on multiprofessional teamwork rather than on medical and nursing staff alone. Occupational therapy is one part of the service provided by the multiprofessional team and it relies on early referral, ongoing communication and liaison and support for all its members if it is to work efficiently and effectively. In particular, the entire team needs to be aware of the changing needs of the individual as the disease progresses.

The multiprofessional team in oncology and palliative care is likely to comprise:

Occupational therapistNursing staffPhysiotherapistDietitianSpeech and language therapistPastoral careCommunity liaisonSurgical appliance officerHome-care nurseArt therapistSocial workerMedical staffPsychological medicine

The National Council for Hospice and Specialist Palliative Care Services (2000) states that: ‘effective rehabilitation is achieved through the work of a well-integrated team of professionals from different disciplines.’ Team members must develop an understanding of each other’s roles within the team. There will inevitably be some overlap and blurring of roles if team members are working closely together, and if members are sensitive to patients’ needs to deal with key individuals. The most important members of the team are the patients, their family and carers.

Occupational therapists find that defining their own role clearly helps them cope with working with the acutely or terminally ill. It should, however, be borne in mind that while clear role identification enables health care workers to achieve their goals, this should not prevent people from working together where boundaries overlap and complement each other.

Providers of oncological and palliative care are increasingly employing occupational therapy services as there is greater emphasis on supporting individuals in their own homes. Occupational therapists have taken the initiative to develop networking and communication within the profession by establishing the Specialist Section of HOPE (Occupational therapists working in HIV/AIDS, Oncology and Palliative Care Education). This, together with growing numbers of palliative care modules in postgraduate education, indicates a rising need for occupational therapists and the expansion of education in these areas.

REFERENCE

National Council for Hospice and Specialist Palliative Care Services (2000) Fulfilling Lives. Rehabilitation in Palliative Care, Land and Unwin Ltd, Northamptonshire.

1

What is Cancer?

JILL COOPER