HOPC Occupational Therapy Conference
November 21st 2014
‘Bringing a Hospice Ethos of Care to
Palliative Patients in a Hospital
Environment’.
Jill McCord, Macmillan Advanced Occupational Therapist
Sarah Rice, Macmillan Advanced Occupational Therapist
Introduction
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History of NUTH AHP Macmillan Project
Who we are and what we do
Our Interventions
Measuring our Impact
Case Studies
What Next?...
Patient Feedback
The AHP Palliative Care Project
4 year project funded by Macmillan - Oct 2012 to Oct
2015:
• Aim to evaluate the benefits of having AHPs in a
specialist palliative care team (SPCT)
• Bring holistic/hospice care ethos to therapy in the
acute care setting
Freeman Hospital:
1 Full Time Physiotherapist
1 Part Time Occupational
Therapist
1 Part Time Rehabilitation
Assistant
Royal Victoria Infirmary:
1 Full Time Physiotherapist
1 Full Time Occupational
Therapist.
Local & National Drivers
Locally Recognition of gaps in service
provision and difficulties in prioritising
palliative type interventions by therapy
staff in an acute setting
1 year Pilot project
results formed the basis of the
successful business case put forward
to Macmillan
NICE Supportive and Palliative Care
Guidelines (1)
promote a multi disciplinary approach to
care to and recommend that
comprehensive rehabilitation services
should be available in all care locations
National End of Life Care Strategy (2)
further developed this emphasising the
need for:
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AHPs in Specialist Palliative
Care Team Project
the same high standards of care to be
available to all people at the end of life,
a skilled and specialised palliative care
workforce to be available in all settings
continuous improvements in the quality of
care – particularly acute service care.
All of this is underpinned in the strategy by
a need to measure the outcome of
palliative care interventions
Who do we treat?
People with:• Anxiety/ Distress
• Pain – Including ‘Total
Pain’
• Fatigue
• Breathlessness
• Weakness
• Functional Problems
(in addition to ward
AHPs)
•  Confidence
What do we add?
Specific OT interventions:
• Anxiety management/ CBT
• Fatigue management
• Hypnotherapy
• Life story work, memory boxes
• Confidence building
• Purposeful activity
• Complex/specialist equipment needs
Educational and advisory role to ward therapists.
Registered
Visually
Impaired
COPD
Margaret
Decision to stop
dialysis
For End of
Life Care
Measuring Our Impact
We selected 4 Outcome Measures:
• PaCA) Palliative Care Assessment score (3) This rates symptom
burden for specific individual service user symptoms.
• (TOMs) Therapy Outcome Measures (4) This uses the framework
of the international classification of functioning (ICF). It has had
validity and reliability well demonstrated.
• (EFAT) Edmonton Functional Assessment (5) Was used in the
pilot study. It is again valid and reliable and gives a broad reflection
of function.
• (POS) Palliative care Outcome Scale (6) Once again validity and
reliability have been demonstrated for this measure.
TOMS
• Suggests that:
– We can help improve a patients situation to
enable them get home even when overall
condition may be deteriorating.
– We can help make improvements in quality of
life
– Patients value our input
Young lady
Pain
Cachexia
Breathlessness
Referral for
Symptom
Management
Low Mood
Nausea
Leanne
Vomiting
Fatigue
Anxiety
Frequent
admissions
Cystic
Fibrosis
OT interventions: - rapport building –
interests/roles; goal setting and purposeful
activity; home assessment visit; fatigue
management; anxiety management – CBT
approach
“Rehabilitation brings added
value to supportive and
palliative care… and is not an
optional extra.” NCAT 2013
What Next?...
• Business Case/ Commissioning
• Awards/ Raising profile
• OT Msc Project
“You’ve really helped us (me) with
everything. More than anyone else, I
couldn’t have asked for more. You’ve
taught me how to breathe properly and
that. The other one’s came and taught me
how to clear my chest but then they
couldn’t come back to see how I got on, I
didn’t like that. And they just wanted to
see me walk. You came and talked with
“The difference was that you
were able to spend the time
explaining things to me,
explaining why my body felt
the way it did, and talking me
through what I needed to do
to get back on my feet. You
were also a friend when I
needed to talk, and you
actually listened.”
me too, that has helped the most.
You’re well worth your money, aye!”
“Just two say thank you four
help and support, if it wasn’t
four your support I would probly
still be in hospital, so many
thanks.”
“You made my life
better, don’t know
what I would do
without your help
recently.”
“I had given up
until you
became involved
- I had lost hope”
“You’ve bent over
backwards to help
with everything,
thank you.”
(Patient’s Husband)
“His wife asked me to
pass on their thanks.
Without your help and the
things you taught him, he
couldn’t have stayed at
home with his family at the
end, which is what he
wanted.”
(OT assistant)
“The continuity made a difference, when I moved somewhere
new you already knew me, you didn’t have to go away and
check things. It was comforting to know that wherever I went
there would be people coming to see me who knew me and
what had gone on. And the encouragement you gave was great,
it kept me going. I can’t thank you enough, you’ve both (SPCT
PT & OT) been a brilliant help.”
References
• Improving Supportive and Palliative Care for Patients with Cancer
(2004) NICE.
• End of Life Care Strategy – promoting high quality care for all adults
at the end of life (2008) DH.
• The Edmonton Functional Assessment Tool: Further Development
and Validation for Use in Palliative Care, Kaasa, T., Wessel, J.
2001, Journal of Palliative Care 17, 1, 5-11.
• Therapy Outcome Measures for Rehabilitation Professionals:
Speech and Language Therapy, Physiotherapy, Occupational
Therapy. Enderby, P., John, A., Petheram, B. 2nd Ed, John Wiley
and Sons Ltd. 2006.
• A User’s Guide to the Palliative care Outcome Scale, Aspinal, F et al
(2002), King’s College London.
• Monitoring a hospital palliative care team using the PaCA tool,
Regnard, C et al; European Journal of Palliative Care, 2005;