Pediatric Oncology Recreational Therapy Survey
Pediatric Oncology Assessment Tool for Recreation Therapy
Rebekah J. Plavnick
Florida International University
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Pediatric Oncology Recreational Therapy Survey
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Abstract
Recreation therapy is a therapeutic modality that utilizes the intervention of activity
participation, therapeutic recreation, and leisure education to improve, maintain and/or develop
physical, cognitive, emotional, and social skills in patients. Patients who are pediatric age in an
oncology unit experience various stressors related to their treatment. “The psychological effect
of extended isolation in a protected environment is of concern to health care professionals on the
pediatric oncology unit at the National Institutes of Health” (O’Connell, 1984). The Children’s
Health Journal announced that “…the development of a comprehensive therapeutic recreation
program designed to address these issues as well as meet individual leisure needs of the isolated
patient, is seen as an essential component of patient care” (O’Connell, 1984). This report will
present a new way to assess the needs of pediatric oncology patients as they pertain to
recreational therapy by using an in house assessment tool called, the Pediatric Oncology
Recreational Therapy Survey (PORTS). This tool will facilitate the CTRS or LRT with
formulating an individualized treatment plan to meet set goals and objectives aimed at increasing
overall health.
Pediatric Oncology Recreational Therapy Survey
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Table of Contents
Cover Page………………………………………………………………………………………...1
Abstract…………………………………………………………………………………………....2
Table of Contents………………………………………………………………………………….3
Introduction to PORTS………...………………………………………………………………….4
Instrument Description.............................................................................................................…...4
Population…………………………………………………………………………………5
Target Domains……………………………………………………………………………7
Response Mode……………………………………………………………………………8
Administrative Guidelines………………………………………………………………...9
Boundaries and Codependency…………………………………………………………..10
Instrument Development & Trial………………………………………………………………...11
Summary & Conclusions………………………………………………………………………...11
Assessment Report Form………………………………………………………………………...13
References………………………………………………………………………………………..18
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Introduction to PORTS
The Pediatric Oncology Recreational Therapy Survey (PORTS) is an in house assessment
aimed to provide the qualified therapeutic recreation specialist with information necessary to
create an individualized treatment plan to increase patient’s overall health. “In addition to
providing the patient with much needed play/leisure experiences, the RT has the opportunity to
aid in reducing the effects of isolation” (O’Connell, 1984). In the Assessment Tools for
Recreational Therapy and Related Fields textbook there are six main interpretations of
assessments they are: confirming the diagnosis, establishing intervention baselines, measuring
client progress, discharge feasibility, program evaluation, and determining loss of function
and/or earning capacity (Burlingame, 2010). The PORTS assessment tool focuses on establishing
intervention baselines and program evaluation.
Instrument Description
Upon admission of a patient to a pediatric oncology unit the recreation therapist will
attend treatment team meeting and prepare to meet the patient. The patient should be
administered the Pediatric Oncology Therapy Survey as soon as possible to ensure quality,
effective care is delivered. The therapist is responsible for the administration and interpretation
of the PORTS assessment tool. The assessment is composed of a rating scale portion as well as a
free response portion. There is ample room to encourage notes from the therapist (i.e. showed
increased signs of grief when discussing sports 2 not being able to participate anymore). The
results derived from the survey will be presented to the treatment team along with the
recreational therapist’s one on one intervention plan. The treatment plan will be carried out and
routinely evaluated concerning therapist competencies, patient compliance, patient treatment
outcomes, and facility integration of program.
Pediatric Oncology Recreational Therapy Survey
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Population. The population to be administered the PORTS assessment tool is anyone admitted
to a pediatric oncology hospital or unit. As depicted by Burlingame the basic characteristics of
the population that influence the assessment tool include: age, typical cognition, social, and
physical skills, and the course of treatment (2010, p.113). The population’s age parameters for
the PORTS is 5-18, in some cases the PORTS can be administered up to age 21. Cases that the
PORTS is administered until age 21 would include: the patient is admitted into the pediatric unit,
the patient’s cognition level is low, there are only recreational therapy opportunities in the
pediatric unit, and/or the treating physician or team prescribed recreational therapy as a
therapeutic modality.
The cognition level necessary to complete the PORTS assessment is adaptable. The way
the test is intended to be administered is by the therapist reading or allowing the patient to read
the questions and choose the appropriate answer. The free-response portion of the assessment
requires increased cognition where the patient will have to formulate complete thoughts that
deliver coherent responses. If necessary the therapist can provide verbal cues as presented on the
assessment report. It is recommended that the patient is not accompanied by guardian or adult in
order to not taint patient responses or physical affect.
Social skills necessary to complete this assessment begins with the ability to be in a room
with the therapist and communicate. Because this is assessment is meant for the pediatric age
group some children may be shy and unwilling to be left alone with a therapist. If this is the case,
the therapist can talk with the guardian or parent and have the parent and therapist be together
with the child to explain the process. The parent will need to leave the room during the actual
assessment. Social skills are an important aspect that is being recorded in the PORTS and it is
Pediatric Oncology Recreational Therapy Survey
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important to gather an accurate measure to then assess activity limitations for the recreational
therapy treatment plan.
Physical skills should not be a major factor when administrating the Pediatric Oncology
Recreational Therapy Survey. Activity limitations that are affected by physical capability will be
evaluated by physical therapists or physicians and then relayed to the recreation therapy
professional. The patient will however need to be able to communicate, sit, and/or lay for an
extended amount of time while being administered the assessment. If the patient needs to switch
between laying and sitting that is permissible.
When administering an assessment the course of treatment for the population being
served is an important factor affecting the necessity of the tool. Some questions the therapist may
ask himself include: “what inherent problems will the client face as a result of treatment that the
use of leisure activities may help mitigate” (Burlingame, 2010, p.113), and what are typical
precautions for this diagnostic group? Some miscellaneous issues that arise at time of diagnosis,
during treatment, or after cessation of treatment may be education, palliative care, finances,
advocacy, employment, complementary and alternative therapies, and cancer prevention
(Labotka, 2006). In 2011, the Journal for Pain and Symptom Management released a feedback
report that evaluated the Pediatric Quality-of-Life of Symptoms Technology (PediQuest).
PediQuest is a “…random controlled trial in children with advanced cancer to determine the
effect of providing families and providers feedback about patient-reported quality of life and
symptoms” (Dussel, 2011). The results from PediQuest conclude that the study showed new
information concerning psychosocial issues and more decisions from providers and parents to
involve psychosocial (56%), pain (34%), social work (33%), or palliative care (29%) consult
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(Dussel, 2011). Recreation therapy is among these initiatives used to alleviate the stressors of
diagnosis, treatment, and discharge in pediatric oncology patients.
Target Domains. The recreational therapist’s scope of practice on a pediatric oncology unit is
important and concise. The scope includes: opportunity of play, social interaction, escape from
treatment reality and leisure education. The PORTS assessment tool provides the therapist with
information to better provide these domains as treatment to the patient.
Information gathered concerning “opportunity of play” involves, what that patient
enjoyed/enjoys doing, what the patient enjoyed/enjoys watching? The information gathered
about the patient’s social interaction level is important because of the increased levels of
isolation that result from pediatric oncology treatment. Information gathered includes: where the
patient feels the safest, how the patient perceives his peers, does the patient like to play with
others? The course of treatment as previously discussed is a very daunting journey that most kids
are unequipped to handle. Information that facilitates the therapist’s understanding of what helps
the child to feel less treated and more living includes answers to questions like, does the patient
understand his diagnosis, how does the patient perceive treatment?
“Therapeutic recreation is a profession committed to helping people with illnesses and
disabilities develop and maintain appropriate leisure lifestyles and to provide recreation
resources and opportunities in order to improve health and well-being” (Datillo, 2011). Leisure
Education is essential to the longevity of therapeutic recreation. Information about the patient’s
leisure education status can be retrieved through questions like, what activities does the patient
show interest in, what was the patient working on before onset of illness, what is available to the
patient through family?
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The target domains for the Pediatric Oncology Recreational Therapy Survey are as stated
above, play, social interaction, escape of treatment reality, and leisure education. These are
essential components within the scope of recreational therapy that will improve the quality of life
and overall health and treatment of patients.
Response Mode. The response mode affects the statistical analysis of the assessment which
ultimately provides the overall information needed to obtain critical indicators. This assessment
is composed of two sections a rating scale and a free-response section. The rating scale will be
able to be quantified while the free-response section will not be easily analyzed. The freeresponse section will provide the therapist with subjective un-basis patient information to be
considered in the formation of the treatment plan. The competences related to effective response
analysis directly effects quality assurance (Burlingame, 2010, p. 139). There are many types of
scales, because the PORTS assessment is aimed at determining attitudes and opinions it
incorporates a nominal scale. Burlingame states that nominal scale are ideal for the determining
trends or demographic information as well as asking about attitudes and opinions (2010, p. 182).
The patient will be presented a phrase or question and asked to give the option that fits
them the most (i.e. I like to participate in activities with others, strongly agree/ agree/ indifferent/
disagree/ strongly disagree). This will allow the patient to be placed in a nominal group of other
patients who enjoying playing in groups, are in the same amount of pain, etc. The PORTS will
not test for all information needed to create an individualized treatment plan, some information
will be incorporated from other professional assessments delivered by the appropriate
professional. This information includes body functions and body structures. When delivering the
PORTS assessment there are many professional considerations to be made not just the structure
of questions, response mode, population, and target domains.
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Administrative Guidelines. The most important guideline when delivering an assessment is
professional competence. “Most of the competencies related to assessment address procedures,
process, and base knowledge” (Burlingame, 2010, p. 136). The Pediatric Oncology Recreational
Therapy Survey has a specific procedure that will be outlined here and also on the assessment
report form. A procedure is defined by Burlingame as, “the act of following a predetermined
sequence of actions to cause the purposeful manipulation of specific conditions” (2010, p.136).
The procedure for the PORTS is as follows: 1. introduce self to patient, 2. record and
confirm patient identity, 3. measure and record blood pressure, heart rate, and pain level, 4.
Begin and follow specific procedure for each section of the PORTS while recording specific
outlined information. The five basic competencies required to follow a procedure is ability to
observe patient behaviors, ability to interview patient, ability to assess patient functional skills,
ability to administer a specific leisure assessment, and ability to administer other inventories and
questionnaires (Burlingame, 2010, p.136).
The process for the PORTS addresses the general guidelines by which the procedure
should be enacted. The process is adaptable by professional judgement (i.e. the patient cannot
leave his bed, the patient is unable to communicate effectively without aide). The process is
concerned with the ability to obtain satisfactory information by use of procedure. The PORTS
assessment contains cues and guidelines to address need for adaptations in procedures. The
therapist should be aware of this alternative process and prepared to deliver the outlined
adaptations when necessary. The PORTS assessment is to be delivered in a confidential area and
require substantial time to complete the tool within one meeting.
The base knowledge necessary to effectively administer the PORTS can be described as
social assessment, affective assessment, and leisure assessment (Burlingame, 2010, p. 137). The
Pediatric Oncology Recreational Therapy Survey
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therapist should have a basic knowledge of how to assess the patient’s social, affective and
leisure skills and interests.
Other issues related to reliability of test results include client cooperation and cultural
issues (Burlingame, 2010, p. 144-145). Cooperation of the patient is important to ensure that the
therapist can report a true picture. Culture is defined as, shared beliefs and mannerisms that bond
a group together (Burlingame, 2010, p. 145). It is crucial that the therapist consider the culture of
the patient when reporting on the PORTS assessment.
Boundaries and Codependency. There are specific boundaries involved when administering
assessment tools. Boundaries affect reliability of test scores and patient vulnerability when
violated (Burlingame, 2010, p.140). The PORTS assessment is delivered immediately when the
patient is admitted to the oncology unit and therefore sets the initial therapist/patient relationship.
The therapist should be careful to set appropriate boundaries and limitations to ensure quality
future therapist/patient involvement. The recreation therapist is an important healthcare provider
entrusted with the treatment of patients as related to leisure and recreation.
Codependency can ultimately create a loss of function, decreased quality of life, and
failed treatment initiatives. Codependency is referred to by Burlingame as a relationship between
two individuals who become emotionally dependent on one another to meet a need. This
relationship is unhealthy for one or both of the involved individuals (2010, p. 141). It is
important for the therapist to consider and be aware of codependency as an issue in assessment
and treatment.
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Instrument Development and Trial
Recreational therapy and other healthcare domains more often than not construct their
assessments on theory as an effort to prove a theory valid or null. The PORTS assessment is set
out to gather information using a scale and free-response format to provide an effective treatment
plan. The measurement aspect of the PORTS is not concerned with the overall completion of the
assessment but rather the individual responses to each individual question, this is considered the
item-response theory. The PORTS involves a criterion-referenced test structure because the
patient’s scores will not be compared to other individuals, there is no pass or fail, and the
assessment is based on task analysis (Burlingame, 2010, p.136).
The development of the PORTS assessment tool was based on available therapeutic
recreation opportunities within a pediatric oncology unit or hospital. By answering the questions
within the assessment tool the therapist will have a clear view of what recreation/leisure
programs to provide the patient.
Summary and Conclusions
The importance of recreation therapy in pediatric oncology can be supported by the
essential necessity of leisure and recreation during the pediatric age frame. O’Connell stresses
the importance in recreation therapy within a protected environment such as a hospital. It is
crucial that the recreation therapy department offer a variety of games, activities, holiday events,
and special events while also incorporating new recreational therapy techniques daily to alter the
monotonous daily routine many patients are subjected to (O’Connell, 1984, p. 120).
Play is a normal component to children. There are several theories used to support the
increased well-being through therapeutic play. The theories include the developmental theory of
Piaget, Erickson’s psychosocial theory, and Vygotsky’s sociocultural theory. Datillo concludes
Pediatric Oncology Recreational Therapy Survey
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that “Children who have benefited from use of play as a therapeutic medium include those with
physical and cognitive impairments, behavior and emotional problems, and children who have
experienced abuse or chronic illness (2011, p. 513).
The PORTS tool gathers information about the patient’s desire to learn more about
leisure and recreation and perceived barriers. This component of recreational therapy is
addressed by leisure education. “Leisure education is particularly suited to the task of helping
individuals in that it addresses the challenges to enjoyable leisure experiences that are often
faced by people with a variety of disabilities” (Datillo, 2011, p. 187).
Upon the conclusion of the Pediatric Oncology Recreational Therapy Survey the therapist
will have the appropriate information to form a balanced treatment plan equipped to address
leisure needs, leisure education, and recreation participation. The results of the plan will be
assessable to all members of the patient’s healthcare team.
Pediatric Oncology Recreational Therapy Survey
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PEDIATRIC ONCOLOGY (PORTS)
In-house assessment tool for recreational Therapy
PATIENT NAME & DATE:
___________________________________________________
Patient Basic Information
Cont.
Date of Birth:
___________________________
Known Allergies:
_________________________
Date of Onset:
___________________________
Precautions:
_________________________
Date of Admission:
___________________________
Physician Orders:
_________________________
Diagnosis:
___________________________
Activity Limitations: ________________________
NOTES: BP: ______ HR: ______ Pain Level: ______
About Our Pediatric Oncology RT Assessment
This assessment will give the therapist a clear view of the patient’s interests and how they can be incorporated
into their individualized treatment plan. RT is a therapeutic modality that utilizes leisure education, activity
participation, and therapeutic recreation.
This assessment contains a rating scale portion and a free response portion complimented with therapist account
of patient affect during assessment.
Administrative Guidelines
Follow outlined procedure per section and question.
Consider cultural issues before, during and after administration of the PORTS assessment.
Allow sufficient time 30-60 minutes in a confidential area
Consider adverse effects of therapist/patient relationship by establishing boundaries and avoiding codependency.
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SECTION I: LEISURE INTEREST [BY CATEGORY]
PROCEDURE: Ask patient to communicate their amount of interest in these leisure/recreation activities by choosing one
response that is closest to their interest level. Circle response. Record any substantial information pertaining to patient affect in
the notes section at the end of section I. Allow 15-30 minutes.
1. INDIVIDUAL ACTIVITY
1a. Painting
Very Interested
Somewhat Interested
Indifferent
Not Interested
Never Interested
Somewhat Interested
Indifferent
Not Interested
Never Interested
Somewhat Interested
Indifferent
Not Interested
Never Interested
Somewhat Interested
Indifferent
Not Interested
Never Interested
Somewhat Interested
Indifferent
Not Interested
Never Interested
Somewhat Interested
Indifferent
Not Interested
Never Interested
Somewhat Interested
Indifferent
Not Interested
Never Interested
Somewhat Interested
Indifferent
Not Interested
Never Interested
Somewhat Interested
Indifferent
Not Interested
Never Interested
Somewhat Interested
Indifferent
Not Interested
Never Interested
Somewhat Interested
Indifferent
Not Interested
Never Interested
1b. Cooking
Very Interested
1c. Gardening
Very Interested
1d. Exercising
Very Interested
1e. Caring for animals
Very Interested
1f. Crafts
Very Interested
1g. Aquatics
Very Interested
1h. Reading
Very Interested
1i. Collecting
Very Interested
1j. Dance
Very Interested
1k. Singing
Very Interested
Notes:________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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2. GROUP ACTIVITY
2a. Team Work
Very Interested
Somewhat Interested
Indifferent
Not Interested
Never Interested
Not Interested
Never Interested
2b. Group Sports (soccer, football, hockey, cheerleading)
Very Interested
Somewhat Interested
Indifferent
2c. Group Performance (plays, dance, music)
Very Interested
Somewhat Interested
Indifferent
Not Interested
Never Interested
Somewhat Interested
Indifferent
Not Interested
Never Interested
Somewhat Interested
Indifferent
Not Interested
Never Interested
Somewhat Interested
Indifferent
Not Interested
Never Interested
Somewhat Interested
Indifferent
Not Interested
Never Interested
2d. Group Discussion
Very Interested
2e. Group Crafts
Very Interested
2f. Book Clubs
Very Interested
2g. Exercise
Very Interested
Notes:________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
SECTION II: FREE-RESPONSE
PROCEDURE: Ask patient to answer the following question to the best of his ability. Explain there is no right or wrong answer.
Record patient answers in the indicated areas. Do not leave any answers blank. Use provided cues if necessary. Allow 30-45
minutes.
1. What physical barriers stop you from participating in leisure or recreation activities?
CUES: Physical barriers are for example, your IV bag stand, the hospital, your wheelchair.
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
2. What emotional/attitudinal barriers stop you from participating in leisure or recreation
activities?
CUES: Emotional barriers are for example, you feel sad when playing with friends. Attitudinal barriers are for example, people think you are
incapable of participation.
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_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
3. What activities would you like to learn more about?
CUES: examples include do you want to become a painter, soccer goalie, etc.
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
4. What activities did you participate in the most before coming here?
CUES: examples include did you go to siblings games, were you a part of a book club, etc.
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
5. What activities do you participate in now?
CUES: examples include, reading, watching TV, etc.
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
6. What is your favorite holiday, why?
CUES: examples include, Cinco De Mayo because my family all gets together and cooks a big feast.
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
7. How do you perceive the environment of this hospital?
CUES: examples include, the nurses are nice, it is very white, the grass is very green, and/or there are a lot of people.
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
8. How do you feel about spending some time here?
CUES: Ask, are you excited to meet new people? Are you scared to be here?
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
Pediatric Oncology Recreational Therapy Survey
SCORE SHEET
Retrieval of rating scores
PROCEDURE: A score of 5 indicates highest possible interest and a score of 0 indicates lowest possible interest
Individual Activity
Painting =
______
Cooking =
______
Gardening =
______
Exercising =
______
Caring for Animals =
______
Crafts =
______
Aquatics =
______
Reading =
______
Collecting =
______
Dance =
______
Singing =
______
Group Activity
Team Work =
______
Group Sports =
______
Group Performance =
______
Group Discussion =
______
Group Crafts =
______
Book Clubs =
______
Exercise =
______
Therapist Name Printed:
______________________________________
Therapist Signature:
______________________________________
Date of Assessment:
______________________________________
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References
Burlingame, J., & Blaschko, T. (2010). Assessment Tools for Recreational Therapy and Related
Fields (Fourth ed., pp. 1-707). WA, Ravensdale: Idyll Arbor.
Dattilo, J., & McKenney, A. (2011). Leisure Education. In Facilitation techniques in therapeutic
recreation (2nd ed., pp. 187-220). State College, PA: Venture Pub.
Dussel, V., Neville, B., Chen, K., Cook, E., Geyer, R., Kang, T., . . . Wolfe, J. (2011). Routine
Feedback of Patient-Reported Distress in Children With Advanced Cancer: Provider and
Family Satisfaction With the Pediatric Quality of Life and Evaluation of Symptoms
Technology (PediQUEST) System (311-B). Journal of Pain and Symptom
Management, 41(1), 187-188. doi:10.1016/j.jpainsymman.2010.10.043
Labotka, R. (2006). Pediatric Oncology. The Journal of the American Medical
Association, 296(4), 450-450. doi:10.1001/jama.296.4.452-b
O'connell, S. (1984). Recreation Therapy: Reducing the Effects of Isolation for the Patient in a
Protected Environment. Children's Health Care, 12(3), 118-121.
doi:10.1207/s15326888chc1203_3
Savino F, Vagliano L, Ceratto S, Viviani F, Miniero R, Ricceri F. (2013) Pain assessment in
children undergoing venipuncture: the Wong–Baker faces scale versus skin conductance
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