Week 6 - Palliative Care Flashcards
How can OT do for their palliative patients?
- Maintain previous occupational patterns
- Leaving a legacy
- Living as fully as possible, making the best of everyday
- Being involved in their social environment
What does the Eastern Cooperative Oncology Group (ECOC) measures?
It assesses the functional status of cancer patients; 6 grades
- Grade 0: fully active, able to carry on pre-disease performance without restrictions
- Grade 1: restricted in physically strenuous activity but ambulatory and able to carry out work of a light / sedentary nature (ie. light housework, office work)
- Grade 2: ambulatory and capable of all self-care but unable to carry out any work activities; up and about for more than 50% of waking hours
- Grade 3: capable of only limited self-care, confined to bed / chair for more than 50% of waking hours
- Grade 4: completely disabled, cannot carry out any activities / self-care, totally confined to bed / chair
- Grade 5: dead
What are the 5 areas of assessment in Palliative Care Outcome Collaboration (PCOC)?
- Symptom Assessment Scale
- Resource Utilisation Group & Activities for Daily Living (RUG-ADL)
- AKPS
- Palliative Care Problem Severity Scale (PCPSS)
- Palliative Care Phase (PCP)
What does the Symptom Assessment Scale under PCOC measure?
Scale of 0 to 10 in the areas of
Pain, breathlessness, respiratory secretions, appetite, nausea, vomitting, bowels, insomnia, fatigue, agitation, low mood, anxiety
What does the Resource Utilisation Group and Activities for Daily Living (RUG-ADL) under PCOC measure?
Looks at 4 main areas: bed mobility, eating, toilet, transfer
Ranking for Toilet, Bed mobility, Transfer
- Independent / supervision (with or without device)
- Limited physical assistance (1 person)
- Other than 2 person assistance (2 pax assistance + device)
- Two or more person physical assist
Ranking for Eating
- Independent / supervision (with or without device)
- Limited assistance (1 person)
- Extensive assistance / tube fed / total dependence
What does the AKPS under PCOC measure?
Similar to ECOC
- Anything above 50% is considered mobile
- Anything below 50% means patient needs quite a lot of help
What does the Palliative Care Problem Severity Scale (PCPSS) under PCOC measure?
Looks at areas apart from physical symptoms; 4 levels
- Level 1: problem is no longer an issue; not actively monitored
- Level 2: problem is mild; still being actively monitored during each review but no action needed to be taken
- Level 3: problem is moderate in severity; action (non-urgent) needs to be taken to manage the problem
- Level 4: problem is severe; requires urgent action to be taken to manage the problem
What does the Palliative Care Phase (PCP) under PCOC measure?
Measures which phase the patent is in; 6 phases
- Phase 1: stable; symptoms adequately controlled and managed
- Phase 2: unstable; development of a new problem or rapid increase in severity of existing problems
- Phase 3: deteriorating; gradual functional decline & worsening of existing symptoms or the development of new but expected problems
- Phase 4: terminal; death likely in a matter of days
- Phase 5: dead
- Phase 6: discharge to home or other facilities
What are the typical interventions for hospice setting?
- Addressing difficulties with ADLs
- Caregiver training
- Patient education: self-management techniques
- Activity engagement
- Equipment prescriptions
- Home assessments
- Motorised mobility training
- Legacy planning
How can we manage patients symptoms of anxiety / breathlessness?
- Non-pharmacological methods (i.e. pursed lip breathing, fan, positioning)
How can we manage patients symptoms of delirium?
Reorientation, distraction, activity engagement, relaxation
How can we manage patients symptoms of depression?
Activity engagement, distraction, distraction, exercise
How can we manage patients symptoms of insomnia?
Strategies to reverse sleep-wake reversal
How can we manage patients symptoms of lymphoedema?
Elevation, massage
How can we manage patients symptoms of pain?
Incorporating breakthroughs in symptoms management, activity pacing, activity modification
How can we manage patients symptoms of weakness & fatigue?
Maintenance of exercise / mobilisation, activity pacing, activity modification
How can we manage patients symptoms of wounds?
Positioning, pressure relief
What are the types of palliative rehabilitation?
Preventative care: no impairment of function yet; therapy is started soon after diagnosis
- Therapy Goals: Prevent onset / reduce severity of anticipated impairments that may cause significant disability
Supportive care: disease advancing; progressive impairments of function and abilities
- Therapy Goals: Provide support to remain as functional as possible; patient can return home and remain active despite functional decline
Restorative care: impairments of function and decreased abilities observed
- Therapy Goals: Maximise function recovery to premorbid status w/o significant disabilities
Comfort care: advanced stage of progressive disease; increasing disability
- Therapy Goals: Minimize / eliminate complications; provide comfort & support; maintain patient’s function
What are the roles of OT in preventative care?
PHYSICAL FUNCTION & REHABILITATION
- Promote patient’s physical
functioning and health
(e.g. exercise, physical activity)
- Lifestyle modifications to incorporate more physical activity into their daily life
ENGAGEMENT IN ACTIVITIES OF DAILY LIVING
- Develop and support a program
to help restore daily routines
and promote a healthy lifestyle
(e.g. lifestyle modifications )
PSYCHOSOCIAL SUPPORT
- Support patient to cope with
bodily changes post treatment
(e.g. activities to improve self-esteem
make-up, dress up for an occasion,
engaging in beauty treatments.
Covering up changes with clothing and
accessories, beauty treatment,
assertiveness training)
EDUCATION
- Educate on expected disabilities associated with disease and/or its treatment
(e.g. peripheral neuropathy, fatigue,
Memory or concentration problems,
pain, edema, mood changes,
breathlessness)
- Educate on early identification of adjustment issues (e.g. shock and disbelief, fear and anxiety, avoidance, anger, guilt and blame, feeling alone)
What are the roles of OT in supportive care?
PHYSICAL FUNCTION & REHABILITATION
- Identify and maximise physical capacity, function and tolerance
- Prevent muscle disuse and deterioration
ENGAGEMENT IN ACTIVITIES OF DAILY LIVING
- Teach patient self-care skills and use of devices to increase self-care ability and mobility
EDUCATION
- Caregiver training (e.g. on assisting patient in ADL, use of equipment, help patient develop daily occupational routines,
- Educate patient / family regarding
mobility training, good body mechanics
and assistive devices,
PSYCHOSOCIAL SUPPORT
- Ensure ongoing assessment of
psychological distress as appropriate
(e.g. anxiety and depression)
What are the roles of OT in restorative care?
PHYSICAL FUNCTION & REHABILITATION
- Supervise patient in appropriate program to restore function or prevent decline
ENGAGEMENT IN ACTIVITIES OF DAILY LIVING
- Advise on maintaining role at work or re-engaging in work
- Suggest patient to talk to employer about situation and explore work arrangements
EDUCATION
- Educate on expected disabilities associated with disease and/or its treatment
- Educate on early identification of adjustment issues
PSYCHOSOCIAL SUPPORT
- Support patient to cope with bodily changes post treatment
What are the roles of OT in comfort care?
PHYSICAL FUNCTION & REHABILITATION
- Prevent joint contractures and pressure sores
- Manage sensory impairment and tissue viability (i.e. Proper positioning in bed, splinting to prevent deformity)
ENGAGEMENT IN ACTIVITIES OF DAILY LIVING
- Improve their well-being and quality of life
EDUCATION
- Caregiver training
- Educate family on providing emotional support for patients
PSYCHOSOCIAL SUPPORT
- Provide psychological support for
patient and family members (e.g. spirituality, life reviews, activities which allow patients to be remembered for who they are)
What is the Breathing Thinking Functioning model about?
Three predominant cognitive and
behavioural reactions to breathlessness that, by causing vicious
cycles, worsen and maintain the symptom
- Breathing: apical breathing causes
reliance on fatiguable accessory muscles of respiration - Thinking: anxiety increases the respiratory rate and can cause muscle tension in both the ventilatory pump and other skeletal muscles
- Functioning: inactivity leads to muscle decondition-ing
