Occupational Therapy News OTnews April 2019 | Page 21

PALLIATIVE CARE FEATURE
Core skills of occupational therapists Specialist skills for palliative care
Holistic practitioners rather than task specific.
Able to grade activities.
Use of environment to facilitate needs of the person social,
institutional, cultural as well as physical.
Looking at the person as an occupational being. Positive risk taking and risk management.
Adaptable and flexible in treatment approach – dealing with
changing situations.
Understanding living with dying, loss and advanced care
planning.
Members of the RCOTSS-OPC national executive committee
were involved in designing and delivering the focus groups, as
well as undertaking a thematic analysis of the data collected. The
following themes were identified from the analysis.
Delivering palliative care
There was a resounding opinion from the participants that palliative
care is everyone’s responsibility and requires an interprofessional
and inter-agency approach. This echoes the sentiment within the
Ambitions for palliative care and end of life (2017) document and
NICE end of life guidelines (2004) that there needs to be a trained
workforce and organisations need to work collaboratively to ensure
the needs of the patients are met.
Although participants felt that it was their role to deliver palliative
care, there were barriers to the delivery of palliative care. The most
significant barrier was limited financial resourcing and pressures on
staff time.
Delivering palliative care is viewed as time-intensive (Hawley
2017), which is difficult to balance against increasing demands on
health and social care services.
A further barrier to delivering palliative care was the wide
geographical variations in the availability of services. The variability
of palliative care services can have a negative impact on the patient,
either by a lack of timely and appropriate intervention to meet their
needs (Marie Curie 2015), or a lack of choice in the care that they
receive (Lancaster et al 2017).
Generalist versus specialist occupational therapy
Some of the reasons given by the participants for referring to a
specialist palliative care occupational therapist included:
• crisis/palliative care emergency;
• when a patient has experienced multiple losses (including loss
of occupations, function complexity of diagnosis (including rapid
change, rapid deterioration or fluctuating function);
• where there is a need for advanced communication skills and
difficult conversations around supporting dealing with loss;
• unrealistic expectation of patient and relatives; complex family/
social dynamics and emotional support; and
• when a ceiling of expertise has been reached by the generalist.
This mirrors findings of several studies outlining the role of a
specialist occupational therapist and the interventions used (Eva
and Morgan 2018; Pergolotti et al 2016; Cooper 2006). Participants
also considered the core skills of occupational therapists and more
specifically, the skills occupational therapists need to deliver palliative
care (see box above).
Specialist palliative care occupational therapists were deemed
to have high level communication skills, which was viewed as being
one of the significant differences between generalist and specialist
occupational therapists.
Another key difference was highlighted as the ability to focus on
quality of life and to work with uncertainty and mortality, which is in
keeping with a palliative rehabilitation approach (Hospice UK 2015).
Training, knowledge and development
The engagement events highlighted a number of different types
of continuing professional development (CPD) activities that
occupational therapists had undertaken to develop their skills in
delivering palliative care.
These included communication skills training, condition/topic
specific training, as well as skills and knowledge gained from peer
support groups through shadowing and clinical supervision.
During discussions it was identified that occupational therapists
faced barriers to carrying out CPD activity, such as difficulties
obtaining funding and a lack of protected CPD time, as well as study
leave not being approved.
Protected CPD time is vital for ensuring that occupational
therapists are able to meet not only the needs of their patients, but
also adhere to the Health and Care Professionals Council standards
of proficiency.
Participants identified a lack of courses specifically for
occupational therapists and limited awareness of palliative care at
a pre-registration level. Participants stated that they would value
occupational therapy or allied health profession specific training.
They also discussed the benefits of palliative care placements,
not only for students, but also for qualified occupational therapy
rotational posts.
Reflection
The national executive committee for RCOTSS-OPC is organised by
volunteers from a range of backgrounds.
The engagement sessions enabled the committee to come
together as a team, drawing on individual’s strengths and expertise,
but also to develop leadership and facilitation skills, as outlined within
the RCOT Career Development Framework.
Furthermore, the engagement sessions enabled the specialist
section to meet its aims of engaging with its members and
participating in research to progress occupational therapy in
oncology and palliative care.
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