FEATURE SERVICE DEVELOPMENT
In conjunction with the Royal College of Nursing
(RCN), an economic assessment of occupational
therapy services at a hospice in Ayrshire, Scotland,
was recently completed, which had three aims:
• to make occupational therapy services in the day
services centre more therapeutically led;
• to increase awareness of the role of occupational
therapy in palliative care and increase the
confidence of the staff to refer to the service; and
• to improve the efficiency of the occupational therapy
service delivery.
To achieve these aims, six practical occupational
therapy-led sessions were added to the existing 12-
week themed programme currently running in day
services.
This changed the way
occupational therapy
services were delivered,
focusing more on groupbased
activities, rather than
one-to-one assessments,
and was offered alongside
the information sessions that
were traditionally offered. This
pilot project was evaluated
over the course of 12 weeks.
The project involved few extra
costs, as all staff were already in
employment and all materials required
were purchased using an existing budget.
No traditional services were eliminated, as
volunteers still offer distraction therapy groupbased
activities, and one-to-one appointments are
still available with the occupational therapy team if
required.
Rationale for change
It is widely recognised that in palliative care, patients
will functionally decline and with that comes significant
losses in participation in day-to-day activities, roles,
decision-making and quality of life.
However, it has been shown that participation
in meaningful activities improves symptoms such
as fatigue, pain and anxiety, it allows patients to
adapt and learn new strategies to maintain their
independence, and also allows them to regain some
control and enhance their quality of life, despite their
reduced ability in function (Mills and Payne 2014).
Hospice UK’s report Rehabilitative palliative care
enabling people to live fully until they die (Tiberini
and Richardson 2015) encourages rehabilitation,
enablement and self-management. The aim is to
optimise people’s function and wellbeing and enable
them to live as independently as possible, despite the
limitations of their illness.
The programme
Traditionally, a 12-week themed programme was
available to all patients attending day services.
Occupational therapy provided group information
sessions on three of these weeks. This included
fatigue management and sleep hygiene, cognition and
self-esteem.
able to
try things in a safe
environment, gives me the
confidence to then attempt
them at home, easing the
‘‘...being
pressure on my
husband.
One-to-one assessments were provided when
identified as appropriate by the occupational therapist
or occupational therapy technical instructor (OTTI)
and, due to the requirement to cover both the
inpatient unit and day services, patients
had to be prioritised daily, based
on their occupational therapy
needs.
Volunteers were also
used for distraction
therapy, such as quizzes,
games, arts and crafts and
gardening.
In addition to the
services already in
existence, practical group
sessions were offered on six of
the 12 weeks, where the themes
were: looking back and moving
forward; anticipatory care planning; being
active; fatigue management and sleep hygiene; selfesteem;
and cognition.
The Integrated Palliative Care Outcome Scale
(IPOS) was used to gather patients’ perceptions of
their anxiety, depression, carer anxiety and practical
problems each week. This is a relatively new
assessment tool which has been introduced to the
Ayrshire Hospice. The other elements collected relate
to physical symptoms, so were not analysed for this
study.
As day services is a rolling programme, only
patients attending on the first day of the project (8 July
2019) were analysed, giving a total of 22 patients. Due
to missed attendance or non-compliance to complete
it, none of the 22 patients had an IPOS score for each
week.
A survey was sent to all staff to gain insight into
their understanding of occupational therapy and
meaningful activities. It revealed that:
• 61 per cent of staff felt not at all confident, not
so confident, or only somewhat confident in
understanding the role of occupational therapy in
palliative care;
46 OTnews August 2020