Palliative care
Palliative care
Feature
Enhancing clinical practice in palliative care
Catherine Brewin , Sarah Cowlishaw and Angie Greener explain why they ’ ve been using non-pharmacological symptom management with their palliative patients , and what the feedback has been so far .
A s a team of occupational therapists , we work in palliative care across acute oncology wards and Hayward House , a palliative care unit with a day centre attached . Hayward House provides symptom management and end of life care , using primarily pharmacological interventions . The unit also has a complimentary therapy unit .
As part of our work in palliative care , we reviewed the evidence relating to nonpharmacological symptom management and began to incorporate symptom management into our clinical work with our palliative patients .
An OT ’ s role in palliative care
Cancer remains one of the leading causes of death in the UK . Occupational therapists are integral to the assessment and treatment of people living with cancer , including those who are palliative and end of life ( An Veen et al 2024 ; Pergoltti 2016 ).
Interventions may include assessment of a patient ’ s home and social circumstances , function and palliative rehabilitation . In addition , there is an increasing body of research into the management of patients ’ symptoms that occupational therapists are well placed to integrate with their practice
An element of palliative care is to control the symptoms of those with a palliative prognosis . Medical interventions for symptoms such as breathlessness , pain , fatigue and anxiety are often unsuccessful in providing complete resolution of symptoms .
Medications also sometimes come with unwelcome side effects ( Eaton et al 2017 ).
Increasingly , non-pharmacological interventions are being used in palliative care settings . Such interventions may include relaxation sessions and techniques for addressing anxiety .
Other therapies may consider the management of fatigue and breathlessness ( Cohelo 2017 ). Symptoms may be interlinked with an overlap between pain , anxiety and fatigue . Breathlessness and anxiety may also be interwoven ( Zhao et al 2021 ).
Approaches that combine both pharmacological and non-pharmacological interventions have had some success in addressing patients ’ symptoms ( Hunter et al 2017 ).
Developing the project plan
We recognised that a busy acute clinical team needed a structure to implement new interventions . We obtained support from our trust ’ s Improvement Team , who helped us to develop a project plan and outcome measures . We used these outcome measures , which were based on a Likert-type scale , to identify the impact of the proposed interventions on patients ’ symptoms .
We requested and received patients ’ comments regarding the success of the intervention and returned data was anonymised . We also carried out stakeholder consultations . This included seeking and incorporating the views of the palliative care group and senior staff involved with Hayward House , including the complimentary therapists .
It was apparent that there was great support for our project , but resources would continue to be a challenge . We addressed this by beginning the project at Haywood House , while we integrated a range of symptom management interventions with our clinical practice .
Guided relaxation
We understood that oncology patients ’ symptoms are multifaceted , and that palliative patients may present several symptoms at any one time . Our work with anxiety and pain advanced the most quickly and provided
26 OTnews November 2024