A prospective study of unmet activity of daily living needs in palliative care inpatients

Aim: To define the unmet needs of activities of daily living as defined by patients and caregivers in a palliative care inpatient unit. Methods: A cross‐sectional prevalence study of a convenience cohort of a dyad of patient/caregiver. Functional status and unment needs were assessed. Agreement between respondents was analysed. Results: Caregivers identified significantly more unmet needs than patients (2.5 vs 2.5; p = 0.03). Areas of unmet need included mobility, leisure and bathing. Conclusion: Routine screening for unmet needs in function should be part of all inpatient palliative care assessments.     

我国姑息护理的发展现状与分析

综述了始息护理的内涵与模式，明白指出其在我国目前的发展现状，提出了我国始息护理的不足与发展的若干建议和目标。     

Has undergraduate education prepared occupational therapy students for possible practice in palliative care?

Background: It has been argued that the unique nature of the occupational therapy role in palliative care (PC) warrants dedicated attention in undergraduate programmes to improve the confidence of occupational therapy graduates to work in this setting. Nevertheless, little is known about either the present PC education or the preparedness of graduates to work in this field. In addressing each of these issues, this study also sought information to guide the development of occupational therapy‐specific undergraduate teaching resources. Methods: Survey information was gathered from two participant groups: (i) six occupational therapy schools from Australia and New Zealand and (ii) 24 occupational therapists employed in PC in Australia and New Zealand. Two different surveys were used, targeting issues specific to each of these two groups. Where possible, data were analysed quantitatively, whereas open‐ended questions were interpreted thematically. Results: Occupational therapy schools reported 2–10 hours of PC‐specific content and requested teaching resources specific to the occupational therapy role. Less than half of the clinicians (45.8%) recalled receiving undergraduate content in PC, and 75% reported having felt unprepared to work in this field. Clinicians who had received PC‐specific content at university felt more prepared to work in this field than those who had not. Several recommendations for teaching PC were made. Conclusions: The link between the extent of PC education received and perceived readiness to work in this field, together with the relatively small amount of dedicated undergraduate PC‐specific content, supports the need to optimise teaching in this unique field.     

Development of a distance education palliative care programme for allied health professionals in Australia

A postal survey of allied health professionals working in hospice and palliative care in Australia was conducted in 1995. Its aims were to investigate the education presently provided for allied health professionals in this field and the interest of these workers in further education. A total of 223 questionnaires were returned. One hundred and sixty-five respondents stated that no specific education for allied health professionals was provided in their workplace. Almost all considered that there was a need for more palliative care education for allied health professionals. Seventy-five per cent said they were interested in distance education in palliative care. The implications of these findings for further training are discussed, as well as the development of a post-graduate distance education package.     

Requirements for occupational medicine training in Europe: a Delphi study

OBJECTIVES—To identify the common core competencies required for occupational physicians in Europe.
METHOD—A modified Delphi survey was conducted among members of the European Association of Schools of Occupational Medicine (EASOM), the Occupational Medicine Section of the Union of European Medical Specialities (UEMS), and of the European Network of Societies of Occupational Physicians (ENSOP). An initial questionnaire based on the training syllabus of the United Kingdom Faculty of Occupational Medicine was circulated and respondents were asked to rate the importance of each item. The results were discussed at a conference on the subject of competencies. A further questionnaire was developed and circulated which asked respondents to rank items within each section.
RESULTS—There was a 74% response in the first round and an 80% response in the second. Respondents' ratings from most important to least important were; occupational hazards to health, research methods, health promotion, occupational health law and ethics, communications, assessment of disability, environmental medicine, and management. In the second round, among those topics ranked most highly were; hazards to health and the illnesses which they cause, control of risks, and diagnoses of work related ill health. Topics such as principles of occupational safety and selection of personal protection equipment were of least importance. Although the assessment of fitness was regarded as important, monitoring and advising on sickness absence were not highly rated. Management competency was regarded as of low importance.
CONCLUSION—This survey identified that respondents had traditional disease focused views of the competencies required of occupational physicians and that competencies were lagging behind the evolving definition of occupational health.


Keywords: competencies; Delphi study; occupational medicine training     

A survey of Israeli occupational therapists' definitions of the profession

The broad definition of occupational therapy, its holistic basis and its unifying characteristics enable occupational therapists to treat their clients as whole human beings. Yet, the holistic basis of occupational therapy and the divergence of its specialty areas seem to be polarised. This study explores Israeli occupational therapists' perceptions of their professional role and boundaries, and how it is affected by professional background; 265 Israeli occupational therapists participated in the study. A two-part questionnaire was constructed: (1) an attitudinal questionnaire including statements on issues that concern occupational therapists regarding the definition of the profession and its role; (2) nine items representing the main unifying characteristics of occupational therapy. Results indicate seven factors underlying the main issues concerning occupational therapists in Israel. From the seven factors two main sources of tension were revealed: strong sense of self-value as compared to lack of recognition by others and the advantages and the pitfalls of the holistic definition of occupational therapy. The most unifying characteristic of occupational therapy was the holistic definition, and the least important was the use of arts and crafts. In addition, occupational therapists from developmental disabilities area of specialty were distinct from others in their perceptions of the profession.     

Assessing structure, process and outcome in palliative day care: a pilot study for a multicentre trial

Palliative day care is an expanding service which remains under-researched. Study designs need to be developed to evaluate the costs and outcomes of the service in ways which are meaningful to patients, clinicians and policy-makers. At the same time, these must be open to the same criteria for rigour and reliability as techniques used elsewhere in health and social service evaluation. To this end, a developmental stage of exploratory research was undertaken at the start of a major multicentre trial of palliative day care to meet two clear aims: to understand more about the structure and processes of palliative day care, and to identify ways in which service outcomes could be evaluated and measured. In-depth observations at five palliative day care centres were undertaken across one health region. This provided a better understanding of the models, outcomes and processes of palliative day care in five different environments. Centres represented the spectrum of medical and social care models and findings were analysed using an organisational systems approach. The findings showed that, despite the lack of a national strategic approach to developing the service, the centres all provided a core set of services which were broadly similar. However, differences in philosophy, ownership, and organisation affected how the services were provided and may have an impact on the costs of the service. The study has provided a more in-depth understanding of palliative day care services in order to design an effective research strategy for evaluating a service which crosses the boundaries of health and social care.     

A survey of end-of-life care in care homes: issues of definition and practice

Care homes throughout the UK provide long-term care for frail older people. Whilst care homes are a home for life, many of the older people living in this setting also die there. There is increased interest in improving the care that older people receive in care homes towards the end of life. One way to achieve this has been through links with specialist palliative care services. The knowledge held in care homes by staff, residents and their family carers has yet to be fully integrated into this work. Consequently, a postal survey of care home managers in one English county was undertaken to examine the characteristics of end-of-life care for older people in these care homes. We sought to establish the managers' understanding of end-of-life care; the extent to which dying and death is present in this setting; the attributes of the resident population living in these care homes; and the availability of resources to support the provision of end-of-life care in this setting. The survey identified that managers held diverse understandings regarding the meaning of end-of-life care. The features of the residents' conditions and the dying that they experience requires a different way to conceptualise end-of-life care. A longer-term perspective is offered here that encompasses the whole period of a person's residence in a care home.     

Promoting health and well-being at the end of life through client-centered care

Background: Client-centered care is the cornerstone of the hospice and includes family members and significant others as the client unit. There needs to be a conceptual shift away from “medicalizing” patients at the end of life to promoting their health and considering their well-being a shared responsibility. Using the hospice philosophy of client-centered care can inform and expand health-promotion occupational therapy practice, particularly for people at the end of life. Objectives. This paper examines client-centered care at the end of life as that which enables engagement in meaningful occupation and promotes health and well-being until one dies. Methods: Constant comparison and thematic analysis is used for 12 interviews of hospice professionals. One of the themes, client-centered care, is discussed relative to the promotion of health and well-being at the end of life. Results: Client-centered care is deemed to be an important approach at the end of life. Conclusions/significance: It is determined that client-centered care at the end of life is vital to promote quality of life, health, and well-being. Further research is indicated.     

The role of geriatric palliative care in hospitalized older adults

ABSTRACT

Take-Away Points:

1. Geriatric palliative care requires integrating the disciplines of hospital medicine and palliative care in pursuit of delivering comprehensive, whole-person care to aging patients with serious illnesses.

2. Older adults have unique palliative care needs compared to the general population, different prevalence and intensity of symptoms, more frequent neuropsychiatric challenges, increased social needs, distinct spiritual, religious, and cultural considerations, and complex medicolegal and ethical issues.

3. Hospital-based palliative care interdisciplinary teams can take many forms and provide high-quality, goal-concordant care to older adults and their families.     

A prospective study of patient identified unmet activity of daily living needs among cancer patients at a comprehensive cancer care centre

Cancer, as a chronic illness, demands a new focus in physical and emotional support. Thus, an assessment of activities of daily living needs among cancer patients was completed. A 1-week, cross-sectional survey of patients was undertaken, by using the Modified Barthel Index, the Eastern Co-operative Oncology Group performance status, a Modified Instrumental Activities of Daily Living Scale and a screening tool. As functional status declined, the number of unmet needs per patient increased. At least one-third of patients who would benefit from assessment were not referred. Without simple screening tools, the needs of this population are not always being recognised or met. Patient identified needs, when analysed by functional level and treatment intent, challenge existing assumptions of service provision. In conclusion, there is an unmet need in this cancer population. By using the Screening Tool on referral, and with each change in level of function (as measured by the Eastern Co-operative Oncology Group), it would help identify patients who may benefit more from occupational therapy assessment.