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Enabling occupation at the end of life: A literature review

Published online by Cambridge University Press:  15 June 2015

Katherine Mills  and
Angela Payne
Katherine Mills*
Affiliation:
College of Health and Social Care, University of Derby, Derbyshire, United Kingdom
Angela Payne
Affiliation:
College of Health and Social Care, University of Derby, Derbyshire, United Kingdom
*
Address correspondence and reprint requests to: Katherine Mills, 89 Berry Hill Road, Mansfield, Nottinghamshire, NG18 4RT, United Kingdom. E-mail: Mills.k3@sky.com
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Abstract

Objective:

Occupation, or meaningful activity, can contribute to the well-being and quality of life of all individuals. It is thus a logical tautology that occupation should be enabled for those at the end of life. Our present review examines current provision of these processes by Occupational Therapist, who can be much-valued members of multidisciplinary palliative care teams.

Method:

Following a literature search and critical selection, 10 global papers were identified examining occupation and occupational therapy at the end of life in the acute, hospice, and community environments.

Results:

Universally, there appeared to be a dearth of therapists working in end-of-life care. Provision of palliative care in hospitals was found to be compensatory or rehabilitative. Hospice therapy emerged as pleasingly occupational, though the number of hospice places was disappointingly few. Community literature was sparse, so it proved challenging to draw definitive conclusions. Promising research refracted light on occupation at home; however, it also revealed stretched domiciliary services, where clients are not well informed about the potential scope of occupational therapy.

Significance of Results:

A “good death” involving a quality end-of-life experience is the foundational goal overarching all therapy and medicine in the provision of palliative care. Arguably, an occupation-focused approach provided by therapists meets client needs to enable meaningful experiences in the limited time left to them. Current occupational therapy practice environments are not necessarily achieving these goals in commensurate fashion. There is a need to promote the role of occupational therapy and circumscribe what therapists can offer. Further research is necessitated across all environments and future funding for therapist positions in palliative teams. End-of-life care can be complex and challenging; however, therapists can facilitate fulfillment of client-centered occupational goals. In engaging with personally constructed nuances of meaning, quality of life can be improved in those deserving of a significant and emotionally rich daily existence during their final days.

Keywords

OccupationOccupational therapyEnd of lifeMeaningQuality of life
Type
Review Article
Information
Palliative & Supportive Care , Volume 13 , Issue 6 , December 2015 , pp. 1755 - 1769
Copyright
Copyright © Cambridge University Press 2015 

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References

REFERENCES

Alzheimer's Society (2014). End-of-life care. Available from http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=428.Google Scholar
Bennett, S. & Bennett, J. (2000). The process of evidence-based practice in occupational therapy: Informing clinical decisions. Australian Journal of Occupational Therapy, 47, 171–180.Google Scholar
Benthall, D. & Holmes, T. (2011). End-of-life care: Facilitating meaningful occupations. The American Journal of Occupational Therapy, 16, 7–10.Google Scholar
Bonikowski, S., Musto, A., Suteu, K., et al. (2012). Independence: An analysis of a complex and core construct in occupational therapy. British Journal of Occupational Therapy, 75, 188–195.Google Scholar
Carrier, A., Levasseur, M., Bedard, D., et al. (2010). Community occupational therapists' clinical reasoning: Identifying tacit knowledge. Australian Occupational Therapy Journal, 57, 356–365.Google Scholar
Carstensen, L., Isaacowitz, D. & Charles, S. (1999). Taking time seriously: A theory of socio-emotional selectivity. The American Psychologist, 54, 165–181.Google Scholar
Christiansen, C. & Townsend, E. (2011). Introduction to occupation: The art and science of living, 2nd ed. Englewood Cliffs, NJ: Pearson Education International.Google Scholar
Cohen, S., Mount, B., Strobel, M., et al. (1995). The McGill Quality of Life Questionnaire: A measure of quality of life for people with advanced disease. A preliminary study of validity and acceptability. Palliative Medicine, 9, 207–219.Google Scholar
Cohen, S., Mount, B., Bruera, E., et al. (1997). Validity of the McGill Quality of Life Questionnaire in the palliative care setting: A multi-centre Canadian study demonstrating the importance of the existential domain. Palliative Medicine, 11, 3–20.Google Scholar
College of Occupational Therapists (2011 a). Code of ethics and professional conduct, 6.1. Available from http://www.cot.co.uk/sites/default/files/publications/public/Code-of-Ethics2010.pdf.Google Scholar
College of Occupational Therapists (2011 b). Professional standards for occupational therapy practice. Available from http://www.cot.co.uk/standards-ethics/professional-standards-occupational-therapy-practice.Google Scholar
College of Occupational Therapists (2014 a). Promoting quality, measuring outcomes. Available from https://www.cot.co.uk/long-term-conditions/promoting-quality.Google Scholar
College of Occupational Therapists (2014 b). What is occupational therapy?: What do occupational therapists do? Available from http://www.cot.co.uk/ot-helps-you/what-occupational-therapy.Google Scholar
Department of Health (2000). The NHS cancer plan: A plan for investment, a plan for reform. Available from http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyandGuidance/DH_4009609.Google Scholar
Department of Health (2008). End-of-life care strategy: Promoting high-quality care for adults at the end of their life. Available from https://www.gov.uk/government/publications/end-of-life-care-strategy-promoting-high-quality-care-for-adults-at-the-end-of-their-life.Google Scholar
Department of Health (2010). Equity and excellence: Liberating the NHS. Available from https://www.gov.uk/government/publications/liberating-the-nhs-white-paper.Google Scholar
Department of Health (2011). National cancer strategy. Available from https://www.gov.uk/government/publications/the-national-cancer-strategy.Google Scholar
Doble, S. & Santha, J. (2008). Occupational well-being: Thinking occupational therapy outcomes. Canadian Journal of Occupational Therapy, 75, 183–190.Google Scholar
Duncan, E. (2011). Foundations for practice in occupational therapy, 5th ed. London: Churchill Livingstone.Google Scholar
Finlay, L. (2004). The practice of psychosocial occupational therapy, 3rd ed. Cheltenham: Nelson Thornes.Google Scholar
Gilbert, P. (2005). Compassion: Conceptualisations, research and use in psychotherapy. London: Routledge.Google Scholar
Gillen, A. & Greber, C. (2014). Occupation-focused practice: Challenges and choices. British Journal of Occupational Therapy, 77, 39–41.Google Scholar
Glassman, W. & Hadad, M. (2009). Approaches to psychology, 5th ed. Maidenhead: McGraw-Hill.Google Scholar
Gross, R. (2005). Psychology: The science of mind and behaviour, 5th ed. London: Hodder Education.Google Scholar
Hagedorn, R. (2000). Tools for practice in occupational therapy: A structured approach to core skills and processes. London: Churchill Livingstone.Google Scholar
Halkett, G., Ciccarelli, M., Keesing, S., et al. (2010). Occupational therapy in palliative care: Is it under-utilised in Western Australia? Australian Occupational Therapy Journal, 57, 301–309.Google Scholar
Hansen, R., Dirette, D. & Atchison, B. (2007). Thinking like an OT. In Conditions in occupational therapy, 3rd ed. Atchison, B. & Dirette, D. (eds.), pp. 1–8. Baltimore: Lippincott Williams & Wilkins.Google Scholar
Health Professions Council (2013). Standards of proficiency for occupational therapists. Available from http://www.hpc-uk.org/assets/documents/10000512Standards_of_Proficiency_Occupational_Therapists.pdf.Google Scholar
Huber, M., Knottnerus, J., Green, L., et al. (2011). How Should we Define Health? BMJ, 343, 235–237.Google Scholar
Iwama, M. (2011). Cultural perspectives on occupation. In Introduction to occupation: The art and science of living, 2nd ed. Christiansen, C. & Townsend, E. (eds.), pp. 35–56. London: Pearson Education.Google Scholar
Jacques, N. & Hasselkus, B. (2004). The nature of occupation surrounding dying and death. OTJR: Occupation, Participation & Health, 24, 44–53.Google Scholar
Jarman, J. (2011). What is occupation? Interdisciplinary perspectives on defining and classifying human activity. In Introduction to occupation: The art and science of living, 2nd ed. Christiansen, C. & Townsend, E. (eds.), pp. 81–100. London: Pearson Education.Google Scholar
Kasven-Gonzalez, N., Souverain, R. & Miale, S. (2010). Improving quality of life through rehabilitation in palliative care: Case report. Palliative & Supportive Care, 8, 359–369.CrossRefGoogle ScholarPubMed
Kealey, P. & McIntyre, I. (2005). An evaluation of the domiciliary occupational therapy service in palliative cancer care in a community trust: A patient and carers perspective. European Journal of Cancer Care, 14, 232–243.CrossRefGoogle Scholar
Keesing, S. & Rosenwax, L. (2011). Is occupation missing from occupational therapy in palliative care? Australian Occupational Therapy Journal, 58, 329–336.Google Scholar
Kuipers, K. & Grice, J. (2009). The structure of novice and expert occupational therapists' clinical reasoning before and after exposure to a domain-specific protocol. Australian Occupational Therapy Journal, 56, 418–427.Google Scholar
Law, M., Cooper, B., Strong, S., et al. (1996). The person–environment–occupation model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63, 9–23.Google Scholar
Lyons, M., Orozovic, N., Davis, J., et al. (2002). Doing–being–becoming: Occupational experiences of persons with life-threatening illnesses. The American Journal of Occupational Therapy, 56, 285—295.CrossRefGoogle ScholarPubMed
Macmillan (2014). Medical and nursing help at home for someone with advanced cancer. Available from http://www.macmillan.org.uk/Cancerinformation/Ifsomeoneelsehascancer/Advancedcancer/Preparationforcominghome/Medicalnursinghelp.aspx#DynamicJumpMenuManager_6_Anchor_7.Google Scholar
McMasters University (2014). Health sciences library: Literature searching. Available from http://hsl.mcmaster.libguides.com/content.php?pid=486614&sid=3990062.Google Scholar
McMillan, S. & Weitzner, M. (1998). Quality of life in cancer patients: Use of a revised hospice index. Cancer Practice, 6, 282–288.Google Scholar
Meredith, P. (2010). Has undergraduate education prepared occupational therapy students for possible practice in palliative care? Australian Occupational Therapy Journal, 57, 224–232.Google Scholar
Miller-Polgar, J. & Vrkljan, B. (2001). Meaning of occupational engagement in life threatening illness: A qualitative pilot project. Canadian Journal of Occupational Therapy, 68, 237–249.Google Scholar
Motor Neurone Disease Association (2014). End-of-life care. Available from http://www.mndassociation.org/life-with-mnd/treatment-and-care/End+of+life+care.htm.Google Scholar
National Association for Hospice at Home (2014). What is hospice at home? Available from http://www.nahh.org.uk/about-hospice-care/what-is-hospice-at-home.Google Scholar
National Council for Palliative Care (2014). Dying matters: End-of-life care. Available from http://www.dyingmatters.org/page/understanding-death-and-dying.Google Scholar
National Health Service (2005). National service frameworks for long-term conditions: Quality requirements. Available from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/198114/National_Service_Framework_for_Long_Term_Conditions.pdf.Google Scholar
National Health Service (2012). National service frameworks. Available from http://www.nhs.uk/nhsengland/NSF/pages/Nationalserviceframeworks.aspx.Google Scholar
National Health Service (2014). Improving quality: Long-term conditions and integrated care. Available from http://www.nhsiq.nhs.uk/.Google Scholar
National Hospice and Palliative Care Organization (2014). Hospice and palliative care: History of hospice care. Available from http://www.nhpco.org/history-hospice-care.Google Scholar
National Institute of Clinical Excellence (2004). Supportive and palliative care (CSGSP). Available from http://www.nice.org.uk/csgsp.Google Scholar
National Institute of Clinical Excellence (2011). Quality standard: End-of-life care for adults. Available from http://guidance.nice.org.uk/QS13.Google Scholar
National Institute on Aging (2014). End of life: Helping with comfort and care. Available from http://www.nia.nih.gov/health/publication/end-life-helping-comfort-and-care/dementia-end-life.Google Scholar
Papapetropoulos, S., Tuchman, A., Laufer, D., et al. (2007). Causes of death in multiple system atrophy. Journal of Neurology, Neurosurgery, and Psychiatry, 78, 327–329.Google Scholar
Parkinson's UK (2014). Preparing for end of life: Why think about end of life? Available from http://www.parkinsons.org.uk/content/preparing-end-life.Google Scholar
Park Lala, A. & Kinsella, E. (2011). A phenomenological inquiry into the embodied nature of occupation at end of life. Canadian Journal of Occupational Therapy, 78, 246–254.Google Scholar
Parnell, T. & Wilding, C. (2010). Where can an occupation-focused philosophy take occupational therapy? Australian Occupational Therapy Journal, 57, 345–348.Google Scholar
Petticrew, M. & Roberts, H. (2003). Evidence, hierarchies and typologies: Horses for courses. Journal of Epidemiology and Community Health, 57, 527–529.Google Scholar
Pizzi, M. (2010). Promoting health and wellness in end-of-life care. Gerontology Specialist Interest Section Quarterly, 33, 1–4.Google Scholar
Pizzi, M. & Briggs, R. (2004). Occupational and physical therapy in hospice: The facilitation of meaning, quality of life, and well-being. Topics in Geriatric Rehabilitation, 20, 120–130.Google Scholar
Priest, H. (2002). An approach to the phenomenological analysis of data. Nurse Researcher, 10, 50–63.CrossRefGoogle Scholar
Putnam, R. (2000). Bowling alone: The collapse and revival of American community. New York: Simon and Schuster.Google Scholar
Rassafiani, M., Ziviani, J., Rodger, S., et al. (2009). Identification of occupational therapy clinical expertise: Decision-making characteristics. Australian Occupational Therapy Journal, 56, 156–166.Google Scholar
Royal College of General Practitioners and Royal College of Nursing (2012). Gold standards framework: Matters of life and death. Available from http://www.goldstandardsframework.org.uk/cd-content/uploads/files/Primary%20Care/RCGP%20Matters%20of%20Life%20Death%20-%20Jul12.pdf.Google Scholar
Schleinich, M., Warren, S., Nekolaichuk, C., et al. (2008). Palliative care rehabilitation survey: A pilot study of patients' priorities for rehabilitation goals. Palliative Medicine, 22, 822–830.Google Scholar
Schunemann, H., Oxman, A., Higgins, J., et al. (2008). Presenting results and “summary of findings” tables. In Cochrane handbook for systematic reviews of interventions. Higgins, J. & Green, S. (eds.), pp. 335–358. Chichester: John Wiley & Sons.Google Scholar
Seymour, J., Bellamy, G., Gott, M., et al. (2002). Good deaths, bad deaths: Older people's assessments of the benefits and risks of morphine and terminal sedation in end of life care. Health, Risk & Society, 4, 287–303.CrossRefGoogle Scholar
Skills for Care (2012). Developing end of life care practice. Available from http://www.skillsforcare.org.uk/Skills/End-of-life-care/End-of-life-care.aspx.Google Scholar
Squire, N. (2011). Contribution of occupational therapy to the palliative care team: Results of a pilot project. European Journal of Palliative Care, 18, 136–139.Google Scholar
Stadnyk, R., Townsend, E. & Wilcock, A. (2011). Occupational justice. In Introduction to occupation: The art and science of living, 2nd ed. Christiansen, C. & Townsend, E. (eds.), pp. 329–358. London: Pearson Education.Google Scholar
Strong, S., Rigby, P., Stewart, D., et al. (1999). Application of the person–environment–occupation model: A practical tool. Canadian Journal of Occupational Therapy, 66, 122–133.Google Scholar
Terry, M. & Westcott, L. (2012). Are occupational therapists in acute general hospitals addressing psychological well-being? British Journal of Occupational Therapy, 75, 296–298.Google Scholar
Tomlin, G. & Borgetto, B. (2011). Research pyramid: A new evidence-based practice model for occupational therapy. The American Journal of Occupational Therapy, 65, 189–196.Google Scholar
Trombly Latham, C. (2002). Occupation as therapy: Selection, gradation, analysis & adaptation. In Occupational therapy for physical dysfunction, 6th ed. Radomski, M. Vining & Latham, C. Trombly (eds.), pp. 358–381. London: Lippincott Williams & Wilkins.Google Scholar
University of Illinois at Chicago (2014). University library: Is all evidence created equal? Available from http://researchguides.uic.edu/content.php?pid=232200&sid=1921074.Google Scholar
University of Oxford (2009). Oxford centre for evidence based medicine: Levels of medicine. Available from http://www.cebm.net/index.aspx?o=1025.Google Scholar
VanderPloeg, W. (2001). Health promotion in palliative care: An occupational perspective. Australian Occupational Therapy Journal, 48, 45–48.CrossRefGoogle Scholar
Whalley-Hammell, K. (2001). Using qualitative research to inform the client-centred evidence-based practice of occupational therapy. British Journal of Occupational Therapy, 64, 228–233.Google Scholar
Whalley-Hammell, K. (2009). Sacred texts: A skeptical exploration of the assumptions underpinning theories of occupation. Canadian Journal of Occupational Therapy, 76, 6–13.Google Scholar
Wilcock, A. (1998). Reflections on doing, being and becoming. Canadian Journal of Occupational Therapy, 65, 248–257.Google Scholar
Wilcock, A. (2007). Occupation and health: Are they one and the same? Journal of Occupational Science, 14, 3–8.Google Scholar
Wilding, C. & Whiteford, G. (2009). From practice to praxis: Reconnecting moral vision with philosophical underpinnings. British Journal of Occupational Therapy, 72, 434–441.Google Scholar
Wilson, L. (2010). Spirituality, occupation and occupational therapy revisited: Ongoing consideration of the issues for occupational therapists. British Journal of Occupational Journal, 73, 437–440.Google Scholar
World Health Organization (2014). WHO definition of palliative care. Available from http://www.who.int/cancer/palliative/definition/en/.Google Scholar