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Palliative Rehabilitation

Palliative Rehabilitation. JO BAYLY JULY 5 TH 2012 WOODLANDS HOSPICE. ___________________________________. Aim of session. To explore rehabilitation in palliative care A conceptual conflict? To consider how the principles of palliative rehabilitation can be incorporated into practice.

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Palliative Rehabilitation

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  1. Palliative Rehabilitation JO BAYLY JULY 5TH 2012 WOODLANDS HOSPICE ___________________________________

  2. Aim of session • To explore rehabilitation in palliative care • A conceptual conflict? • To consider how the principles of palliative rehabilitation can be incorporated into practice.

  3. Rehabilitation?

  4. Rehabilitation Improves Patient Outcomes: • Chronic pulmonary disease (Lacasse et al 2007) • Cardiac disease (Jolliffe et al 2001) • Degenerative neurological conditions (Khan et al 2007)

  5. Palliative care aims to improve patient outcomes through: “the active holistic care of patients with advanced, progressive illness. Management of pain and other symptoms and provision of psychological, social and spiritual support is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families” WHO (2002)

  6. Rehabilitation aims to improve patient outcomes by: • maximising patients physical, psychological, social & economic function either through restoration of previously held abilities AND/OR • helping patients acquire new skills and behaviours appropriate to a changing health status • Promoting self-management and resilience • Recognising complexity and involving coordinated MDT working. (Rankin J 2008)

  7. Function? • What do we understand by the term function? • physical, psychological, social, environmental & economic • What is the impact of symptoms and concerns on function?

  8. Daily Living… what’s important to you?

  9. NICE GUIDANCEImproving Supportive and Palliative Care for Adults with Cancer. The Manual • “Cancer and its treatment can have a major impact on patients’ ability to carry on with their usual daily routines” Ch 10.1 • “Cancer rehabilitation attempts to maximise patients’ ability to function, to promote their independence and to help them to adapt to their condition” Ch 10.2

  10. Who provides Palliative Rehabilitation? • Dietitian • Occupational Therapist • Physiotherapist • Speech & Language Therapists • Lymphoedema Specialists NICE GUIDANCE: Improving Supportive and Palliative Care for Adults with Cancer. The Manual (2004)

  11. Holistic Needs Assessment • “all patients have their needs for rehabilitation services assessed throughout the patient pathway” Ch 10.12 • “all patients who need rehabilitation services access them when and where they need them, and services are provided without delay” Ch 10.12 NICE GUIDANCE: Improving Supportive and Palliative Care for Adults with Cancer. The Manual (2004)

  12. Assessment of rehabilitation needs • Does use of a holistic needs assessment tool identify functional rehabilitation needs resulting from disease or treatment related symptoms? • Evidence suggests rehabilitation needs are not identified in oncology clinics (Cheville 2011, Gamble 2011) • What holistic assessment tool is used in your organisation? • Are rehabilitation needs identified?

  13. Uncertainty Fear Anxiety Fatigue Communication Loss of function Shame Depression Breathlessness Identity & Role Pain Guilt Concerns for family Stigma Impaired mobility Thoughts of death Reduced nutrition & weight loss Sanders et al 2010; Fitch et al 2010; Henoch et al 2009

  14. Dietz’s model of rehabilitation in oncology and palliative care: • Preventative - disability predicted & prevented if early intervention • Examples- • Restorative - no or little residual disability expected • Examples-

  15. Dietz’s model of rehabilitation in oncology and palliative care: • Supportive - disease is controlled, but progressive disability probable & continued support needed • Examples- • Palliative - disability cannot be corrected due to progressive disease but maximum quality of life in terms of comfort & function is the aim • Examples-

  16. Rehabilitation in palliative care- a conceptual conflict? Liminality Temporality (Lawton 2000; Little 1998)

  17. Rehabilitation in palliative care • Helps patients gain opportunity, control, independence, resilience and dignity. (NCAT 2011) • Responds quickly to help people to adapt to their illness. • Takes a realistic approach to defined goals. • Is continually evolving, taking its pace from the individual (National Council for Hospice & Specialist Palliative Care Services, 2000. Fulfilling Lives. London: NCHPSPC) • Can help people prepare for death? (Charon 2009) • Rehabilitation in a deteriorating body? (Rasmussen 2010)

  18. Time may be short… What’s important to your patient? • Any symptom or concern impacting on physical, • emotional or social functioning? • Any risk of future problems or deconditioning? • Consider referral to rehabilitation team, OT, physio, dietitian, SALT.

  19. Thank you for participating Jo Bayly Woodlands Hospice 0151 529 2299 Joanne.bayly@aintree.nhs.uk

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