Palliative Care
Palliative Care is the active total care of patients and their families by a multiprofessional team when the patient's disease is no longer responsive to curative treatment (World Health Organisation 1990). It concentrates on alleviating symptoms ranging from physical, psycho-social and spiritual problems and operates in acute hospitals and the community as well as hospices.
Palliative Care Team
Palliative Care services are usually based around a specialist Palliative Care unit funded either by the NHS or a charitable trust. These units can provide any or all of the following services:
- palliative day care
- Inpatient care providing symptom control, respite and terminal care
- community support including hospice-at-home
This team may comprise doctor, nurse, social worker, chaplain, occupational and physiotherapist, dietitian, psychologist.
The Palliative Care approach is applicable to any patients with non-curable disease e.g. multiple sclerosis, motor neurone disease, cardiac failure and not just cancer or HIV/AIDS.
The Occupational Therapist serves a role in in-patient care using assessment and treatment of functional problems, and facilitating discharge planning.
Community support
Supportive rehabilitation (Dietz. 1981) involves the occupational therapist working in close liaison with the interdisciplinary team. An up-to-date prognosis enables the team to make realistic treatment goals and provide on-going support including the patient's quality of life issues.
Day Care
As well as working with patient's functional problems, the occupational therapist has a leading role in Day Care. Administration criteria to Day Care is essential as regular case review as explained above.
The treatment programme may include socialisation and creative activities which are in every sense therapeutic and not merely diversional.
Day Care or Day Hospice has been described as 're-affirming living without ever denying dying'.
Palliative rather than terminal care
The terms palliative and terminal care should not be used interchangeably.
Palliation refers to alleviating symptoms rather than aiming to cure the disease and is associated with the advanced stages of all diseases.
Terminal care refers to an important part of Palliative Care and usually to the management of patients during their last few days or weeks, from a point at which it becomes clear that the patient is actively dying from their disease.
The occupational therapist is unlikely, therefore, to be involved in terminal care other than possibly providing equipment for comfort. Continuing emotional support to patients and carers may continue prior to onset of terminal phase.
