Oncology and Palliative Care
Definition[edit | edit source]
End-of-life care, also known as Palliative care is defined by the World Health Organization as “an approach that improves the quality of life of the patients and their families who face the problems which are associated with life-threatening illnesses, through the prevention and relief of suffering by means of early identification, impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual.”[1] Palliative care is all about relieving suffering and achieving the best possible quality of life for the patients as well as their caregivers. [2] All of this can be explained by one goal of helping the patients to die with dignity.[3]
Role of Physical Therapist[edit | edit source]
As defined by the World Confederation for Physical Therapy; “Provide services to individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the life-span... Physical Therapists are concerned with identifying and maximising quality of life and movement potential within the spheres of promotion, prevention, treatment/intervention, habilitation and rehabilitation.”[4] Therapists play an essential role in the interdisciplinary approach to palliative care by providing increased quality of life, function, and overall experience through physical and functional dimensions of care.[5] Essentially, a physical therapist aims to maintain optimal function, prevent atrophy and soft tissue deformities, influence pain control, foster independence and educate each patient with the resources they need to make all other goals attainable.[6]
In the literature, many authors write that a physical therapist's role in palliative oncological care is as follows: gait training, therapeutic exercise, neuromuscular re-education, modalities, manual therapy and patient education.[6][7][8][9]
Interventions[edit | edit source]
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Palliative Care Models[10][edit | edit source]
The patient and family is at the center of care, and addressing their desires is reflected in palliative physical therapy models.These models consider the extreme variations of the end-of-life course which may include periods of improvement, stabilization, and decline; also included within the models is the limited reimbursement structure of managed care. These models include
- Rehab light
- When symptoms have been managed and the person is feeling trail though somewhat better, they may express a desire to regain strength and mobility, even with the awareness that their condition is life limiting. A gentle rehabilitation program with weekly or biweekly visits can be applied, with instruction in limited but effectively targeted home exercise program and measured sitting or walking for endurance.
- Case Management
- Often proceeds with a monthly, bimonthly, or “as needed” visit schedule to re-evaluate physical and functional status changes as a result of knowing that care needs will arise because of the progressive nature of the illness. It monitors conditions, to anticipate changes in care needs, and to provide ongoing training for often elderly family caregivers.
- Rehabilitation in reverse
- As impairments of strength and motor control change, it may threaten the patients ability to remain safely at home in the care of those they love. At various thresholds of decline, more support or assistance will be required to successfully navigate the environment and may require the use of a properly fitted cane, walker, or other assistive device. Physical assistance by caregivers is also likely to be required at some point as well, whether with ambulation, transfers or even moving in bed. Skilled physical therapy intervention and training can be provided throughout the course of decline, as it reflects the broad knowledge and teaching provided by therapists in more traditional settings, but in reverse order. This care can meet the patient’s desire to maintain maximal independence and mobility, and the family’s desire to successfully care for their loved one at home.
- Sklled maintenance
- In some complex situations with issues such as balance, tone, and coordination, it may not be possible to train a caregiver to manage this activity safely and may require skilled physical therapy intervention.
- Supportive Care
- Steps are taken to enhance patient comfort and improve quality of life and are essential to effective end-of-life care. Demonstration and teaching of appropriate techniques by the therapist to caregivers such as:
- Massage-provides temporary relief, long term management of edema, somato-sensory stimulus, and reduces muscle tension.
- Active, assistive, or passive range of motion-eases discomfort of inactivity and prevents contractures.
- Guided imagery-provides a common pleasant experience when combined with range of motion activities
- Vestibular stimulation-a gentle rocking motion and provide comfort.
- Conversation-provides sharing of information, meaning, and understanding which can support the end-of-life process.
Patient Experience[11][edit | edit source]
A study by Dahlin & Heiwe that interviewed patients who participated in physical therapy within palliative cancer care, found that they experienced the feeling of motivation and encouragement, relief and well-being, hope for a time-limited improvement in a specific area, independence, and security. Patients also expressed that their own knowledge was insufficient of what physical therapy could do for them and it was hard for them to know what they could ask for during their sessions. In some cases physical therapy has not been offered to them at all, or patients felt they did not have enough treatment.
Physical Therapy Pain Management (current best evidence)[edit | edit source]
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Case Reports/ Case Studies[edit | edit source]
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Resources[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
References[edit | edit source]
- ↑ WHO Definition of Palliative Care. Geneva: World Health Organization; c2003. Available from: http://www.who.int/cancer/palliative/definition/en/
- ↑ Chochinov HM. Dignity-conserving care - a new model for palliative care: helping the patient feel valued. JAMA 2002; 287(17); 2253-60.
- ↑ Machkey KM, Sparling JW. Experiences of older women with cancer receiving hospice care: significance for physical therapy. PhysTher 2000; 80(5);459-68.
- ↑ World Confederation for Physical Therapy. Policy Statement: Description of Physical Therapy What is Physical Therapy? London, UK. Available from http://www.wcpt.org/policy/ps-descriptionPT [last accessed on 2014 March 25]
- ↑ Eagan KA, Abbott P. Interdisciplinary team training- preparing new employees for the specialty of hospice and palliative care. J Hosp Palliat Nurse. 2002; 4:161-171.
- ↑ 6.0 6.1 Kumar SP, Jim A. Physical Therapy in Palliative Care: From Symptom Control to Quality of Life: A Critical Review. Indian J Palliative Care. 2010; 16(3): 138-146.
- ↑ Flomenhoft D. Understanding and helping people who have cancer: A special communication. Phys Ther. 1984; 64:1232-1234.
- ↑ Rashleigh LS. Physiotherapy in palliative oncology. Aust J Physiother. 1996; 42:307-312.
- ↑ Santiago-Palma J, Payne R. Palliative care and rehabilitiation. Cancer. 2001; 92:1049-1052.
- ↑ Briggs R. Clinical decision making for physical therapists in patient-centered end-of-life care. Topics in Geriatric Rehabilitation 2011; 27(1): 10-17.
- ↑ Dahlin Y, Heiwe S. Patients’ experiences of physical therapy within palliative cancer care. Journal of Palliative Care 2009; 25(1): 12-20.
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