Date Presented 03/28/20
OT provided to acute palliative care (APC) clients with cancer follows an impairment-driven approach. Occupation-based problems (OBP) and COPM performance and satisfaction score changes are described among 10 clients. Self-care OBP were more common than productive and leisure. Fifty percent of the clients experienced significant COPM performance and satisfaction score changes, suggesting clients may benefit from an occupation-based approach within APC.
Primary Author and Speaker: Karen Enlow
Additional Authors and Speakers: Anne Fleischer, Leslie Hardman
PURPOSE: For cancer survivors whose disease is progressing, an acute care admission along with a palliative care (PC) consultation is often needed (Numico et al, 2015). When a referral is made to OT during this admission, a non-standardized assessment focusing on impairments is commonly completed; thus, missing the client’s goal to regain independence in valued occupations (Weinstock-Zlotnick & Hinojosa, 2004). To align acute care OT with occupation-based practice and palliative care philosophy, support for occupation-based person-centered care is needed. To address this OT practice need, this prospective cohort study was designed to describe the palliative care clients’ occupational performance problem areas, Canadian Occupational Performance Measure (COPM) perceived satisfaction and performance score changes between the initial and discharge evaluation.
METHOD: IRB approval was received to collect data during standard of care OT initial and discharge assessments of palliative care clients, which included the administration of the COPM. Client’s whose data was stored met the following inclusion criteria: a) >20 years old, b) cancer diagnosis prior to the admission, c) received a palliative care consultation, d) consented to OT evaluation and treatment and e) admitted and discharged between January 1 and March 31, 2019. Exclusion criteria were a) unable to complete the COPM due to cognitive impairment and b) did not have an occupation-based goal. After the data was collected, occupational performance problem areas were categorized and graphed by self-care, productivity and leisure. The difference between the pre- and post-COPM scores was graphed by case.
RESULTS: Ten OT clients completed pre- and post- COPM assessment and received acute care OT treatments. Identified occupational performance problems were categorized as: self-care (75%), productivity (12.5%), and leisure (12.5%). Fifty percent of these acutely ill clients, who had a variety of cancer diagnoses and co-morbidities, demonstrated significant improvements in their COPM performance and satisfaction scores.
CONCLUSION/IMPACT STATEMENT: COPM was shown to be an effective person-centered occupation-based assessment for those transitioning into palliative care within an acute care setting. Additionally, the COPM and OT philosophy specifically aligns with palliative care, which supports OT role within palliative care. Lastly, this study provides support for acute care OT to use standardized occupation-based assessment within palliative care for those with a cancer diagnosis.
References
Numico.G., Cristofano, A., Mozzicafreddo, A., Cursio, E., Franco, P., Courthod, G., …Silvestris, N. (2015). Hospital admission of cancer clients: Avoidable practice or necessary care? PLOS ONE 10(3): e0120827. Retrieved from: https://dx.doi.org:10.1371/journal.pone.0120827
Weinstock-Zlotnick, G. & Hinojosa, J. (2004). Bottom-up or top-down evaluation: is one better than the other? The American Journal of Occupational Therapy, 58(5), 594-599. Retrieved from: http://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=ccm&AN=106578359&site=ehost-live&scope=site&authtype=shib&custid=s8356098
Law, M., Bapstiste, S, Carswell, A, McColl, M., Polatajko, H., & Pollock, N. (2014). Canadian Occupational Performance Measure. 5 th ed., CAOT Publications ACE, Ottawa
