Date Presented 04/05/19
Primary Author and Speaker: Lisa Knecht-Sabres
Contributing Authors: Ashley Weppner, Cassandra Powers, Brooke Siesel
BACKGROUND: There are a record number of individuals with an end-stage life threatening illness in the United States.1 The distinct value of occupational therapy (OT) in end-of-life care is to facilitate quality of life for clients and their caregivers through engagement in occupations during the clients’ remaining days. 2 The literature suggests that there are inconsistencies in the referral to allied therapy services for patients in hospice care.3 A potential reason for inconsistent access to OT may be that healthcare professionals misunderstand the role and value of OT in: (1) helping the terminally ill attain their end of life goals; (2) enhancing quality of life; and, (3) facilitating closure with end of life arrangements.4
PURPOSE: The purpose of this study was to explore healthcare professionals’ perceptions and knowledge regarding the role of OT in hospice care and to better understand why OT may be underutilized in this setting.
DESIGN: A convergent mixed method design was used to gather data. Electronic surveys were distributed to healthcare professionals across the United States who had experience working in hospice care. Participants were required to have at least one year of professional experience working in a hospice setting, be able to read English, and be at least 18 years of age. 104 professionals from 31 different states participated in this study.
METHOD: Researchers modified an existing survey, with permission of the authors, to explore participants’ knowledge about the role of OT as it relates to hospice care. The modified survey was peer-reviewed by practitioners and experts in the field prior to data collection. Research Electronic Data Capture (REDCap) was used to build and manage the online survey. Descriptive statistics was used to analyze quantitative data and content analysis was used to identify patterns with qualitative data. Rigor was enhanced through peer-review, multiple coders, and triangulation.
RESULTS: The results of this study revealed that OT’s role in hospice care is misunderstood and OT services are underutilized. Five themes were identified regarding the underutilization of OT services: (1) lack of reimbursement; (2) timing of referral; (3) knowledge of the role of OT; (4) refusal of services by family members; and (5) lack of OT presence in this setting.
CONCLUSION: This study revealed that health care professionals do believe that OT’s are vital members of the hospice care team. However, many recipients of hospice care are not receiving OT for numerous reasons.
IMPACT STATEMENT: This study illustrated the need to educate healthcare professionals regarding the distinct role of the OT practitioner as part of the interdisciplinary hospice team. Further research and evidence on the benefits of OT intervention for patients, family, and caregivers in hospice care is needed. More consistent referrals to OT may better ensure that the terminally ill are able to attain end-of-life goals and live their lives to the fullest, regardless of life expectancy. The findings of this study also appear to suggest that OT practitioners need to advocate and lobby for more healthcare reimbursement dollars in in this area of practice. Lastly, since OT is considered a covered service in hospice care by Medicare, perhaps, education on the available funding for therapy services is warranted.The researchers of this study hope that these findings will lead to further education and better understanding of OT's role in hospice care, which may better ensure that the recipients of hospice care are able to attain their end of life goals and live their lives to the fullest, regardless of life expectancy.
References
1. Hammill K, Bye R, & Cook C. (2014). Occupational therapy for people living with a life- limiting illness: A thematic review. British Journal of Occupational Therapy, 77, 582–589.
2. American Occupational Therapy Association. Official Documents: Role of Occupational Therapy in End-of-Life Care (2016). American Journal of Occupational Therapy, 70(2): 1-16. doi:10.5014/ajot.2016.706S17
3. Lyons M, Orozovic N, Davis J, & Newman J. (2002). Doing-being-becoming: Occupational experiences of persons with life-threatening illnesses. American Journal of Occupational Therapy, 56, 585–295. http://dx.doi.org/10.5014/ajot.56.3.285
4. Asworth E. (2014). Utilizing participation in meaningful occupation as an intervention approach to support the acute model of inpatient palliative care. Palliative and Support Care, 12, 409–412.
