Occupational therapy is a health discipline rather than medical discipline; it focuses on effect of disease or injury on everyday living. It is a unique non medical focus.
Occupational therapy is concerned with the consequence of disease or injury as they affect a person’s ability to function rather than the disease pathology itself.
Occupational therapy can be defined as an art and science of directing man’s response to selected activities, to promote and maintain health, to prevent disabilities, to evaluate behaviour and to treat patient with physical dysfunction (Sharon, Lewis (2008).
The individual is seen as healthy, when he has learned the skill necessary for successful participation in the range of role he is expected to play through his life. The role changes through life and there are times when existing skills lag behind new needs. Dysfunction occurs when individual is unable to maintain himself with his environment, because he does not have the skills necessary for coping with current situation. An instance is a street dancer that lost one of his legs, or violist lost one of his fingers (Annie, 2002).
Therapist work to keep the arousal high by expanding the activities offered into tasks that sustain the individual interest and promote new role and habits.
Ultimately, therapy work to introduce occupation that can provide sustainable positive reinforcement from the environment.
A LIFE LIMITING CONDITION
A life limiting condition is a state in which an individual fells as a victim to an illness or diseases that exposes victims to risk of losing their life, some of this conditions are irreversible and perhaps could eventually leads to termination of a victim’s dear life (Florence,2006).
There are four categories of life limiting and life threatening conditions,
1-conditions for which curative treatment may be feasible but can fail, then access to palliative care become necessary when treatment fail or during an acute crisis, irrespective of the duration of that threat to life. If otherwise, there is successful curative treatment, then there is no need of palliative care services. Examples are cancer, irreversible organ failure of heart, liver, kidney etc.
2- Condition where premature death is inevitable, there may be longing period of intensive treatment aimed at prolonging life and allowing participation in normal activities .Examples are cystic fibrosis, Duchene muscular dystrophy.
3- Condition where disease progress without curative treatment options, the only treatment in this category is palliative and may extend over many years (Cherny, 2010,(journal)).
Example: Batten disease.
4- Condition where disease is irreversible but non-progressive causing severe disability that could susceptibility leads to health complication and likelihood of premature death. Examples include cerebral palsy, brain or spinal cord injury, complex health care needs.
When life limiting conditions is no longer responds to curative treatments, patient are provided with long term care options based on their choice to meet their health care needs. An example of this kind of care is Hospice.
HOSPICE CARE: is designed to provide comfort and support to patients and their families when their condition is no longer responding to curative treatments. Once the patient has been diagnosed with terminal illness with life expectancy of six months or less, patient may consider hospice care as an alternative (Goh, 2010).
This care is designed to provide comfort care, spiritual as well as emotional support for patient in the final phase of terminal illness. Hospices provides symptoms management and pain control, thus enhances the quality of life of patient at this critical time.
CANCER (As a Life Limiting condition)
Cancer is a diseases in which human cells display uncontrolled growth beyond the normal limit, This is abnormal , this growth could invades adjacent tissues and sometime spread to other location in the body(a process call metastasis). According to Greisinge, A.S et al. (2009) Cancer was described as an uncontrollable growth of a cell.
PATHOLOGY OF CANCER; this is process involves to diagnose cancer usually by a pathologist. It is done through an examination of cancerous cell. This could be carried out clinically by laboratory analysis, where various examinations are carried out on urine, blood, body tissues. Tissue can be obtained from a biopsy or surgery. The diagnosed tissue shows the type of cells that is proliferating, it also shows its histological grade, genetic abnormalities and other features of tumor.
The result obtained helps in evaluating the prognosis of the patient and to choose best treatment for the diseases (Cancer Journal, 2010)
EPIDEMOLOGY OF CANCER AND ITS PROGRESSION
This is a way of detection of cancer and possible prevention, way to know possible causes of cancer and its trend(s). Observational epidemiological study shows that there is association between specific cancer and risk factors . Majority of this risk factors are modifiable, the leadings one among others are tobacco smoking, alcohol use, and infections. Likewise obesity and overweight are also a leading cause as could be observed in developed countries. Majority of cancer risk factors are environment factors, hereditary factors and lifestyle related. In developed countries such as United Kingdom, cancer accounts for morbidity of annual toll of approximately about 20 percent of all death (Greisinge, A.S et al. (2009).
According to genetic epidemiology (Schull and Weiss, 2008) there are specific dominants type of familiar cancer as a typical models of inherited susceptibility to cancer .There are threefold risk of same cancer occurring among family members of patient, for instance ;as observed in most published studies (Thomas 1980), breast cancer is most popular , follow by stomach, colon and uterine. The risk for breast cancer is 3.8 higher in mother or daughter compare to sister and grandmother or aunt which are 2.9 and 2.7 respectively. Stomach colon breast cancer shows a double rate in monozygotic twin than dizygotic twins (Nakano, 1997).
Different form of cancers diseases occurrence varies in related to the risk factors that are majorly expose to in each countries. Oral cancer is more common in southern Asia , oral cancer are more common for instance in India where tobacco chewing is important, in Bombay the risk of oropharygeal cancer is common as related to smoking of their dried leaf cigarette called “BIDI”.
Liver cancer is rare in the west but most common in China and neighbouring countries due to endemic presence of hepatitis B and aflatoxin in their population. Lung cancer incidence has increased in a parallel fashion in various third world countries with tobacco smoking becoming more common(Truesdale, Journal(2010)).
In U.S cancer is second to cardiovascular disease as leading cause of death, unlike in UK where cancer is the leading cause of death. In developing countries (many third world countries) cancer incidence appear much lower. Cancer is responsible for about 25 percent of all death in United States (S. Payne, 2008).
The rapid progression of cancer makes it most dangerous diseases and could lead to death if not timely detected.
END OF LIFE CARE, ACTUAL AND POTENTIAL ROLE OF OCCUPATIONAL THERAPY
Time often become an enemy rather than a friend for a patient who has a terminally ill diseases such as cancer. Depression, acceptance of faith becomes inevitable couple with loneliness. The end of life care is commissioned to meets the need of such patient, and this service improves their quality of life even for such limited of time.
End of life care service aimed to support individual with life limiting diseases, who are approaching end of their life, this care is necessary to save them from depression and offers the victims opportunity to live as well as possible until they die.
Palliative care is an aspect of end of life care delivered by health and social care staff with specific training in the management of pain and other symptoms .Provision of support such as psychological, spiritual and social support (Habrand, 2009).
People approaching their end requires a combination of health and social care services as provided in care home or hospices.
End of life care is type of care giving to a patient with terminally ill disease such as cancer. They are kept under palliative care, managing their pain and are giving opportunities to improve quality of life for the duration of their awaiting death expectation.
This is a moment of depression, feels lonely and unmotivated .Overwhelmed and confused.
Helping such patient to deals with the obstacle at this moment amount to rendering him a last gift of life.
Various forms of therapy are necessary for patient with life limiting condition, among these is occupational therapy.
CONTRIBUTION OF OCUPATIONAL THERAPY
This is a form of therapy that provides client with a dynamic functional state It enable patient to perform his or her daily occupation to satisfactory and affective level and to respond positively to changes by adapting activities to meet the changes need (Creek, 2003, page54)
Pains of cancer are most dreaded, apart from the severe biological pain that is experience by fewer than half of patient dying of cancer. There are other forms of pains which are equally devastating; these include pains of isolation, abandonment and loss of role. While biological pain are being control by hospice physician, Occupational therapist play an important part in giving patients opportunity to live out their lives in as dignified and purposeful manner as their disease permits. They contribute in pain management role and pain of loss of role
Although the life cannot be saved but the final days of life, week or month should be fulfilling. Since the aim of Occupational therapy is to maximize the patient potential, therefore among their potential role is diagnostic honesty.
This is one of the basic tenets of hospices philosophy; cancer patient should be enrich with sufficient information about their status for they need this to make decision(s) about their life. Maximize patient potential role, assist the terminally ill patient to realize their potential through examining and supporting strategies for achievement in self care , work and leisure.
Ø Identify client daily activities, rate client performance in these activities and rate satisfaction in these performance.
Ø Teach patient how to address, adapt to any physical limitation that result from cancer treatment
Ø Improve patient mobility and self care issues, by identifying what the patient needs, and finding ways to meet their needs.
Ø Enabling patient to use their body parts in an adaptive way to meet their daily needs and coping with their conditions.
Ø Modifying their perception of pain and modification of their life style. Teach them how to carry out their daily activities and cope with stress through occupation.
CONTRIBUTION OF OCCUPATIONAL THERAPY TO PROMOT HEALTH AND WELL BEING OF CANCER PATIENT
The contributions of Occupational therapist are as follows:
Ø Rehabilitation process
Ø Provide equipment that assists with activities, offers expertise in modifying the environment to maximize patient independence.
Ø Offers support and education about the diseases
Ø Facilitate patient health and wellbeing through engagement in occupation.
Ø Enable the patient to set goals and at the same time have satisfaction of fulfilling of those goals within the limited period of their existence.
Ø Improving the patient quality of life by diverting their attention towards effective use of their available time and disappearance of loneliness feelings.
IMPAIREMENT AND ACTIVITIES LIMITATION OF OCCUPATIONAL THERAPY
RELATED TO CANCER PATIENT
Sometime there are some limitation that could prevent labour of an occupational therapist on patient to result in vain, one of it is when an occupational therapist work in system and environment which make it difficult to assess occupational need of their clients. This is most often due to factors such as dominance of the medical model, couple with significant political, institutional and financial pressure which characterize modern health and social care (Newhouse, 2007).
Rogers (1991) claimed and argued convincingly that biomedical influences on traditional health care have being a limiting factor in the development of occupational therapy because of their emphasis on disease and function rather than emphasis on performance and competence. Influence on occupational therapy (chp1 page6) (Rogers 1991)
In cancer patient, fatigue and reduction in physical ability are often severe problem regardless of disease stage and modalities of treatments
INTERVENTION, MANAGEMENT, SUPPORT AND REHABILITATION
A time like this when terminal ill clients faces inevitable changes to their previous life plans, their goals in life are constantly shifting as their perception of themselves and that of their future is dramatically changing and irreversibly altered, forces them to mentally and spiritually prepared for their death.
The most important intervention at this stage is to influence patient thinking, by helping them to re-determines their goals, support and directs them towards achieving these goals. This will give them a sense of personhood and control. Revisiting certain time in their past in order to re-evaluate the experiences and deals with outstanding issues. Addressing any unfinished business, this could give client sense of satisfaction and emotional closure; feelings that they have achieved their goals and that they can let go of this life.
When people expectation of themselves do not match their physical or mental abilities and their goals are unachievable, introducing sub-goals is a viable option (Bye, 1998)
So to have a positive intervention in patient life could be approach from different perspectives. For instance poor level of physical function can be countered with activity on cognitive function, decision making plane where goals can still be achieve.
Goals in palliative care are client established, though it may not be fully achieve because of deterioration and death. The process of goal setting in itself will be therapeutics as it will be perceived as a positive experienced by patients (Bye, 1998).
Having influence on how client feels they are being perceived by others can be an important goal in palliative care. Patients are aware of how their disease, illness or treatment has affected their appearance, their physical and mental illness, they are depress for this untruly revelling of their identity and would wish people know what they were like before. Personalising their environment with photos, press cuttings, poems painting etc are ways of best intervention. As is having some control over their activities of daily livings. This is important factors in that Patients feels that they are participating and controlling the situation, this gives client a sense of success and continuity of participation in the daily activities.
Rehabilitating patient is a form of restoring back their ability and to improve their quality of life. It involves therapy, but not limited to various forms of therapies such as physical therapy, occupational therapy and speech therapy. Rehabilitation help Cancer patient to regain strength, decrease fatigue and improve quality of life.
Measurement of outcome in palliative care can be viewed from perspectives of patient, their carers or staff. Review meeting, reflections meeting will provide the staff with the opportunity for evaluation and perhaps realignments of patient goals. Feedback from patient family, relatives and carers either verbally, in the form of cards or letter after patient death will be an indication of their satisfaction with the services.
Measurement of successful outcome to activities will be related to unique goals of individual patient. Individual choose to pursue these goals in different ways either by changing direction or by professional guide, in response to patient past and present life trajectory and issues that influences them. Continue participation and drive to pursue their goals can be accepted as a measure of successful outcome.
A poor outcome will be indicative of poor outcome goal setting on the part of people involved. Unfortunately this may result in low self-esteem and fear of failure
Evidence based practice is movement of fundamental importance in the delivery of health care throughout the developing world (Bithell, 2000, p58)
According to director of physical Therapy Academic programme and Canadian physiotherapy Association (1995), Evidence based practice has a theoretical body of knowledge and uses the best available scientific evidence in clinical decision making and standardize outcome measures to evaluate the care provided.
Evidence based practices are client centred practices based on client information and a critical review of relevant research.
Evidence based practices demonstrate how the evidence generated from the research studies were used to inform clinical practices , to influence the development of service that were responsive to patient needs and to provide a sound knowledge based for education and professional development. Occupational therapy have developed theoretical interpretation of practices that go beyond biomedical approach.( Geoffrey, 2000).This has been achieved by developing theories of professional practices that are interpreted and elaborated in practice, concerned with guiding principles of client centred and holistic health care.
Palliative care according to Wold Heath Organisation (WHO) Definition, is an approach that improves patient life and their families facing the problem associated with life-threatening illness, this is achieve through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other physical , psychosocial and spiritual problems(WHO 2005).
Palliative care could also be defined as a treatment that enhances comfort and improvement of individual life. No therapy is excluded from consideration, the expected outcome is relief from distress, easing of pain and enhancing quality of life.
Palliatives cares means making general activities still within the patient grasp while their condition deteriorate towards death. A dying patient with limiting
Condition has many challenges facing them, especially that of existential nature, Palliative care are aimed to improve the quality of life of a patient and their family who have the problem of life limiting diseases such as cancer.
The occupational therapist should understand how patient sees their self at this point, knowing this help the therapist to approach more appropriately and able to render what we call end- of life care
For instance expression of love, reminding such patient of her prior days of glory, discussing about their faith and spiritual believe , what they have achieved in term of their believe. This could rest their mind as related to uniting with their creator after death.
Pain is a sensory experience, sensation of pain leads to suffering and this in turn generates pain behaviour. Pain behaviour refers to all form of behaviour generated by an individual which reflect the presence of nociception, including facial expression, seeking health care attention etc.
It is pain behaviour that constitutes our clinical observation about chronic pain. An individual with acute illness will resume a well behaviour after recovery from the illness, in chronic illness; reduction of symptoms does not automatically lead to resumption of well behaviour.
Pain behaviours which begins in response to nociception may eventually occur due to totally or partly other reasons such as reinforcement consequences provided by environment.
Treatment given to this patient should be able to provide opportunity for re-engaging the patient into the life role which constitutes the well behaviour. Treatment must systemically remediate deficit in the patient well behaviour. There must be a systemic effort that can restored back vocational activities that can keeps patient going in life.
At times there are no known apparent causes for an individual pain, There may not be significant factors that could be obtain as a causes of patient pain. Suffering from sense of loneliness and isolation could be an escalating factor that could emerge pain in an individual. Because at this stage no physical reason could be determine for that type of pain, no physician treatment procedures may be necessary. The persistence of a problem beyond the healing effort of the disease indicates another approach is needed.
To manage such client, life around them became source of treatment. Thus recommendation of occupational therapy becomes an integral part of total plan for this type of client.
The severe biological pain experience by patient dying from cancer could be control as well as manage by hospice physician. However, cancer patient experience other form of pain as well, that can be equally devastating, and this is a pain of isolation, pain of abandonment and pain of loss of role.
The entire essay shows the importance and principles of occupational therapy to hospice care. Both encourage patient to resume their former role and lifestyle either by physical adaptation or devise coping mechanism to overcome barriers. Hospice is concerned with the quality of life during the time remaining to the dying patient. Occupational therapy help the terminally ill resume his occupational role and as such has a definite place in facilitating quality of life.
Occupational therapy has a unique contribution to make to the terminally ill person because of its focus on the use of time and significant of time left for the ill patient. It offer opportunity to use this time creatively and to bring satisfactory to the closer months , weeks ,days of patient life, this is a contribution of immeasurable importance.
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