an inTeRlink feature article

PALLIATIVE CARE
by Charles Sourby, CTRS

For the patient who does not respond to treatment, or, who is medically determined to be at the end stage of the disease process, being admitted to a hospital or hospice is a common occurrence.

Treatment for the patient at the terminal or end stage of cancer increasingly involves an approach called palliative care.

The palliative approach to treatment includes control of pain and other symptoms while simultaneously addressing the individual patient’s psychological, social, and spiritual concerns, in an effort to provide the best possible quality of life for the dying patient as well as his or her family.

Palliative care is the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social, and spiritual problems is paramount. The goal of palliative care is achievement of the best possible quality of life for patients and their families. Many aspects of palliative care are also applicable earlier in the course of the illness, in conjunction with anti-cancer treatment.

Is monumental, involving the search for meaning, confronting fears, dealing with the loss of control, and issues of loss.

The dying patient often experiences anger, guilt, disorganization, isolation, and depression.

Those receiving palliative care need to socialize. Support is derived from seeing others in similar situations. Research demonstrates an elevated sense of hope and a better outlook following social interactions with peers.

The patient, often in pain, is to endure life’s final stages. (In some cases the diagnoses is less than ninety days old.) The patient receives palliative medical treatment and has psychosocial needs addressed through contact support, compassion, and comfort provided by a number of disciplines to help complete life with dignity and grace.

The Role of the Recreation Therapist who works in a Palliative Care Setting

1. To provide activities/programs/social visits to residents commensurate with and appropriate to their mental and physical status.
2. To inform, invite and provide special escort to activities and programs of choice.
3. To modify activities/programs/social visits offered to match resident’s mental and physical changes.
4. To provide guidance to staff as to appropriate recreational activities.
5. To provide guidance and support to families as to appropriate recreational activities to match resident’s status
6. To provide for “final wish” opportunities to residents as tolerated and feasible.
7. To coordinate with care plan team to provide maximum care.

Conclusion

Recreation Therapy is an effective intervention in Palliative Care involving the search for meaning, confronting fears, dealing with the loss of control, and issues of loss. Recreation Therapy addresses the dying patient’s negative feelings; threats to self esteem and help restore a sense of control, contributing to an improved quality of life.

Approach to treatment includes control of pain and other symptoms while simultaneously addressing the patient’s psychological, social, and spiritual concerns, in an effort to provide the best possible quality of life. Therapeutic Recreation reduces boredom, fosters a sense of accomplishment and enhances psycho-social supports within the patient’s community.

References

Breitbart, W. & Holland, J.C. (1993) Psychiatric aspects of symptom management in cancer patients, Washington DC, The American Psychiatric Press. pp. 155-165

Cimino, J.E. (1997) Commentary: Non-abandonment, physicians and nurses as allies, New York, The American Journal of Hospice & Palliative Care (Vol14 [3]) pp. 106-107

Connoly, P. (1993) Balancing changing health care needs with the shortage of quality health care professionals: Implications for therapeutic recreation, Journal of Loss, Grief & Care, New York , Haworth Press. pp.15-21.

Kubler-Ross, E. (1969) On death & dying, New York, Macmillan Publishing, pp. 38-110

Kunstler R. & Sokoloff, S. (1993) Clinical effectiveness in intensive therapeutic recreation: A multiple case study of private practice intervention. Journal of Loss, Grief & Care, New York. 23-28.

Sourby, Charles A. (1998), Barbara-Palliative Care, Journal of Therapeutic Horticulture

Stoll, B. A. (1988) Coping with cancer stress, The Netherlands, Nijhoff Publishers, pp. 45, 86, 116, & 119.