Exploring the interface between palliative care and rehabilitation services

Background: Palliative rehabilitation involves multi-professional processes and interventions aimed at optimising patients’ symptom self-management, independence and social participation throughout advanced illness. Rehabilitation services were highly disrupted during the Covid-19 pandemic. Aim: To understand rehabilitation provision in palliative care services during the Covid-19 pandemic, identifying and reflecting on adaptative and innovative practice to inform ongoing provision. Design: Cross-sectional national online survey. Setting/participants: Rehabilitation leads for specialist palliative care services across hospice, hospital, or community settings, conducted from 30/07/20 to 21/09/2020. Findings: 61 completed responses (England, n = 55; Scotland, n = 4; Wales, n = 1; and Northern Ireland, n = 1) most frequently from services based in hospices (56/61, 92%) providing adult rehabilitation. Most services (55/61, 90%) reported rehabilitation provision becoming remote during Covid-19 and half reported reduced caseloads. Rehabilitation teams frequently had staff members on sick-leave with suspected/confirmed Covid-19 (27/61, 44%), redeployed to other services/organisations (25/61, 41%) or furloughed (15/61, 26%). Free text responses were constructed into four themes: (i) fluctuating shared spaces; (ii) remote and digitised rehabilitation offer; (iii) capacity to provide and participate in rehabilitation; (iv) Covid-19 as a springboard for positive change. These represent how rehabilitation services contracted, reconfigured, and were redirected to more remote modes of delivery, and how this affected the capacity of clinicians and patients to participate in rehabilitation. Conclusion: This study demonstrates how changes in provision of rehabilitation during the pandemic could act as a springboard for positive changes. Hybrid models of rehabilitation have the potential to expand the equity of access and reach of rehabilitation within specialist palliative care.

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Neuropalliative rehabilitation—managing neurological disability in the context of a deteriorating illness

Oxford Textbook of Neurorehabilitation ◽

10.1093/med/9780199673711.003.0027 ◽

2015 ◽

pp. 341-351 ◽

Cited By ~ 1

Author(s):

Gail Eva ◽

Jo Bayly ◽

Diane Playford

Keyword(s):

Palliative Care ◽

Rehabilitation Services ◽

Active Engagement ◽

Coordination Of Care ◽

Ability To Work ◽

Care Needs ◽

Neurological Disability ◽

Neurological Conditions ◽

Rehabilitation Needs ◽

Palliative Care Needs

Although the concepts of ‘rehabilitation’ and ‘palliative care’ may seem paradoxical, the two approaches have a great deal in common. Rehabilitation for people with deteriorating, life-limiting neurological conditions can be organized into four distinct but overlapping categories: preventative, restorative, supportive, and palliative.Patients with neurological conditions can report palliative care needs from diagnosis; neuropalliative rehabilitation needs to be available within the context of whatever services are most appropriate for the patient’s circumstances at the time, requiring excellent coordination of care between neurology, palliative care, and rehabilitation services. Neuropalliative rehabilitation follows the same process that would be used in other conditions, but is underpinned by specific palliative care skills which include the ability to work flexibly with rapidly changing conditions, as well as understanding and being able to manage the tension between the patient’s active engagement in life and acknowledging loss and death.

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Rehabilitation Services and Palliative Care

Home Healthcare Now ◽

10.1097/nhh.0000000000000769 ◽

2019 ◽

Vol 37 (3) ◽

pp. 174-175

Author(s):

Christopher Wilson

Keyword(s):

Palliative Care ◽

Rehabilitation Services

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Neuropalliative rehabilitationManaging neurological disability in the context of a deteriorating illness

Oxford Textbook of Neurorehabilitation ◽

10.1093/med/9780198824954.003.0029 ◽

2020 ◽

pp. 401-411

Author(s):

Gail Eva ◽

Jo Bayly ◽

E. Diane Playford

Keyword(s):

Palliative Care ◽

Rehabilitation Services ◽

Active Engagement ◽

Coordination Of Care ◽

Care Needs ◽

Neurological Disability ◽

Neurological Conditions ◽

Rehabilitation Needs ◽

Palliative Care Needs ◽

Palliative Patients

Although the concepts of ‘rehabilitation’ and ‘palliative care’ may seem paradoxical, the two approaches have a great deal in common. Rehabilitation for people with deteriorating, life-limiting neurological conditions can be organized into four distinct but overlapping categories: preventative, restorative, supportive, and palliative. Patients with neurological conditions can report palliative care needs from diagnosis; neuropalliative rehabilitation needs to be available within the context of whatever services are most appropriate for the patient’s circumstances at the time, requiring excellent coordination of care between neurology, palliative care, and rehabilitation services. Neuropalliative rehabilitation follows the same process that would be used in other conditions, but is underpinned by specific palliative care skills which include the ability to work flexibly with rapidly changing conditions, as well as understanding and being able to manage the tension between the patient’s active engagement in life and acknowledging loss and death.

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Physiotherapy Intervention in Palliative Care for HIV Comorbidities: Can it be a Best Practice for Public Policy for Palliative Care in Zambia?

Journal of Preventive and Rehabilitative Medicine ◽

10.21617/jprm2020.224 ◽

2020 ◽

Vol 2 (1) ◽

pp. 92-104

Author(s):

Esther Munalula Nkandu ◽

◽

Micah Mutuna Simpamba ◽

Hastings Kachingwe Shula ◽

Theresa Lesa Chisoso ◽

...

Keyword(s):

Palliative Care ◽

Community Health ◽

Community Health Workers ◽

Quantitative Data ◽

Health Workers ◽

Rehabilitation Services ◽

People Living With Hiv ◽

Community Based ◽

Physiotherapy Intervention ◽

Living With Hiv

Introduction:The prolonged life expectancy for people living with HIV has led to an increase in the prevalence of people living with HIV and AIDS.Most of these patients are experiencing episodes of wellness and illness with related disability. In Zambia, many HIV patients who required rehabilitation services were not able to access these services.A community based physiotherapy intervention programme using Community Health Workers who were equipped with basic physiotherapy skills was set up in Mtendere and Chawama Townships of Lusaka, Zambia from 2008 to 2015.This study set out to assess the intervention output in relation to patients’ trends, process of the intervention and challenges experienced for the period October, 2012 to September, 2014.Methods: This evaluation reviewed monthly and annual reports of the programme from October, 2012 to September, 2014.A desk review of palliative care related reports and policy was also reviewed. Both qualitative and quantitative data was extracted from these reports, with quantitative data being analyzed using excel while qualitative data was analysed usingQSR NVIVO 10 after being transcribed and translated from texts.Results: The patients’ trends during this period showed a steady increase in the proportion of new patients being enrolled onto the programme compared to those who were being lost to follow up, death, discharge or other loss such as transfers and many others. Themes under qualitative analysis were Community Health Workers, procurements, service delivery programme challenges and palliative care policy.The programme planned to conduct two trainings for each of the years under review but only managed one in each year. There were many challenges identified under this programme and all of them bordered on inconsistencies in the release of funds.Conclusion: This evaluation shows that the prevalence of HIV patients presenting with disabling conditions has been increasing and there is need to provide the needed rehabilitation services through the community based programme. Using Community Health Workers to provide physiotherapy services in the community enables many patients to access these services and hence a policy that supports this would be ideal. Keywords:palliative care; physiotherapy; HIV comorbidity; public policy

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Understanding the impact of the Covid-19 pandemic on delivery of rehabilitation in specialist palliative care services: An analysis of the CovPall-Rehab survey data.

10.1101/2021.04.13.21255380 ◽

2021 ◽

Author(s):

Jo Bayly ◽

Andy Bradshaw ◽

Lucy Fettes ◽

Muhammed Omarjee ◽

Helena Talbot-Rice ◽

...

Keyword(s):

Palliative Care ◽

Online Survey ◽

Rehabilitation Services ◽

Free Text ◽

Specialist Palliative Care ◽

Advanced Illness ◽

Cross Sectional ◽

Care Services ◽

Palliative Care Services ◽

The Impact

Abstract Background: Palliative rehabilitation involves multi-professional processes and interventions aimed at optimising patients symptom self-management, independence, and social participation throughout advanced illness. Rehabilitation services were highly disrupted during the Covid-19 pandemic. Aim: To understand rehabilitation provision in palliative care services during the Covid-19 pandemic, identifying and reflecting on adaptative and innovative practice to inform ongoing provision. Design: Cross-sectional national online survey. Setting/participants: Rehabilitation leads for specialist palliative care services across hospice, hospital, or community settings, conducted from 30/07/20 to 21/09/2020. Findings: 61 completed responses (England, n=55; Scotland, n=4; Wales, n=1; and Northern Ireland, n=1) most frequently from services based in hospices (56/61, 92%) providing adult rehabilitation. Most services (55/61, 90%) reported rehabilitation provision becoming remote during Covid-19 and half reported reduced caseloads. Rehabilitation teams frequently had staff members on sick-leave with suspected/confirmed Covid-19 (27/61, 44%), redeployed to other services/organisations (25/61, 41%) or furloughed (15/61, 26%). Free text responses were constructed into four themes: (i) fluctuating shared spaces; (ii) remote and digitised rehabilitation offer; (iii) capacity to provide and participate in rehabilitation; (iv) Covid-19 as a springboard for positive change. These represent how rehabilitation services contracted, reconfigured, and were redirected to more remote modes of delivery, and how this affected the capacity of clinicians and patients to participate in rehabilitation. Conclusion: This study demonstrates how changes in provision of rehabilitation during the pandemic could act as a springboard for positive changes. Hybrid models of rehabilitation have the potential to expand the equity of access and reach of rehabilitation within specialist palliative care.

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Much Ado About Fried Chicken: Abetting Aspiration or Respecting Autonomy?

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-18-0207 ◽

2019 ◽

Vol 28 (3) ◽

pp. 1356-1362

Author(s):

Laurence Tan Lean Chin ◽

Yu Jun Lim ◽

Wan Ling Choo

Keyword(s):

Palliative Care ◽

End Of Life ◽

Multidisciplinary Team ◽

Biopsychosocial Model ◽

Family Members ◽

Clinical Decisions ◽

Goals Of Care ◽

Complex Needs ◽

Aspiration Risk ◽

Patient Centric

Purpose Palliative care is a philosophy of care that encompasses holistic, patient-centric care involving patients and their family members and loved ones. Palliative care patients often have complex needs. A common challenge in managing patients near their end of life is the complexity of navigating clinical decisions and finding achievable and realistic goals of care that are in line with the values and wishes of patients. This often results in differing opinions and conflicts within the multidisciplinary team. Conclusion This article describes a tool derived from the biopsychosocial model and the 4-quadrant ethical model. The authors describe the use of this tool in managing a patient who wishes to have fried chicken despite aspiration risk and how this tool was used to encourage discussions and reduce conflict and distress within the multidisciplinary team.

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