Physical therapy professionals have a critical role to play in meeting the needs of patients nearing the end of life. An update on the expanding involvement of physical therapists in providing palliative care and hospice care is presented in the January special issue of Rehabilitation Oncology, official journal of the Academy of Oncologic Physical Therapy, a component of the American Physical Therapy Association. The journal is published in the Lippincott portfolio by Wolters Kluwer.
"Physical therapy, since its inception more than 100 years ago, always has been a palliative medical intervention," according to an introduction by Guest Editors Christopher M. Wilson, PT, DScPT, DPT, and Richard W. Briggs, PT, MA. The special issue of Rehabilitation Oncology "includes an outstanding collection of writing by an interdisciplinary group of clinicians with diverse practices from around the world, reflecting the scope and effect that physical therapy may have on individuals facing death to help them live well and with dignity until death."
What's the role of physical therapy for patients nearing the end of life? New insights and perspectives
To meet the needs of individuals facing life-threatening illness, effective education on end-of-life care for healthcare professionals-in-training will be essential. An original research paper describes and evaluates an interprofessional, simulation-based learning experience to improve knowledge and attitudes regarding end-of-life care among nursing and physical therapy students. The lead author is Denise Campbell, DNP, RN, ACNS-BC, CEN, CHSE, of University of Michigan-Flint.
The interprofessional educational experience involved a clinical scenario of a patient with end-stage lung cancer who had decided to transfer to hospice care. The scenario included a conflict between two of the patient's children, who disagreed about their father's wishes for end-of-life care. Physical therapy and nursing students were assigned to play the roles of the patient, family, and healthcare professionals, with prompting and discussion by faculty members.
The simulation had an overall positive impact on the students' self-rated attitudes toward caring for patients nearing the end of life and their families – particularly on items related to speaking frankly about death and personal feelings about providing care to a dying patient. Attitudes were often informed by the students' personal experience with death and dying of those close to them.
Participants reported that the exercise helped them understand the importance of providing patient-centered, respectful care and maintaining patients' dignity and quality of life. The simulation helped the students appreciate the importance of communicating with the patient and family; the results suggested the need for more progress in collaborating with other healthcare team members regarding end-of-life care.
"There is significant evidence demonstrating the unpreparedness of health care professionals in caring for the dying patient," Dr. Campbell and coauthors write. Adding to previous reports, the study suggests that "incorporating an end-of-life simulation into curricula improved students' knowledge, skills, and attitudes toward patients and their family members at end-of-life."
Other special issue papers highlight the differences and similarities in palliative rehabilitation compared to traditional rehabilitation; the importance of clinically useful measures of functional outcomes; the need to provide culturally affirming care; the use of transcutaneous electrical nerve stimulation (TENS) as an alternative for treatment of advanced cancer pain; and the spiritual aspects of physical therapy palliative care for patients and families.
While the special issue highlights the progress made, many challenges remain in building a body of evidence to support the value of physical therapy services for patients with terminal illness. "Any therapist who has helped a patient take one of the last walks he or she will ever take, given a patient the tools to sit up to visit with his or her family one last time, or held the hand of a person in the last minutes of his or her life knows the effect of the services that we provide," the Guest Editors write. "Now we must prove it with scientific evidence."
DOI: 10.1097/01.REO.0000000000000192
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About Rehabilitation Oncology
Rehabilitation Oncology is the official quarterly publication of the Academy of Oncologic Physical Therapy, a component of the American Physical Therapy Association. The journal is the primary peer-reviewed, indexed resource for advancing oncologic physical therapy practice and cancer rehabilitation through the dissemination of definitive evidence, translation of clinically relevant knowledge, and integration of theory into education, practice, and research.
About the Academy of Oncologic Physical Therapy
The Academy of Oncologic Physical Therapy (a component of the APTA) advances physical therapist practice to maximize the lifelong health, well-being and function of persons affected by cancer and HIV. The association consists of professional Physical Therapists managing the musculoskeletal, neuromuscular, integumentary and cardiopulmonary rehabilitative needs of patients resulting from the treatment of active cancer disease. This encompasses acute secondary sequela of cancer treatments such as surgery, radiation therapy, and chemotherapy; long-term secondary sequela of said treatments and palliative care.
