Caroline Belchamber, Physiotherapy Lecturer, Bournemouth University, and Senior Physiotherapist at Lewis-Manning Hospice, Poole, Dorset, UK, explains the background to her longer article, which is published in the May/June edition of the European Journal of Palliative Care.
The open and supportive environment of palliative rehabilitation ‘fosters a sense of hope and helps people regain a sense of connectedness, enabling them to live rather than just existing.’
What is palliative rehabilitation?
When the quantity of life can no longer be increased, the quality of life must be maximised.1 The aim of palliative care is to reduce the degree to which disabilities become permanent or interfere in everyday life irrespective of how long that life may be,2 paralleling rehabilitation, which promotes a kind of wellness to exist even at point of death, such as the experience of a good death.3 Therefore palliative rehabilitation is essential in enhancing the lives of people with cancer. (See also http://ncat.nhs.uk/sites/default/files/Gateway_11008_DEC_rehab_20081117_0.pdf )
My research explored palliative rehabilitation,4 within a specialist palliative day care centre which included: group work 5 (social, exercise and diversional therapy); non-pharmacological approach to breathlessness, (breathing techniques, relaxation, pacing, lifestyle changes, anxiety and fatigue management); lymphodema management and aromatherapy, all seen as important components within palliative rehabilitation and delivered by a multidisciplinary palliative care team. I was involved in the exercise group and non-pharmacological approach, where I brought a number of skills to palliative rehabilitation including respiratory and knowledge of human function and movement, enabling me to maximise the person’s potential no matter how long they had left to live. Using physical approaches I promoted, maintained and restored physical, psychological and social wellbeing, while continually assessing the person’s changing health status.6 Through semi-structured interviews using interpretative phenomenology I captured the meaning of my participant’s lived experience of palliative rehabilitation. A key factor identified was ‘fostering a sense of hope,’ described in my article.7
Does the following statement sound familiar to you?
‘The beginning was devastating, it is difficult to cope with, it is difficult to take in when they say, you know, there is nothing they can do, and you have not got very long left to live, and you think of death and you know, I was frightened, I was terrified of dying. To be honest it is very hard to accept when they turn up and tell you what you’ve got. It’s like a cardboard shutter coming down.’
Do you wonder when faced with this situation how you can help foster hope?
Remember that the deepest prison, sealed off from light and sound, cannot hold the human spirit if hope endures. It is a window to the wider world. It is the link to love.8
Are we as professionals bringing ‘spirituality and compassion’ to those living with cancer? Do we ‘bring hope and consolation to the end?’ Are we enabling people with cancer ‘to live until they die?’ Are we providing ‘good medical practice and humanity?’ as spoken by Dame Cicely Saunders in this BBC Radio 4 recording.
Does palliative rehabilitation have a place in cancer survivorship?
The term ‘palliative’ brings with it unfortunate connotations, which doesn’t do justice to the concept of palliative care. Palliation relieves a variety of distressing symptoms, but is not the sole prerogative of hospice carers. Palliative care should begin at diagnosis and be an integral part of the cancer journey,9 meaning that it could last from a few days to months and in some cases years.1 Palliative care is now starting to be recognised as an integral part of care delivered alongside cancer treatment services,10 consequently palliative rehabilitation is an appropriate inclusion within the Cancer Survivorship Agenda. (For an international perspective see http://jco.ascopubs.org/content/24/32/5166 and for research see http://www.wcrf.org/blog/tag/cancer-survivorship/ ).
To find out more…
The article to which this post relates, ‘Fostering hope through palliative rehabilitation’, by Caroline Belchamber, Mamood Gousy and Caroline Ellis-Hill, is published in the May/June 2013 edition of the European Journal of Palliative Care, (Vol. 20, no. 3).
If you already have a web-based subscription to the European Journal of Palliative Care you will be able to download this issue plus all articles in the journal archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.
- Hill D, Hart K, A. practical approach to nutritional support for patients with advanced cancer. International Journal of Palliative Nursing 2001; 7 (7): 317-321.
- Robinson D. The contribution of physiotherapy to palliative care, European Journal of Palliative Care 2000; 7 (3): 95-98.
- Michael K. A case for rehabilitation in palliative care. Rehabilitation Nursing; 2001.26 (3): 84 & 113.
- Belchamber CA, Gousy MH, Ellis-Hill C. Fostering a sense of hope through palliative rehabilitation. European Journal of Palliative Care 2013; 20 (3): 136 – 139.
- Belchamber C. Participant’s perception of Group work in the management of cancer symptoms in older people. Groupwork 2009; 19 (2): 79 – 100.
- Rankin J, Robb K, Murtagh N, Cooper J, Lewis S. Rehabilitation in cancer care. London: Wiley-Blackwell: 2008.
- Belchamber, CA, Gousy MH. Rehabilitative care in a specialist palliative day care centre: A study of patient’s perspectives. International Journal of Therapy and Rehabilitation 2004; 11 (9): 425-34.
- Brown PB, 1928. In Exley H. A special gift of hope and courage, Watford: Exley publications Ltd: 2003.
- Gillham L. Physiotherapy-palliative care, Physiotherapists in Oncology and Palliative Care 1992; 78: 3.
- Department of Health (DH). National Health Service (NHS) Cancer Plan. Executive summary, London: HMSO: 2000.