THIS MONTH’S EDITOR’S CHOICE FROM PALLIATIVE MEDICINE . . .
Marc Sampedro Pilegaard is an occupational therapist at The Research Initiative for Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark. Mark has just submitted his PhD thesis evaluating the efficacy of an occupational therapy-based intervention in people with advanced cancer. Here, he explains more about the background for the most important article from his PhD thesis, which is the ‘Editor’s choice’ for the April 2018 issue of Palliative Medicine.
In Denmark, like other Western countries, people with advanced cancer increasingly want and are expected to manage their daily life at home (1). Still, research shows that they have difficulties performing everyday activities like cleaning, dressing and/or cooking (2, 3). This may interfere with their ability to manage daily life at home.
My study is part of a larger research project, the Activity, Cancer, and Quality of Life at Home project initiated in 2012 by Professor Karen la Cour and Associate Professor Åse Brandt.
Responding to a call for multidisciplinary palliative interventions, they obtained funding from the Danish Cancer Society and the TrygFonden for a mono-disciplinary occupational therapy project. The evidence for occupational therapy needed to be established in order to be able later to integrate occupational therapy with other health services in palliative care. My article reports the efficacy of the ‘Cancer Home-Life Intervention’ based on a fully powered randomised, controlled trial of a brief, tailored occupational therapy-based intervention developed as part of the project. The aim of the intervention was to support people with advanced cancer doing activities important for them and hence reap quality-of-life benefits from doing these activities. The core element of occupational therapy is to enable meaningful and/or purposeful activities, but meaningfulness differs from person to person as illustrated in this quote:
“I do know that it is important to vacuum, but to me, it really doesn’t mean that much.” (Participant, Mona, mother of two children).
We therefore provided individualised interventions comprising one to three home visits and one to three follow-up telephone contacts. The content and extent of the intervention differed from person to person.For instance, vacuuming was not a priority for Mona. She would rather do gardening, which was difficult for her because of fatigue and mobility limitations. This therefore became the main target of the intervention for Mona; the occupational therapists instructed her in compensatory strategies, such as using assistive devices to ease gardening and instructing her in ergonomic lifting techniques, among others. She received in total two home visits lasting 135 minutes and one follow-up telephone contact.
Overall, we found no effect of the intervention, but we gained valuable knowledge about developing and evaluating a complex intervention like ‘Cancer Home-Life Intervention’. We learned how important it is to test the intervention in a minor study before proceeding to a larger, more expensive trial.
- Although our study found no effect of the intervention, people with advanced cancer still have substantial problems with their daily life at home.
- People with advanced cancer may therefore still need and benefit from occupational therapy.
- Future studies should devote enough time to developing and feasibility testing the intervention.
1. Higginson IJ and Sen-Gupta GJA. Place of care in advanced cancer: a qualitative systematic Literature review of patient preferences. J Palliat Med 2000; 3(3): 287-300.
2. Rainbird K, Perkins J, Sanson-Fisher R et al. The needs of patients with advanced, incurable cancer. Br J Cancer 2009; 101(5): 759-764
3. Cheville AL, Troxel AB, Basford JR et al. Prevalence and treatment patterns of physical impairments in patients with metastatic breast cancer. J Clin Oncol 2008; 26(16): 2621-2629.
Read the full article in Palliative Medicine . . .
This post relates to a longer article,‘The ‘Cancer Home-Life Intervention: A randomised controlled trial evaluating the efficacy of an occupational therapy-based intervention in people with advanced cancer’, by Marc Sampedro Pilegaard, Karen la Cour, Lisa Gregersen Oestergaard, Anna Thit Johnsen, Line Lindahl-Jacobsen, Inger Højrisand Åse Brandt, published in Palliative Medicine, Vol 32 (4):744–756. Article first published January 4, 2018.
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