Authors (including presenting author) :
Wang YX(1), Leung WY(1), Cheng OY(1), JAO CY (1), Wu A(1)
Affiliation :
Occupational Therapy Department, Caritas Medical Centre
Introduction :
Breathlessness is one of the most common and distress symptoms in advanced cancer patients. Patients suffering from refractory breathlessness experience marked activity limitation, which causes functional deterioration and requires repeated hospital admission. Both patients and their caregivers have increased physical and psychological burden and reduced quality of life. International evidence shows positive effect of non-pharmacological treatment in breathlessness for advanced cancer patients. Multidisciplinary breathlessness day service is developed locally in recent years and Occupational Therapy is an essential component. However, there remains doubts about whether this kind of program is feasible and beneficial for in-patients in a palliative care unit (PCU) at end of life.
Objectives :
1. To explore the feasibility and effectiveness of an in-patient Occupational Therapy based multidisciplinary breathlessness management program for advanced cancer patients in PCU.
2. To explore symptom specific outcome measurement feasible for in-patients with advanced disease.
3. To enhance Occupational Therapy service in program-based symptom management in PCU in Caritas Medical Centre (CMC).
Methodology :
A personalized in-patient Occupational Therapy based multidisciplinary breathlessness management program were piloted in PCU in CMC. Occupational therapists screened the eligibility of patients who fulfilled the inclusion criteria and did not violate the exclusion criteria. Activities of daily living (ADL) performance and breathlessness severity were measured by Modified Barthel Index (MBI) and Barthel Index-dyspnea (BI-d) respectively, in initial assessment and pre-discharge phase. BI-d was employed to identify patients’ self-perceived breathlessness when performing core ADL tasks. Addressing patients’ unique distress, personalized action plan and individualized strategies for breathlessness management were provided to maximize patients’ self-care function and participation. Wilcoxon signed-rank test was used to compare patients’ outcome measurements.
Result & Outcome :
Ten patients admitted to PCU were recruited into the program between Jan 2021 and Oct 2021. Although low functional status, BI-d was feasible to be conducted and facilitated patient to expressing their breathlessness level when performing basic ADL tasks. Significant improvement in ADL was shown when compared the pre-discharge MBI total score with the initial score (Z = -2.032, p<0.05). Meanwhile, patients experience less breathlessness when performing the ADL tasks, significant change in lowering BI-d scores (Z = -2.803, p=0.005) was shown. Although the small sample size, the results demonstrated an Occupational Therapy based multidisciplinary breathlessness management program could help improving patient’s ADL function, reduce distress of breathlessness, enable return home respecting patients’ wishes for advanced cancer patients in PCU.
