Authors (including presenting author) :
Chui PF(1), Cheung SF(1), Tsoi YN(1), So YC(1), Tsang PM(2), Ng CW(1), Leung KH(1), Chan KH(1), So CT(1)
Affiliation :
(1)Occupational Therapy,Princess Margaret Hospital
(2)Occupational Therapy, Poi Oi Hospital
Introduction :
In Hong Kong, around 90% of death happens in the hospital. However, the quality of death in Hong Kong ranked 22 in a list of 80 countries featured in the 2015 Quality of Death Index. To enhance the quality of service, the LKB multi-disciplinary team started to provide the End Of Life (EOL) program in early 2016.
EOL program has brought a specific concern to those patients who reach the last stage of life. Curing is not the majority. Facilitating a peaceful leaving, definitely, is a role shared by patients’ families. For our service provision, we're not only focusing on the patients. We empower families to be a vibrant role in the caring process as well.
Objectives :
This program aims at avoiding unnecessary physical, emotional or spiritual suffering of the patient, and emphasizing the patient’s dignity and quality of life. Occupational Therapist, being one of the team members, assists to provide symptomatic care and to facilitate dignified and peaceful closure of life for patients.
Methodology :
The potential case was screened by the medical officer. Less than 2-week life expectancy was an essential selection criterion. Thorough assessments on mental condition, self-care, level of respiratory distress and relatives interviews were performed before recruitment.
Result & Outcome :
190 in-patients were referred to OT for EOL service from April 2016 to September 2019. 144 cases died (76%) within 2 weeks upon recruitment. The average bed-day in the EOL program was 6. The number of female and male patients was 93 (65%) and 51 (35%) respectively. Their mean age was 83. The oldest one was aged 102 while the youngest one was 44. The mean length-of-stay in the EOL program was 6 days. The average number of OT attendance was 4.
The Glasgow Coma Scale was 7 which indicated severely impaired consciousness. The average modified Barthel Index score was 3. Palliative Performance Scale indicated 90% of this group of the patient was bed bound. Interpreting the Respiratory Distress Observation Scale, 47% of patients had no distress. 10% of them had mild distress. 29% of them had moderate level. 14% was suffered from severe distress. Our services are heightened. We enhanced autonomy in basic self-care and let this type of patient engage in active living through assistive devices and adaptive techniques in performing self-care activities. We educated them on various relaxation methods for Breathlessness Management. Patients acquired skills in energy conservation to achieve Fatigue Management also. Besides, for the patients with a low conscious state, we educated families to participate in grooming and oral hygiene, head and limb positioning for pressure relieving maneuvers. During their care, we encouraged releasing limbs or trunk holders. We loaned supporting cushions for postural support. In an appropriate situation, therapists guided families to do life reviewing and to accomplish their last wishes.
