Dying changes everything. The effect that working with terminally ill patients has on physical therapists (PT) and the expanding involvement of PTs as hospice care providers is the subject of this special investigation in the January special issue of Rehabilitation Oncology.
“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, in a media release from Wolters Kluwer Health: Lippincott Williams and Wilkins.
Simulating End-of-life for Learning
The special issue includes an original research paper that 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.
Enlighten View of Dignity and Respect
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, the release explains
“There is significant evidence demonstrating the unpreparedness of health care professionals in caring for the dying patient,” 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.”
Value of PT for Terminal Patients Still Debated
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, per the release.
“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.”
[Source(s): Wolters Kluwer Health: Lippincott Williams and Wilkins, Newswise]