A 73-year-old woman with a diagnosis of lung cancer is experiencing increased breathlessness, anxiety and fatigue. She lives with her husband in a two-storey house. She is admitted to the palliative care unit for symptom management.
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1. How did the occupational therapist (OT) assess and identify the primary intervention goals for the patient?
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Correct answer:
Using sensitive and supportive communication skills, combined with relevant formal assessment (e.g. Assessment of Quality of Life at the End of Life (AQEL) and Australian Therapy Outcome Measures for Occupational Therapy (AusToms)), the OT assessed the impact of symptoms on occupational performance, participation and quality of life. Use of a standardised goal setting tool (e.g. Canadian Occupational Performance Measure (COPM)) ensured that goals set were realistic and achievable in the context of a life-limiting disease. Multidisciplinary team liaison supported a patient-centred and coordinated approach.
Patient goals identified were
- To shower independently without feeling breathless and fatigued.
- To function with greater ease and confidence in the home environment.
- To re-engage in the meaningful activity of baking.
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2.What non-pharmacological interventions did the OT implement to address the symptoms of breathlessness and fatigue with this patient?
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Correct answer:
Education and practical advice was provided on the principles of fatigue and breathlessness management including energy conservation (planning, prioritising and pacing). Breathing techniques were applied to functional performance in activities of daily living, and relaxation methods were introduced for anxiety management. Using these principles, the activity of showering was analysed and broken down into achievable steps. Assistive equipment (shower stool and long-handled sponge) was provided to minimise effort, reduce symptom burden and enhance the patient’s overall confidence during showering.
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3. How did the OT address the patient’s home environment to facilitate a safe and successful discharge?
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Correct answer:
A home safety assessment was completed. Recommendations were agreed including the provision of assistive equipment (e.g. shower stool, stair rail and grab rails) to enhance functional independence and safety and to increase confidence. Carer education was provided to promote mutual support and assistance in the practical application of breathlessness and fatigue management principles in the home environment. Liaison with community healthcare professionals supported on-going coordinated patient care.
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4. How did the OT enable the patient to re-engage in the meaningful activity of baking?
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Correct answer:
The OT explored the activity, its associated meaning for the patient and identified the barriers and enablers to engagement. Practical therapeutic sessions were held to facilitate on-going engagement, enhance functional ability and the application of symptom management principles.
