Assistive devices among people living at home with advanced cancer: Use, non-use and who have unmet needs for assistive devices?

OBJECTIVE: To investigate which assistive devices people with advanced cancer have and whether they are in use. In addition, to explore the characteristics of people with advanced cancer who have unmet needs for assistive devices. METHODS: This descriptive cross-sectional study used data from a randomised controlled trial evaluating efficacy of an occupational therapy-based intervention. Participants were 237 people with advanced cancer. Data were collected by means of instruments about demography, functioning and assistive devices. RESULTS: The most frequent assistive devices possessed by the participants were as follows: (1) small aids for dressing (47%), (2) Pillow for positioning (40%) and (3) electrically operated adjustable bed (39%). The prevalence of assistive devices was 92% (95% confidence interval [CI]: 88%-95%) with 14.2% non-use, largest for trolley tables (50%). In all, 27.4% of the participants were found to have unmet needs for assistive devices. These participants had similar characteristics to the other participants except from lower activity of daily living (ADL) ability (p values = <0.001). CONCLUSION: The assistive devices possessed by the participants were primarily for positioning and resting, and most were in use. More than a fourth of the participants had unmet needs for assistive devices and were characterised by lower ADL ability.

The development of the 'Cancer Home-Life Intervention': An occupational therapy-based intervention programme for people with advanced cancer living at home.

BACKGROUND: Occupational therapy-based interventions may help people with advanced cancer to live actively despite their illness. However, there is limited evidence concerning what kinds of content intervention should encompass, and how this should be done. OBJECTIVE: To describe the development and content of an occupational therapy-based intervention programme for people with advanced cancer living at home. MATERIAL AND METHODS: In the development of the intervention, an evidence synthesis was performed based on a systematic literature search, data from a cross-sectional study, and experiences from an expert panel. RESULTS: The programme contains six components: 1) An initial interview to select which of the other five components to address, based on the participants' individual needs. The interview addressed problems and needs of participants in relation to prioritized activities, in order to tailor the following components: 2) prioritisation of resources, energy and everyday activities; 3) adaptation of activities; 4) adaptation of posture and seating; 5) provision of assistive technology; and, 6) modification of the physical home environment. CONCLUSION: An occupational therapy-based intervention programme for people with advanced cancer living at home has been developed. The study generates knowledge and insights relevant to improving the treatment of this patient group.

Process evaluation of the Cancer Home-Life Intervention: What can we learn from it for future intervention studies?

BACKGROUND: The Cancer Home-Life Intervention showed no significant effects, and examination of the processes affecting or inhibiting outcomes is relevant. AIM: To evaluate the Cancer Home-Life Intervention for its processes of implementation, mechanisms of impact and contextual factors. DESIGN: Process evaluation conducted alongside the randomised controlled trial, using quantitative and qualitative methods (ClinicalTrials.gov NCT02356627). The Cancer Home-Life Intervention is a tailored, occupational therapy-based programme. SETTING/PARTICIPANTS: This study took place in participants' homes and at hospital. A total of 113 home-dwelling adults (⩾18 years) with advanced cancer who had received the Cancer Home-Life Intervention were included, together with five intervention-therapists. RESULTS: All 113 participants (100%) received a first home visit; 32 participants (26%) received a second visit; and 4 participants (3%) received a third visit. Median number of delivered intervention components were 3 (interquartile range: 2; 4). Identified barriers for effect included unclear decision process for intervention dosage; participants' low expectations; participants' lack of energy; and insufficient time to adopt new strategies. The trial design constituted a barrier as the intervention could only be provided within a specific short period of time and not when relevant. Intervention components working to solve practical everyday problems, enhance enjoyment and increase a sense of safety were perceived as useful. CONCLUSION: Future interventions can benefit from inclusion criteria closely related to the intervention focus and clear procedures for when to continue, follow-up and terminate intervention. Decisions about dose and timing may benefit from learning theory by taking into account the time and practice needed to acquire new skills.

Everyday activities when living at home with advanced cancer: A cross-sectional study.

OBJECTIVE: This study aimed at exploring everyday activities of people with advanced cancer living at home: which everyday activities they perform; perceived and observed quality of performance of self-care and household activities; which activities they would like to be able to perform; and determine any gender differences. METHODS: Outpatients (n = 164) with advanced cancer were recruited from Danish oncology units. Data were based on medical hospital records, standardised questionnaires, a 1-day diary, standardised interviews and standardised observations. All data were subject to descriptive and statistical analyses. RESULTS: More than 95% of the study sample was classified in ECOG performance status 1 and 2. Compared to population-based norms, the participants reported lower levels of global health and quality of life, as well as lower physical and role functioning. Across gender, participants spent the majority of the day involved in self-care and leisure activities. They reported to perform self-care independently without risk, although 60% reported problems with mobility. While heavy household activities were reported as most problematic, participants prioritised support to engage in more active leisure and social activities. CONCLUSION: People with advanced cancer experience problems related to performance of and engagement in everyday activities indicating a need for palliative rehabilitation services.

Impact of pain, fatigue and dyspnoea on occupational performance in people with advanced cancer: A longitudinal study.

Background: Pain, fatigue and dyspnoea are symptoms commonly experienced by people with advanced cancer, which may impact on their occupational performance. It is not known whether these symptoms impact their occupational performance over time.Objective: To examine correlation between pain, fatigue and dyspnoea and occupational performance and the impact of such symptoms on occupational performance over time in people with advanced cancer.Material and Methods: A longitudinal study was conducted including 242 participants assessed at baseline and after six and 12 weeks. Spearman's rank-order test and mixed linear models were performed.Results: The correlation between pain, fatigue and dyspnoea and occupational performance at baseline spanned from trivial to moderate (Spearman's rho: -0.004 to 0.34). Only pain had a statistically significant impact on activities of daily living (ADL) motor ability over time (p = 0.01). Participants with no pain problems had the largest decrease in ADL motor ability (-0.24 logits (95%-CI: -0.37 to -0.12)), but the observed decrease was not clinically relevant (≥-0.30).Conclusion: Pain, fatigue and dyspnoea did not seem to highly correlate with occupational performance or impact occupational performance over time of people with advanced cancer.

Subgroup effects of occupational therapy-based intervention for people with advanced cancer.

Background: Many people with advanced cancer have decreased ability to perform activities of daily living (ADL). We recently performed a randomized, controlled trial (RCT) assessing the efficacy of an occupational therapy-based program, the 'Cancer Home-Life Intervention' in people with advanced cancer (N = 242) and found no overall effects on ADL ability. However, heterogeneity of treatment effect may disguise subgroup differences.Objective: To investigate whether subgroups of people with advanced cancer gain positive effects from the 'Cancer Home-Life Intervention' on ADL ability.Material and method: An exploratory subgroup analysis including 191 participants from a RCT. The outcome was ADL motor ability measured by the Assessment of Motor and Process Skills (AMPS). Subgroups were defined by age, gender, years of education, type of primary tumor, functional level, and activity problems.Results: The 'Cancer Home-Life Intervention' had no statistically significant effect in the six subgroups. Modifying effects of age (0.30 [95% CI: -0.05 to 0.64]) and gender (0.23 [95% CI: -0.11 to 0.57]) were not found.Conclusion: There were no subgroup effects of the 'Cancer Home-Life Intervention'on ADL motor ability. Some indications suggest greater effects for those aged below 69 years; however, this result should be interpreted with caution.

The Association between ADL Ability and Quality of Life among People with Advanced Cancer.

BACKGROUND: Occupational therapy and occupational science are founded on the theoretical core assumption that occupation and quality of life (QoL) are closely related. However, such theoretical core assumptions must be supported through empirically based research. OBJECTIVE: To investigate the association between QoL and occupation, here self-reported and observed ADL abilities as a part of occupation, among people with advanced cancer, including determining whether self-reported or observed ADL ability had the stronger association with QoL. METHODS: The study was nested in a cross-sectional study. The association between ADL ability and QoL among 108 people with advanced cancer was investigated using the ADL Interview (ADL-I), the Assessment of Motor and Process Skills (AMPS), and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-C30). RESULTS AND CONCLUSIONS: Results showed that high observed ADL motor ability was associated with high QoL. In contrast, observed ADL process ability and self-reported ADL ability were not significantly associated with QoL. Oppositely expected, observed ADL ability had a stronger association with QoL than self-reported ADL ability. Thereby, the study to some extent contributes knowledge confirming the theoretical core assumptions about the relation between occupation, here performance of ADL, and QoL.

The association between having assistive devices and activities of daily living ability and health-related quality of life: An exploratory cross-sectional study among people with advanced cancer.

OBJECTIVE: To explore whether people with advanced cancer who had assistive devices had higher or lower ADL ability and/or HRQoL than people with advanced cancer who did not have assistive devices. METHODS: A cross-sectional study of 164 participants with advanced cancer. Self-reported ADL ability and HRQoL were assessed using the ADL-Interview and the EORTC QLQ-C30. Data regarding assistive devices were collected using a study-specific questionnaire. Data were analysed using multiple linear regression. The regression coefficients (B) were presented in crude form and adjusted for potential confounding variables (age, gender, cohabiting, receiving help, physical functioning, fatigue and pain). p-Values (p) < 0.05 were considered statistically significant. RESULTS: Having assistive devices was associated with lower ADL ability (B = -0.923, p = <0.0001), but this association was not significant after adjustment where it was found that physical functioning was a confounder positively associated with ADL ability (B = 0.030, p = <0.0001). No significant association was found between having assistive devices and HRQoL. Both fatigue (B = -0.336, p = <0.0001) and pain (B = -0.124, p = 0.010) were negatively associated with HRQoL. CONCLUSION: The participants had the same ADL ability and HRQoL regardless of them having assistive devices. Interventions addressing physical functioning or fatigue and pain might contribute to enhancing ADL ability and HRQoL among people with advanced cancer.

The 'Cancer Home-Life Intervention': A randomised controlled trial evaluating the efficacy of an occupational therapy-based intervention in people with advanced cancer.

BACKGROUND: People with advanced cancer face difficulties with their everyday activities at home that may reduce their health-related quality of life. To address these difficulties, we developed the 'Cancer Home-Life Intervention'. AIM: To evaluate the efficacy of the 'Cancer Home Life-Intervention' compared with usual care with regard to patients' performance of, and participation in, everyday activities, and their health-related quality of life. DESIGN AND INTERVENTION: A randomised controlled trial ( ClinicalTrials.gov NCT02356627). The 'Cancer Home-Life Intervention' is a brief, tailored, occupational therapy-based and adaptive programme for people with advanced cancer targeting the performance of their prioritised everyday activities. SETTING/PARTICIPANTS: Home-living adults diagnosed with advanced cancer experiencing functional limitations were recruited from two Danish hospitals. They were assessed at baseline, and at 6 and 12 weeks of follow-up. The primary outcome was activities of daily living motor ability. Secondary outcomes were activities of daily living process ability, difficulty performing prioritised everyday activities, participation restrictions and health-related quality of life. RESULTS: A total of 242 participants were randomised either to the intervention group ( n = 121) or the control group ( n = 121). No effect was found on the primary outcome (between-group mean change: -0.04 logits (95% confidence interval: -0.23 to 0.15); p = 0.69). Nor was any effect on the secondary outcomes observed. CONCLUSION: In most cases, the 'Cancer Home-Life Intervention' was delivered through only one home visit and one follow-up telephone contact, which not was effective in maintaining or improving participants' everyday activities and health-related quality of life. Future research should pay even more attention to intervention development and feasibility testing.

Managing occupations in everyday life for people with advanced cancer living at home.

BACKGROUND: People with advanced cancer are able to live for extended periods of time. Advanced cancer can cause functional limitations influencing the ability to manage occupations. Although studies have shown that people with advanced cancer experience occupational difficulties, there is only limited research that specifically explores how these occupational difficulties are managed. OBJECTIVE: To describe and explore how people with advanced cancer manage occupations when living at home. MATERIAL AND METHODS: A sub-sample of 73 participants from a larger occupational therapy project took part in the study. The participants were consecutively recruited from a Danish university hospital. Qualitative interviews were performed at the homes of the participants. Content analysis was applied to the data. RESULTS: Managing occupations were manifested in two main categories; (1) Conditions influencing occupations in everyday life and (2) Self-developed strategies to manage occupations. SIGNIFICANCE: The findings suggest that people with advanced cancer should be supported to a greater extent in finding ways to manage familiar as well as new and more personally meaningful occupations to enhance quality of life.