Exploring the role of palliative care occupational therapists in supporting compassionate communities in end-of-life care.

INTRODUCTION: The compassionate communities' movement is a public health approach to end-of-life care that emphasises the integral role of communities in supporting and caring for dying persons and their informal carers. Although occupational therapists have well-established roles in palliative care teams, little is known about their potential in assisting in the formation and maintenance of compassionate communities. METHOD: Data were gathered via semi-structured interviews with nine Australian occupational therapists with experience in specialist palliative care. Interview questions were based around the British Columbia Compassionate Community Ideal framework. Key themes were derived through qualitative descriptive analysis, blending deductive, and inductive reasoning. FINDINGS: Interviewees indicated that occupational therapists have a role in supporting compassionate communities that centres on the facilitation of networks and connections between palliative care professionals and in the promotion of informal care networks. The importance of education and awareness raising were also discussed as valuable to the development of community capacity. It was also suggested that occupational therapists have important skills to support dying persons and their caregivers to remain engaged and safe in their homes and communities, in a meaningful and sustainable way. However, many interviewees maintained a profession-centric view on control within compassionate communities, as opposed to approaches that are community led. CONCLUSION: Findings offer early insights into the promise and potential of occupational therapists in supporting the compassionate communities' movement. However, education regarding the ethos of the compassionate communities' movement so as to facilitate a shift away from professionally oriented modes of practice may be needed to maximise success.

Identifying Facilitators of and Barriers to Referrals to Occupational Therapy Services by Israeli Cancer Health Care Professionals: A Qualitative Study.

IMPORTANCE: Persons living with and beyond cancer (PLWBC) are rarely referred to occupational therapy services despite their functional difficulties. An understanding of the barriers to and facilitators of occupational therapy referrals from the perspective of cancer health care professionals could help minimize referral gaps. OBJECTIVE: To explore cancer health care professionals' perspectives on and knowledge of occupational therapy's role in cancer care, identify the barriers, and explore solutions to optimize referrals. DESIGN: Multiexplanatory qualitative case study. SETTING: Community and hospital cancer clinics in Israel. PARTICIPANTS: Six in-person focus groups of cancer care Israeli nurses and social workers, totaling 28 participants. RESULTS: Two main themes were identified: (1) barriers to occupational therapy referrals and (2) partial facilitators of occupational therapy referrals. The four barriers subthemes were (1) gaps in knowledge about symptoms' effects on daily functioning, (2) gaps in knowledge regarding occupational therapy's role in cancer care, (3) bureaucratic and organizational barriers, and (4) unavailability of occupational therapy services. The two facilitators subthemes were (1) collaborations and communication with occupational therapists and (2) awareness of occupational therapy services. Participants suggested practical solutions for improving occupational therapy referrals, interdisciplinary collaboration and communication, and integrating occupational therapy into cancer care. CONCLUSIONS AND RELEVANCE: Barriers to referrals included gaps in participants' knowledge that link side effects to functional difficulties indicating a need for referral to occupational therapy. Participants' suggestions to bolster referrals can be implemented by occupational therapists to reduce patients' unmet needs and bridge existing gaps in cancer care. Plain-Language Summary: This research helped to identify barriers and facilitators regarding insufficient knowledge about occupational therapy's role in cancer care and adds a better understanding of gaps in referrals to occupational therapy. In addition, cancer health care professionals who participated in the study suggested practical solutions for reducing barriers and maximizing support for referral. With these nuances, occupational therapy practitioners can work with medical cancer care units (i.e., acute care hospitals, medical cancer centers, and community health care clinics) to target the use of strategies that work for their units to ensure that persons living with and beyond cancer receive needed occupational therapy services.

Occupational adaptation for adults living with advanced cancer: A phenomenological longitudinal study.

INTRODUCTION: People living with advanced cancer want to continue participating in their valued occupations amid cancer progression. However, increasing dependence and bodily deterioration challenge a person's ability to do so, thus requiring adaptation to how they engage in their occupations. Theoretical frameworks on the process of occupational adaptation often do not address the implications of progressive functional decline. METHODS: A longitudinal phenomenological design was used to understand the lived experience of occupational engagement for working-aged adults living with advanced cancer. A semi-structured interview series explored participants' experience of occupational engagement and how this changed over time. Data were analysed thematically and mapped against the Model of Human Occupation (MOHO). FINDINGS: Eight adults (40-64 years old) participated in 33 interviews over 19 months. Three themes were constructed from the data: ongoing adaptation through doing, the significance of volition in adaptation, and everyday life is contingent on my environment. Study findings demonstrate that the process of adaptation occurs through occupational engagement, is motivated by volition, and is affected by the environment. Volition and the environment play a more central role in occupational adaptation than occupational competency for the advanced cancer cohort. CONCLUSION: Study findings further MOHO's theoretical conceptualisation of occupational adaptation by identifying the centrality of volition and the environment in the process of adaptation. For people living with advanced cancer, disease progression results in unremitting functional decline, thus rendering competency an unstable and untenable construct. Rather, this paper argues that occupational adaptation is facilitated by volition (i.e., the motivation behind the doing) and the environment, thus fostering a sense of identity and meaning at the end of life. Occupational therapists' awareness of the significance of volition and the environment can thus foster continued occupational engagement and meaning at the end of life for people living with advanced cancer.

Visual Dysfunction and Occupational Performance in Persons With Parkinson's Disease.

IMPORTANCE: Visual function is critical to support occupational performance for persons with Parkinson's disease (PwP), yet it can be adversely affected by the disease. OBJECTIVE: To evaluate the prevalence and general awareness of visual dysfunction and identify the association between visual dysfunction and occupational performance in PwP. DESIGN: Self-reported cross-sectional electronic survey. PARTICIPANTS: PwP, identified from a registered database at a neurological institute, were invited to complete the survey through emails and newsletters. OUTCOMES AND MEASURES: The survey contained items of self-reported visual difficulties, diagnosed eye conditions, and about general awareness about disease-related visual dysfunction. Ophthalmological symptoms and occupational performance were measured with the Visual Impairment Parkinson's disease Questionnaire and the Revised Self-Reported Functional Visual Performance Scale, respectively. RESULTS: Data from PwP (n = 92; Mage = 69 yr) were analyzed. Nearly half were unaware that their disease could affect vision. Awareness was not associated with disease duration. Individuals reporting awareness tended to report difficulties with vision. Functional activities requiring vision were mildly impaired, and the frequency of ophthalmologic symptoms (commonly related to ocular surface disorder) was low. Nevertheless, a higher frequency of ophthalmologic symptoms was positively associated with a higher degree of disability in activities of daily living (Spearman's ρ = .49, p < .01). CONCLUSIONS AND RELEVANCE: Visual dysfunction related to Parkinson's disease may affect occupational performance. Screening for changes in vision in these individuals may aid occupational therapists in addressing functional independence and activity engagement. What This Article Adds: People with Parkinson's disease may not have a general awareness that the disease can adversely affect visual function. Those individuals with awareness tend to notice changes in vision, and this disease-related visual dysfunction may limit engagement and participation in everyday activities. Active evaluation of visual function in people with Parkinson's disease is recommended. Occupational therapists could play a key role by screening for visual dysfunction and providing patient education in the clinic.

Telehealth Utilization Among Occupational Therapists in Oncology: Results From a National Survey.

While the COVID-19 pandemic introduced wide expansion of telehealth access in health care, evidence concerning telehealth use in occupational therapy (OT) for cancer survivors remains limited. The objective of this study was to identify the prevalence and perceptions of telehealth services among occupational therapy practitioners (OTPs) in oncology. Descriptive statistics and qualitative content analysis were used to analyze data from a pre-pandemic national survey of OTPs (n = 126) focusing on telehealth. Most OTPs in oncology settings support telehealth use, despite a dearth of access prior to the pandemic. The highest levels of telehealth endorsement among OTPs related to ease of accessibility (48%). Treatments rated as best suited for OT oncology telehealth sessions included education (41%), quality of life/well-being/lifestyle (21%), and psychosocial interventions (19%). These data suggest widespread benefits of telehealth-delivered OT treatment in oncology. Advocacy is needed to ensure the continuation of legislation allowing expanded telehealth access and reimbursement for OT.

Occupational therapy's contributions to combating climate change and lifestyle diseases.

BACKGROUND: The interdependence between human occupations, lifestyle diseases and climate change provides an opportunity to address them simultaneously. Occupational therapists' training in lifestyle modification and knowledge about the impact of the physical environment on daily occupations puts them in a unique position to contribute to global efforts of combating climate change and lifestyle diseases through the promotion of sustainable occupations. AIM: To illustrate how occupational therapists can contribute to global efforts of combating climate change and lifestyle diseases by framing climate change from a personal and public health perspective. METHOD: In this discussion paper we argue that occupational therapists can use education and lifestyle modification to support individuals in the prevention and management of lifestyle diseases and that they can help design and advocate for environments that promote sustainable occupations. RESULT: This discussion paper highlights the contributions that occupational therapists can make to how we understand and address climate change and lifestyle diseases. CONCLUSIONS AND SIGNIFICANCE: We argue that by framing the climate change discourse from a health perspective, occupational therapists can contribute to global efforts of combating climate change and lifestyle diseases by supporting individuals to engage in sustainable occupations and communities to facilitate this engagement.

Wheelchair-mounted robotic arms: a survey of occupational therapists' practices and perspectives.

PURPOSE: Despite the benefits of wheelchair-mounted robotic arms (WMRAs), occupational therapists are not yet widely involved in the recommendation or implementation of these assistive devices. The purpose of this study was to investigate and compare the current practices and perspectives of occupational therapists who had and had not recommended a WMRA on the recommendation, training, and implementation of WMRAs. METHODS: This was a descriptive cross-sectional study. An online survey was sent to Canadian, European, and American occupational therapists who had or had not worked with WMRAs. Respondents were asked close-ended questions about their experience, role, barriers, motivations, and future needs regarding WMRAs. We compared results between respondents who had and had not recommended WMRAs using descriptive statistics. RESULTS: Ninety-three North American and European occupational therapists completed the survey. Of those, 29 (31.2%) had recommended a WMRA, mostly the JACO robotic arm (n = 26, 89.7%) in rehabilitation centres (n = 18, 62.1%). Their perspectives on their role and barriers related to WMRAs were similar to those who had never recommended a WMRA. All respondents recognised the relevance of occupational therapists' contribution, and most reported interest in WMRAs (n = 76, 81.7%). However, many barriers emerged, mainly related to limited funding (n = 49, 76.6%), lack of training and knowledge (n = 38, 59.4%), and resource constraints (n = 37, 54.4%). Future needs identified matched these barriers. CONCLUSION: This survey provides novel insight into occupational therapists' perspectives on WMRAs. It highlights that health professionals need to have easier access to funding, formal training, and resources to support their involvement with WMRAs.Implications for rehabilitationMost occupational therapists are interested in working with WMRAs, considering the potential of these devices to support individuals with upper extremity impairments in their daily activities. They also recognise their unique contribution to the assessment, recommendation, and implementation process among multidisciplinary teams.WMRA recommendation is relevant in various clinical settings and with a wide range of client populations. Nevertheless, it appears that occupational therapists working with adults, in rehabilitation centres or specialised clinics, may have more opportunities to get involved in this process and to attend formal training on this technology, as compared to other settings.Many barriers remain, impeding occupational therapists' role in the recommendation and implementation of WMRAs. Addressing these barriers may increase the number of devices that are successfully adopted and utilised by individuals with upper extremity impairments. In particular, future research and health policies should focus on access to sufficient funding, formal training, and resources for occupational therapists relative to their role in recommending and implementing WMRAs.

Using activity-based therapy for individuals with spinal cord injury or disease: Interviews with physical and occupational therapists in rehabilitation hospitals.

OBJECTIVE: To understand if and how physical therapists (PTs) and occupational therapists (OTs) use activity-based therapy (ABT) and its associated technologies for the rehabilitation of individuals living with spinal cord injury or disease (SCI/D) in Canadian rehabilitation hospital settings. DESIGN: Qualitative study. SETTING: Through rehabilitation hospitals participating in the Rick Hansen Spinal Cord Injury Registry, we recruited licensed OTs and PTs to participate in focus groups. PARTICIPANTS: Twelve PTs and ten OTs from nine sites across eight provinces participated. OUTCOME MEASURES: To inform the development of a semi-structured interview guide, we used the Theoretical Domains Framework. To analyze the data, we used interpretive description. RESULTS: We identified three themes that influenced therapists' use of ABT and associated technologies for SCI/D rehabilitation. (1) Therapists' decision-making approach to ABT and technology. Therapist roles, site-specific dynamics and goal setting influenced decision-making. Assuming roles such as mentor, liaison and advocate led to more ABT use. Site-specific dynamics concerned levels of ABT knowledge, teamwork, and staffing. In hospital rehabilitation, there was competition between discharge and neurorecovery goals. (2) Therapist perceived individual factors. Patient factors either increased (i.e. patients' motivation, self-advocacy) or prevented (i.e. mourning period, tolerance) the likelihood that ABT was introduced by therapists. (3) ABT and equipment access. Technology was used for ABT in a variety of ways. Access was affected by visible (e.g. equipment cost) and invisible barriers (e.g. departmental relations). CONCLUSIONS: The use of ABT and its associated technologies in Canadian rehabilitation hospitals is variable. Ongoing education could be offered, and site-specific implementation strategies could be developed, to promote ABT use.

Occupational therapy for people with Parkinson's disease in Israel: A SWOT analysis.

BACKGROUND: Despite the important role that occupational therapy (OT) plays in management of Parkinson's disease (PD), few patients with PD in Israel seek such treatment. AIMS: To capture the opinions of internal and external (to the profession) informants regarding OT's role in the management of PD, to identify factors that may affect the utilization of OT, and to identify potential strategies for promoting such use. MATERIAL AND METHODS: Fifty-two occupational therapists and nine neurologists who specialize in movement disorders completed online questionnaires containing both closed and open-ended questions. An analysis of strengths, weaknesses, opportunities, and threats (SWOT) was performed on the responses, and text analyses were performed on the responses to the open-ended questions. RESULTS: Identified strengths included respondents' self-confidence in treating patients with PD, and collaboration with multidisciplinary teams. Weaknesses included lack of specific training, low frequency of seeing patients with PD, overlapping treatment objectives with other healthcare professions, and lack of familiarity with guidelines. Patients' and physicians' limited acquaintance with OT, and referral rates were acknowledged as both opportunities and threats. CONCLUSIONS/SIGNIFICANCE: Strategies for promoting the use of OT among Parkinson's patients include specific training and increased awareness of OT for referring physician and patients.

Understanding home modification outcomes from the perspective of older people and people with a disability: informing home modification evaluation.

PURPOSE: There is limited evidence to guide therapists in home modification outcome evaluation. Involving consumers in evaluating home modifications is critical to progressing practice. This study investigated the home modification experience and outcomes most valued by older adults and individuals with a disability in Australia. MATERIALS AND METHODS: An interpretive description approach was used. Twenty participants aged 24-93 who had received major home modifications were interviewed and transcripts were analysed thematically. RESULTS: Two major themes emerged: life before and during modifications - "it was all hard," and life after modifications - "to have a life." People's prior experience of home, the circumstance of and time to plan modifications, the perceived value of the modifications, and the home modification process and funding influenced perceptions of outcomes. Valued home modification outcomes included those that enable people to experience emotional and physical health, and safety; do what they want; maintain the image of the home; and plan for the future. Experiences and perceptions of modifications ranged from supportive to disruptive. CONCLUSIONS: These findings point to the need for therapists to deeply understand and evaluate their clients' experiences of home and life as an initial and critical step in the home modification process.Implications for rehabilitationMajor home modifications result in broad and meaningful outcomes of importance to clients.Occupational therapists need to partner with clients to understand their life before and during modifications to achieve positive outcomes.Evaluation of major home modifications needs to be integrated and prioritised in daily practice.

Research capacity and culture in an Australian metropolitan public mental health service: scoping the skills and experience of social workers and occupational therapists.

BACKGROUND: Investment in a clinical research culture appears to be associated with benefits for consumers, staff, and overall organisational performance. The validated 55-item Research Capacity and Culture (RCC) tool was developed specifically to gauge the research capacity and culture of health professionals and workplace settings within which they work. Results of some individual studies suggest that professional discipline and workplace setting may impact RCC results however it has never been used in a dedicated public mental health setting. Therefore, this study will explore the research capacity and culture of allied mental health clinicians (Part 1). Another aim is to explore potential connections between workplace settings, locations and disciplines based on published RCC-based data to help signpost potential impediments to service improvements (Part 2). METHODS: Part 1: An RCC-based online survey canvased Australian Social Workers and Occupational Therapists (n = 59) based in a metropolitan public mental health service. Non-parametric analyses explored links between research-related experience and participant characteristics. Part 2: Comparative analyses explored the potential influence of workplace settings and professional disciplines on published RCC results. RESULTS: Part 1: Overall, the research capacity and experiences of mental health Social Workers and Occupational Therapists seemed modest. Discipline was statistically associated with level of research-activity experience, weighted towards occupational therapy; demographic characteristics were not. Only two items in the RCC were rated high; many more items were rated low. Part 2: Published studies exploration found no link between RCC ratings and workplace location, setting, or professional discipline. Sampling biases and use of modified, non-validated RCC versions likely impacted the results. CONCLUSIONS: Allied mental health clinicians may not be sufficiently experienced, knowledgeable, or confident with a range of research-related activities given the emphasis on workforce research capability in policy and practice nowadays. This may be commonplace across health-based organisations. We recommend the systematic implementation of research training programs in (mental) health services, and a 'whole-of-service levels' approach be used i.e., transform policy, culture and leadership as well as provide practical resources with individual training. Potential benefits include a positive impact on organisation functioning, clinicians' confidence and practice, and improved consumer outcomes.

Exploring Certified Hand Therapists roles in workplace injury prevention, treatment, rehabilitation, and collaboration with occupational safety professionals.

BACKGROUND: Certified Hand Therapy is a subset of occupational/physical therapy that is relatively unknown to the common individual. Certified Hand Therapists (CHTs) help those with upper extremity injuries, whether it be those with workplace injuries, those who suffered a traumatic injury or those recovering from major surgery to reach the point where they are able to be independent and back to doing daily life activities. OBJECTIVE: This study aimed to discern the roles that Certified Hand Therapists have in rehabilitating individuals with upper extremity injuries, to assess their participation in work-related injury prevention, to examine with whom CHTs interact during the rehabilitation process, and to gain insight into how the relationships between CHTs and occupational safety professionals can be improved. METHODS: Structured interviews were conducted with eight occupational therapists who are Certified Hand Therapists or are in the process of being certified. Interviews were recorded, transcribed and analyzed to determine themes relative to the study objectives. RESULTS: Content analyses determined trends in job roles, interactions with occupational safety professionals, the importance of patient education in prevention and rehabilitation and barriers to effective treatment of work-related injuries. CONCLUSION: CHTs shared similar thoughts regarding their profession. CHTs revealed common themes in the eight interviews conducted. Specifically, many CHTs believe education is a vital part of the profession in terms of improving the profession and in the rehabilitation process. In addition, patient compliance and the current workers' compensation system were seen as challenges when rehabilitating patients.

Improving Resident Knowledge of Ergonomics Guidelines.

OBJECTIVE: To improve resident knowledge of ergonomics guidelines for surgery, vaginal deliveries and repairs, and documentation. PROJECT SUMMARY: We consulted with a licensed occupational therapist at our institution regarding our difficulties with maintaining proper ergonomics while operating, performing deliveries, and documenting. We conducted two separate sessions: one in the obstetrics workroom regarding techniques to improve the ergonomics of our documentation and one in the operating room and labor and delivery unit to address techniques to avoid injury and promote long-term wellness. The sessions were conducted during morning report at our institution, and the obstetrics and gynecology teams attended both sessions. The sessions were available by videoconference for the entire residency program. Handouts were created to present basic ergonomics guidelines and were provided at the conclusion of the sessions. The handouts summarized the information provided during the sessions and included recommendations for adjustments that could be made in the workroom, operating room, and delivery room. The sessions were conducted during ACOG Wellness Week. OUTCOME: Adjustments were made in the obstetric and gynecology team workrooms to improve ergonomic function. Sessions improved resident knowledge of ergonomics recommendations for vaginal deliveries. Recommendations included guidelines for arm and shoulder position, tucked chins, and appropriate bed height (sitting vs standing). Adjustments were made in the workroom to position the top of the monitor just below eye level and arm's length away, and chairs were adjusted so that the keyboard and mouse height were just below elbow height. Residents were encouraged to keep arms and wrists in a relaxed, neutral position and to sit all the way back in the chair with back supported and feet firmly on the floor. Residents improved their knowledge of ergonomics guidelines and increased awareness of posture and positioning both on the labor and delivery unit and in the operating room. RELEVANCE TO WOMENS HEALTH OR PHYSICIANS IN PRACTICE: Work-related musculoskeletal disorders are prevalent among surgeons and can have a significant effect on productivity and career longevity. If we are able to implement evidence-based guidelines developed by high-quality ergonomics research, we can potentially protect obstetricians and gynecologists from injury and improve overall wellness.

A systematic review of work-related interventions for breast cancer survivors: Potential contribution of occupational therapists.

BACKGROUND: A high number of breast cancer survivors need to resume work. Therefore, interventions aimed at effective work-related transitions are important. OBJECTIVE: A systematic review to determine what occupational therapy interventions are effective in work-related transitions of breast cancer survivors. METHODS: Multiple databases were searched for studies on work-related interventions within the scope of occupational therapy. Studies were included if 70% or more study participants were working age (> 18 years) breast cancer survivors, and work-related transition outcome measures were used. RESULTS: The search yielded 2 872 articles, of which 12 met the inclusion criteria. When classified according to the International Classification of Function Framework, quantitative sources focussed on Body Structures and Functions component and Multicomponents (consists of the Body Structures and Functions Component and the Activities Component) showed positive effects on improving the work-related transitions of BC survivors, however, the effects were statistically insignificant and the strength of evidence was moderate. Participants in a qualitative source reported that after they underwent a physical exercise programme their work performance improved. A Multicomponents intervention study showed statistically significant improvements on self-reported work-related outcomes of BC survivors. Low evidence was found for implementing a vocational rehabilitation case management programme targeting the Activities component, which showed positive effects in reducing the sick leave days of BC survivors, but the effects were statistically insignificant. No evidence was found for programmes focussed on restoring the Participation component. CONCLUSION: The evidence included in this systematic review were insufficient to recommend occupational therapy interventions that are effective (showing statistically significant improvements) for work-related transitions of BC cancer survivors.

Occupational Therapy Practice in Palliative and End-of-Life Care in Québec.

Background. There is an emerging evidence base about the scope of occupational therapy in palliative and end-of-life care, but little is known about this practice in Québec or barriers impeding it. Purpose. To describe Québec occupational therapists' practice in palliative and end-of-life care and barriers they encounter. Method. Using the Québec regulatory board members list, we invited occupational therapists working in palliative and end-of-life care to answer an online survey comprising 24 closed- and 5 open-ended questions. We analyzed data using descriptive statistics and content analysis. Findings. The 67 survey participants mainly optimized comfort and safety in meaningful occupations such as mobility, transfers, and hygiene. Barriers to their practice included organizational obstacles and unfamiliarity with their role. Implications. Findings highlight the need to improve education and awareness among occupational therapists and other healthcare professionals about the scope of what occupational therapists can do in palliative and end-of-life care.

The occupational impact of bowel cancer: Survivors' voices and advancing the role of occupational therapy assessment and intervention.

INTRODUCTION: The aim of this study was to investigate the occupational impact (i.e., how engagement in occupation is affected) of having had bowel cancer and the role of occupational therapy with bowel cancer survivors and their significant others. METHODS: Two rounds of semi-structured interviews were carried out with individuals who had completed treatment for bowel cancer, with interviews designed to gain insight into their occupational experiences post treatment. Thematic analysis was utilised to construct themes and patterns founded on the perceptions of participants. Analysis involved concurrent data collection and analysis, constant comparative analysis, and iterative analysis. FINDINGS: Eighteen participants were interviewed, with occupational impact evident across multiple aspects of everyday life. Four themes were identified: Changes in eating habits, changes in toileting habits, changes in relationships, and rethinking occupational choices. CONCLUSION: Findings of the occupational impact of having had bowel cancer reveal a possible role for occupational therapists with people affected by bowel cancer. Occupation focused assessments and self-management programmes are identified as a possible means of meeting the needs of this population, making use of the experiences of peers to provide a credible, relatable voice.

Project ECHO: Enhancing palliative care for primary care occupational therapists and physiotherapists in Ireland.

Project ECHO (Extension for Community Healthcare Outcomes) uses videoconferencing technology to support and train healthcare professionals (HCPs) remotely. A 4-month fortnightly ECHO programme was developed and implemented to enhance palliative care provision by primary care therapists. Teaching and case-based discussions were facilitated by palliative care specialists. A mixed-methods cohort study was used to evaluate the project. ECHO participants completed pre- and post-programme questionnaires regarding their knowledge and skills across key palliative care domains. Focus groups were held before programme commencement to explore participants' attitudes and experiences of palliative care and after programme conclusion to explore their experiences of ECHO. Twenty-six primary care HCPs commenced the ECHO programme. Mean scores in self-rated confidence in knowledge and skill improved significantly (p < .002) following the programme. Twenty-one primary care HCPs completed the post-ECHO surveys and scores of self-rated confidence in knowledge and skills were significantly higher than pre-ECHO scores. Ninety-five percent of participants (n = 19) reported ECHO met their learning needs and was an effective format to enhance clinical knowledge. Eighty-five percent of participants (n = 17) would recommend ECHO to their colleagues. Project ECHO improved palliative care knowledge and skills of primary care HCPs in Ireland, with potential to address the growing need for integrated palliative care services.

Occupational therapy in oncology palliative care for adolescents and young adults: Perspectives of Australian occupational therapists.

INTRODUCTION: Palliative Care Australia suggests current needs (emotional wellbeing, understanding of cancers impact on relationships, everyday activities, and life milestones) for adolescent and young adults in palliative care are unmet due to a lack of age-specific palliative care facilities in Australia. This includes the provision of occupational therapy that can impact these unmet needs. Although the occupational therapy role in palliative care has been documented, little is known about existing occupational therapy services or occupational needs for young people with palliative care needs. The aims of this study were to obtain occupational therapists insights of working with this population in Australia regarding (1) gaps in palliative care services for this population; (2) facilitators and challenges to providing occupational therapy for this group; and (3) perceived occupational needs of young people living with a life-limiting cancer diagnosis. METHODS: Using snowball sampling, an online survey was distributed to occupational therapists with experience working in palliative cancer care with adolescents and young adults. Available for 6 weeks, the survey included demographic, work history, and service delivery questions. Forced-choice questions were summarised descriptively, and content analysis was used to analyse free-text data. RESULTS: Eleven completed surveys were returned. Overall, therapists perceived current palliative care services for this population within Australia to be lacking. Two gaps emerged: age-appropriate facilities and gaps in provision of psycho-social and occupational therapy services. Funding, lack of knowledge of the occupational therapy role, and professional confidence were highlighted as challenges to practice. Main occupational needs related to maintenance of as "normal" a life as possible: maintaining occupational role engagement, continuing connection with others, and being heard regarding their occupational needs. CONCLUSION: Findings suggest a need for service changes, including custom-designed facilities, improved funding, training and mentoring, to support age-appropriate and occupation-focussed care for the young person in cancer-specific palliative care.

Clinicians' experiences of discontinuing routine hip precautions following total hip replacement surgery: a qualitative analysis.

PURPOSE: Hip precautions are routinely provided in the UK, despite evidence suggesting that they are no longer needed. A change in practice was introduced into an orthopaedic service whereby the provision of routine hip precautions was discontinued for selected individuals receiving a primary total hip replacement. The change involved implementing a new regime of "no precautions" which was facilitated using a number of key strategies. The aim of this study was to explore the experiences of clinicians associated with the change in practice. MATERIAL AND METHODS: Individual semi-structured interviews were conducted with clinicians who had experience of delivering both hip precautions and no hip precaution regimes. Data were analysed thematically. RESULTS: Ten orthopaedic staff (two senior occupational therapists, one occupational therapy support worker, three senior physiotherapists, two surgeons, and two senior nurses) were interviewed. Three main themes were identified: changes experienced, perceptions of the new regime, and challenges experienced. CONCLUSION: Several barriers and facilitators to the successful changeover were identified. Successful strategies in changing practice included assigning "Hip Champions", staff education and targeted training. It is proposed that holding multidisciplinary education and training would be the ideal model.Implications for rehabilitationKey strategies for changing practice were educating staff and providing targeted training.Multidisciplinary training might prevent discrepancies in the advice given to patients.Appointing "Hip Champions" provided clear role models and enabled new clinical behaviours to be enforced.

Occupational Therapists, Physiotherapists and Orthopaedic Surgeons Agree on the Decision for Carpal Tunnel Surgery.

BACKGROUND: Therapist-led pathways have been proposed as waitlist management strategies prior to surgery for conditions such as carpal tunnel syndrome (CTS) in public hospitals. These models of care typically shift the initial care of patients and decision-making from surgeons to therapists and, have been shown to reduce the number of patients requiring surgery and improve wait-times. This occurs despite limited evidence of surgeon-therapist agreement on key decisions, such as the need for surgery. The purpose of this was study was to assess the agreement between therapists and orthopaedic surgeons regarding the need for surgery for patients who have CTS. METHODS: This blinded inter-rated agreement study was embedded in a multicentre randomised parallel groups trial of 105 patients with CTS referred to four orthopaedic departments and waitlisted for an appointment. The trial evaluated the effect of a therapist-led care pathway on the need for surgery and outcomes related to symptoms and function. Patients were randomised to either remain on the orthopaedic waitlist or receive group education, a splint and home exercises. The decision on the need for surgery at 6 months was made by a member of the orthopaedic consultant team or by one of the 14 participating therapists. The therapists and surgeons were blinded to each other's decision. Agreement was determined using percentage agreement, kappa coefficients (k), prevalence-adjusted and bias-adjusted kappa (PABAK), and Gwet's first-order agreement coefficient (AC1). RESULTS: Substantial agreement was seen between therapists and surgeons regarding the need for surgery (PABAK=0.74 (0.60-0.88)). Agreement was significantly associated with experience (P=.02). Therapists with advanced experience and scope of practice demonstrated perfect agreement with surgeons (PABAK=1.00 (95% CI: 1.00-1.00)). Mid-career therapists demonstrated substantial agreement (PABAK=0.67 (95% CI: 0.42-0.91)) and early-career therapists demonstrated fair agreement (PABAK=0.43 (95% CI: -0.04-0.90)). CONCLUSION: Therapists with advanced scope of practice make decisions that are consistent with orthopaedic surgeons.