Authors (including presenting author) :
Lui TC(1), Chee KK(1), Mak PT(1), Wong YPJ(1), Lam WK(2), Au HYT(2)
Affiliation :
(1) Occupational Therapy Department, Grantham Hospital, (2) Palliative Day Care Center, Palliative Medical Unit, Grantham Hospital
Introduction :
Pain is one of the most prevalent symptoms among palliative patients and it takes a toll on patients’ quality of life and activities of daily living (ADL). According to the World Health Organization, up to 55% of patients with cancer experience pain. Although Occupational Therapy (OT) has provided services in dyspnea and fatigue management programs for years, there is no structured OT program for pain. Therefore, a pilot project of OT Pain Management Program for Palliative Care (PC) patients is launched since August 2024 to provide holistic OT service and care.
Objectives :
1. To facilitate self-management in pain by utilizing various OT’s non-pharmacological interventions. 2. To empower patients and carers with different coping skills and knowledge to promote better quality of life.
Methodology :
Patients who met the following criteria would be screened and referred by nurses in PC day center to the pilot program: 1)Palliative patients with mild to moderate pain with Visual Analogue Scale pain (VAS)score(1-7 out of 10); 2)Age 18 or above; 3)Cognitive sound: Abbreviated Mental Test (AMT) ≥7; 4)Sitting tolerance ≥ 1 hour; and 5)Cantonese speaker. However, patients who are deaf/blind/mute or in confusion state will be excluded from the program. The program utilized 1) Brief Pain Inventory Short Form (BPI-SF); 2) Visual Analogue Scale (VAS); 3) Depression, Anxiety & Stress Scale 21 (DASS-21); 4) WHO Well-being Index 5 (WHO-5); 5) Pain Self Efficacy Questionnaire (PSEQ);and 6) Confidence in Pain Self-Management (using NRS) as the outcome measure to assess varies aspects in pain and self-management. The Occupational Therapy Pain Management Program aims to facilitate palliative day patients in better self-pain management. The program consists of six sessions including one assessment session and five treatment sessions. Additional sessions and treatment services can be provided depending on the needs of patients, including carer education, home visit for home modification and Bowen therapy treatment. The duration of each session is 20-30 minutes. The program focuses on enhancing patients’ knowledge of pain, introducing mindfulness practices, utilizing therapeutic art activities (Zentangle), learning energy conservation and the use of assistive aids to reduce the adverse effects of pain and better manage their pain. After each session, home programs are given to patients for practice to consolidate their learning and utilize the skills and knowledge learnt in their activities of daily living.
Result & Outcome :
A total of 6 patients were referred from the Palliative Care Day Centre and recruited into the pilot program (Male/Female: 3/3, Age: 52-85, Median=83.5) in August 2024. From August 2024 to January 2025, 29 sessions were provided including assessment and training. Diagnosis varied from Lung Cancer (n=1), Cervical Cancer (n=1), Colon Cancer(n=1), Breast Cancer (n=1), Meningioma (n=1) and End Stage Renal Disease (n=1). Among these 6 recruited patients, all patients had completed the initial assessment and 4 completed the whole program up to early January 2025. 1 patient is still undergoing the program. 1 patient withdrew from the program due to death. Results showed improvements in all aspects, including reduced severity of pain (VAS: Median= 4 to 2; Pain Severity Score in BPI-SF: Median= 15.5 to 7.5), less interference of pain in ADL function (Pain Interference Score in BPI-SF: Median=29 to 16), increased self-efficacy in pain management (NRS: Median=6 to 7; PSEQ: Median= 38.5 to 39). For psychosocial well-being and quality of life, all domains including depression, anxiety and stress fell into the normal range and indicated better quality of life (DASS-21: Depression: Median=1.5 to 2; Anxiety: Median= 1 to 2; Stress: Median= 5 to 1; WHO-5: Median= 14.5 to 15). Patients who participated in the OT pain management program showed prominent improvements in self-efficacy in managing pain, pain severity, quality of life and psychosocial well-being.
