Psychology and psychiatry in palliative care is a specialist area that addresses the psychological and/or psychiatric needs of palliative
care patients, families and caregivers. Many factors can affect the psychological health of an individual in palliative care including:
- Coping with terminal illness and advanced disease
- Adjusting to changes in physical health and living circumstance
- Grief
- Existential concerns
- Anxiety
The team takes a holistic approach to understanding the difficulties that a patient may be experiencing and determines whether patients may benefit from supportive psychotherapy and/or medication to obtain relief from anxiety, depression, trauma, existential, spiritual or other forms of distress, confusion or sudden changes in thinking, and a range of other psychiatric problems. This is often a very distressing time for families, so psychological support may also be offered to loved ones. The team is also involved with supporting staff and educating professionals in the community about the role of psychology and psychiatry in palliative care.
The role of social work in palliative care is to enhance quality of life and promote wellbeing for patients, families and caregivers. The social
worker works in partnership with patients, families and caregivers in the context of a multidisciplinary team.
A major role is to provide counselling, support, advocacy and information to address the psychological and social issues that arise during
palliative care. These issues may include:
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adjusting to the diagnosis and/or prognosis
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dealing with loss, fears, grief, goals and aspirations
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accessing community services
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financial matters, including entitlements
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legal matters, including wills and powers of attorney
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accessing advocacy and support groups
The social worker also coordinates family meetings to articulate goals of care, makes referrals to community services and assists in planning discharge home or to residential care.
Pastoral Care is person-centred, holistic care primarily involved with supporting the spiritual care and wellbeing of patients, families and carers. It helps people connect to self, others, nature and transcendence. Pastoral care can help to strengthen relationships and ease existential pain. They can also clarify issues such as letting go, saying goodbye, reconciling and seeking or giving forgiveness. People are comforted when they are heard, recognised and validated for who they are. Pastoral care is respectful and supportive of all beliefs, religious traditions and cultures, as well as of those who do not have any religious beliefs or affiliations.
Pastoral care practitioners working in palliative care are members of the multidisciplinary team specifically providing spiritual, emotional and bereavement support to patients, family and carers. They are trained professionals who assist people to give expression to their inner world and to become more aware of their values, hopes and longings as they seek to make some sense of their experience. When living with a terminal
illness, issues about the purpose and meaning of life, suffering and death can become more acutely important. Pastoral care practitioners are therefore available seven days per week, indicating the high priority given to this aspect of palliative care.
In palliative care there is often a need to facilitate meaningful rituals for patients, families and carers. As a multidisciplinary team member the Pastoral Care Practitioner is able to respectfully share the importance of a person’s faith, culture, practice and rituals associated with pre- and post-death practices.
Occupational Therapy in palliative care aims to promote dignity, autonomy and quality of life and plays an integral role in optimising individual
patients’ ability to engage in the activities they value.
The Occupational Therapy role includes:
- Promoting engagement in meaningful activity throughout the disease trajectory
- Fatigue management education
- Relaxation training
- Lymphoedema management
- Health promotion
- Supportive counselling for psychological adjustment related to loss of function and reframing of occupational goals
- Optimising the hospital environment for comfort, safety and engagement in activity, including seating, positioning, pressure care, equipment
- Optimising the home environment through home assessment, environmental modification, equipment prescription and education
- Supporting and educating informal caregivers
- Enabling participation in activities that support quality of life, including reminiscence, legacy work, creative activities.
While working within the multidisciplinary palliative care team, the Occupational Therapist uses a person-centred approach to address the holistic
needs of each individual to support and maintain quality of life
Physiotherapy is the evidence-based assessment, treatment and management of a wide variety of conditions that effect physical function. It aims
to restore function or reduce the impact of dysfunction related to permanent disease or injury through manual therapies, prescription of exercises,
provision of equipment, motivation, education and advocacy.
In palliative care, the physiotherapist forms an integral part of the multi-disciplinary team providing assessment, symptom management, restorative
care, discharge planning and end-of-life care to patients with advanced disease. They take a holistic approach, working closely with patients and
their families/support networks to determine goals of therapy that are relevant to the individual and promote functional ability, quality of life and
social wellbeing. This includes (but is not limited to):
- Mobility assessments
- Provision or modification of walking aids
- Falls prevention
- Chronic oedema management
- Development of exercise programs
- Referrals to rehabilitation services and other community agencies
The service is available to patients on the ward at both St Vincent’s Palliative Care sites as well as those attending the day hospice.
Dietitians are experts in food and nutrition, who provide therapeutic diets or alternative nutrition support, education,
counselling and discharge planning to optimise a patient’s health and wellness.
Dietetics continues to play an important part in Palliative Care. Goals of therapy may change where emphasis is no
longer placed on meeting an individual’s nutritional requirements with aggressive nutrition support or enforcing strict
dietary restrictions. Dietitians work with patients and families in order to maximise the pleasure that can come with
eating and drinking. They encourage nutritional interventions that can minimise weight loss and improve energy and
strength, such as the provision of nutritional supplement drinks, nourishing foods and meal-time support.
They also provide advice to assist in the dietary management of uncomfortable side-effects of illness such as anorexia,
nausea, taste changes and constipation.
Art therapy can be used wherever people face questions of meaning. Art is one way of assisting people to make some kind of sense of an experience
or integrate their experience. The language of imagery enables this to happen by placing feelings outside of the self into the image, which then becomes a container and may also be a window on the way that the patient organises internally.
Art therapy can be used to manage symptoms through the process of making art or provide the art therapist with an opportunity to assess a person’s
functioning through either the form a work takes or the content of the imagery.
Art therapists work at both St Vincent’s Palliative Care sites, but offer a ceramics based art program at Caritas Christi Hospice in Kew, where a kiln is
available. Patients are frequently surprised by what they can achieve, especially if they haven’t made art since their school days. Patients and their
families use the program to express themselves emotionally and spiritually, including:
- In life review
- As an expression of feelings
- As a distraction to current circumstances
- To create gifts to present to loved ones
- Simply for the pleasure of using the art materials
Music therapy in palliative care aims to provide opportunities for patients and people close to them, in enriching and supportive music-based experiences as they deal with life threatening conditions. Music therapists can invite patients, sometimes with families and friends, to:
- Listen to live or recorded music
- Compose songs
- Share improvised music
- Reflect on musically inspired memories
- Perform music
- Have therapeutic music education or appreciation sessions
- Become involved in personalised music programs aimed to promote relaxation and symptom relief
Children may also become involved in playsongs and made up musical stories, playing instruments, and singing, which can be fun, reduce discomfort, and enable symbolic expression. Music therapy sessions can be held in hospices and other hospital settings, and in homes, nursing homes and day programs. People tend to choose music that reflects feelings, memories, people, and images that they want to connect with. Time in music therapy might be used to:
- Increase self-awareness through discussing elicited reflections with the therapist (who uses counselling skills as necessary)
- Have enjoyable aesthetic, possibly transcendent experiences
- Engage in music-based life review
- Create CD legacies with personalised messages
- Entilate feelings
- Experience satisfaction and pride in creative accomplishments
Music therapists focus on the therapeutic process rather than the musical products and try to offer music-based opportunities for patients to be touched in meaningful ways which are enjoyable, affirmative, uplifting, and memorable.
Palliative care volunteers provide special support to patients, family members and staff at both St Vincent’s Palliative Care sites
through friendly visits, a cooking program, offering drinks from the drinks trolley or by simply changing the water in a vase of flowers.
Palliative care volunteers may also provide gentle conversation, contact through hand massage or quiet companionship. In this way they
offer emotional support to patients and families.
At the Caritas Christi Hospice in Kew the provision of home-made treats through the cooking program has great meaning to many people.
The sharing of food and drinks forms a significant and powerful cross-cultural ritual, creating an environment where food is valued for more
than its nutritional role.
This can make a very positive contribution to the patient and family experience.
The volunteers at St Vincent’s Palliative Care Services are a wonderful part of the interdisciplinary team and much appreciated in the lives
of patients and families.