Alix G. Sleight, Leah I. Stein Duker; Toward a Broader Role for Occupational Therapy in Supportive Oncology Care. Am J Occup Ther 2016;70(4):7004360030. https://doi.org/10.5014/ajot.2016.018101
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© 2021 American Occupational Therapy Association
Supportive care in oncology helps people cope with cancer and its psychological, physical, and emotional side effects. However, cancer survivors report dissatisfaction with supportive care and a need for more psychosocial and self-management services. Occupational therapy practitioners represent an integral part of the supportive care team because their scope of practice emphasizes function. Through a focus on function, practitioners address the full spectrum of physical and psychosocial care. Currently, conceptualizations of occupational therapy for cancer survivors often focus solely on physical interventions and, therefore, do not represent the unique involvement of the profession in supportive oncology care. We advocate for a focused framework for occupational therapy practitioners in oncology as experts in function and providers of both physical and psychosocial treatments. Barriers to a focus on function are identified, and strategies are suggested for expanding involvement for the profession in supportive oncology care.
Advocate for the importance of psychosocial supportive care for cancer survivors. Mental health is essential for function. However, a lack of team support for the treatment of emotional and psychosocial concerns has been cited as one of the main barriers faced by health care professionals working in oncology (Dilworth et al., 2014). This lack of support may inhibit creative, psychosocially oriented treatments that would satisfy the unmet supportive care needs of cancer patients. Advocacy is needed within individual practice settings to broaden accepted definitions of supportive care.
Develop and test the efficacy of physical and psychosocial function-oriented occupational therapy interventions for the oncology population. High-quality evidence is needed demonstrating that occupational therapy is efficacious in diverse supportive care roles beyond those involving biomechanical rehabilitation and ADLs. Strong evidence supporting an expanded role for occupational therapy may bolster referrals for a broader array of supportive care needs. Additionally, greater evidence supporting the efficacy of occupational therapy psychosocial interventions may promote the inclusion of occupational therapy in oncology-related practice guidelines such as those provided by the NCCN for distress management, thereby incorporating our profession into documents that determine the standard of care for the oncology population on a national level.
Continue professional discourse regarding the implementation of an entry-level clinical doctorate in occupational therapy (OTD). Although there is still much debate about the merits of the OTD within the profession (AOTA, 2014; Smith, 2007), an OTD specializing in oncology would certainly provide occupational therapists with a more comprehensive education, enabling them to expand their knowledge as it relates to potential functional impairments in the oncology population; to disseminate more specific, tailored education about self-management to cancer survivors; and to provide appropriate psychosocial interventions.
Establish supportive care services that are accessible and appealing across genders, ethnicities, and ages. Women cancer survivors have been shown to express more needs and participate more often in rehabilitation activities, whereas older adults with cancer often report more unresolved supportive care needs (Holm et al., 2012). If occupational therapy practitioners are aware of these common disparities, they will be more likely to identify clients who may have difficulty obtaining supportive care.
Ensure that clients are informed about the full breadth of available occupational therapy services. In a cross-sectional survey of patients with breast, lung, or gastrointestinal cancer, more than half of patients did not use supportive care services simply because they were not aware that the services were available (Kumar et al., 2012). If a client is unaware of the breadth of an occupational therapy practitioner’s scope of practice, the client may neglect to mention functional, psychosocial, or self-management needs. People with cancer need clearer information and communication about the role of function-based care in survivorship and the nature and availability of psychosocial and education-based services provided by occupational therapy practitioners.
Move toward function-oriented models of care. Recently proposed models of care such as the Impairment-Driven Cancer Rehabilitation Model (Silver, Baima, & Mayer, 2013) and the Prospective Surveillance Model (Stout et al., 2012) suggest that screening for functional limitations should take place throughout the entire care continuum. If these models of care are integrated into contemporary practice settings, occupational therapy’s role in supportive care may expand through increased screening and treatment for functional issues.
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