P-146 Rehabilitative palliative care – a challenge on the hospice inpatient unit?

Abstract

Background Traditionally hospices are seen as providing care and comfort at the end of life. However, many people with a terminal illness have rehabilitation needs – to maintain or improve function, independence and quality of life. This is increasingly the case as benefits of palliative care are being seen as relevant for a widening population with a range of terminal illnesses, and at different stages in their disease. Rehabilitative palliative care aims to empower patients to achieve realistic goals to optimise function and independence within the limitations of their illness, and is increasingly recognised as an essential part of holistic palliative care. However, this approach can seem confusing and at odds with caring for the dying, and may be misunderstood by patients, families and health professionals. This misunderstanding may reduce opportunities for patients to optimise their final weeks and months, and may be especially challenging on the hospice inpatient unit. Aims To explore the views and experiences of inpatient unit staff about rehabilitative palliative care, and how these influence models of care and practice. To identify barriers and practices that are helpful, and to begin a conversation about ways to widen opportunities for a rehabilitative approach. Methods • qualitative semi-structured interviews • 18 inpatient unit staff • range of health care professions • interviews taped and transcribed verbatim. Results Five themes emerged: • perceptions of hospice and palliative care • understanding of ‘palliative rehabilitation’ • patient psychology • staff priorities and experiences • opportunities and barriers. Conclusions There are many examples of good rehabilitative practice on the inpatient unit, although these are not often named as such. Barriers to this approach may be rooted in perceptions and misunderstandings at public and organisational levels as well as at the bedside. Opportunities for further developing a rehabilitative approach were seen to depend on time and resources, communication and continuity, teamwork, leadership and identifying ‘champions’.