The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer

[SarahLyon]

Read Full Text: The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer
Journal: Journal of Geriatric Oncology (Impact Factor: 3.359)
Year Published: 2015
Ranked 39th on our 2014-2019 list of the 50 most influential articles

The first step to providing great OT care is getting the right referral at the right time.

But, like every step of therapy delivery, this can be a complex process.

There aren’t always clear physician guidelines that dictate screening for specific functional deficits. While we OTs might immediately recognize when a patient would benefit our services, a physician might not always think to refer out to OT.

In the Club, we’ve already discussed the importance (and, in many cases, the complexities) of screening patients for Autism Spectrum Disorder (ASD) and cytomegalovirus (CMV). And, we’ve unfortunately noted that the screening and referral process can be less than ideal.

This week’s article looks at functional deficits among older adults with cancer—and we see a similarly complex story: in the sample studied, 65% of older adults with cancer had at least one functional deficit that was identified as being potentially amenable by PT/OT.

65%! That’s a significant number.

But the frustrating part is that only 9% received an OT/PT referral within 12 months of a noted deficit!

More salient points about this study for OTs to consider

This study included 529 patients. Researchers pulled patients’ data from a cancer cohort registry and linked it to their billing data; this enabled the researchers to determine patients’ functional deficits and check if they were subsequently referred to OT and/or PT.

The patients were all recruited from the University of North Carolina (UNC) Health Care oncology outpatient clinics, with the following eligibility criteria:

• Age 65 older
• Able to consent to complete a geriatric assessment
• Demonstrates English writing and reading proficiency

The study found that the chances of having potentially modifiable functional deficits were higher for certain patients. These included:

• Older patients (with increased age, there’s increased risk of functional deficits)
• Those with comorbid conditions
• And those with less than a college degree

Most importantly, though, the numbers I mentioned in the intro suggested a major underutilization of OT/PT services for these patients.

I think the article summarizes the importance of this study quite nicely:

“The results outline the great need for intervention and referrals to OT/PT in this population. Early identification of OT/PT related functional deficits with the geriatric assessment may lead to increased referral to OT/PT and potentially decreased disability and cost.”

Takeaways for OT practitioners

(These are my personal takeaways, and were not mentioned in the article.)

A large percentage of older adults with cancer may not be receiving the rehab they may need

This is one of those studies that seems to back up something I see happening in my own community. For whatever reason, many older adults with cancer are left to struggle with functional deficits, without the support of rehab. This is very unfortunate, as OT/PT could likely help many of these folks immensely in their daily lives.

In this article, the authors mentioned another study that had similar findings. The results pulled at my heartstrings.

A large cross-sectional study of 2,200 adults with cancer were asked about their perceived need for rehabilitation and 39% felt they did not receive the care they needed.

The solution to this problem seems to be as simple (but also utterly complex) as improving communication between non-rehab medical providers and therapists.

And this leads to my second takeaway…

As OTs, we need to be asking ourselves: how can we better communicate our value to other healthcare providers?

I thought this line from the study was really powerful:

“Clinicians who could potentially refer to OT/PT report a general lack of understanding of the services, a perception that rehabilitation is inappropriate for adults with cancer and overall difficulty with knowing when to refer and to whom.” (page 7)

This backs up what I have seen anecdotally in my own practice.

I’m eager for you all to share and discuss some successful ways you communicate with other practitioners regarding how OT can help patients with cancer—and any patient population, for that matter.

Effective communication is already a challenge in our hectic and fragmented healthcare system—and it is only going to become more so as exponential amounts of healthcare- and rehab-related research is being conducted.

I’ll go ahead and start the conversation.

I had the most success with referrals when I did a “Lunch and Learn” with our physicians and, now that I have a better grasp of new research coming out each year, I would definitely want to do at the very least a yearly touch-point with our local physicians—but I’m not sure which methods would be the most effective.

I’m excited to hear your thoughts!

Listen to my takeaways in podcast form:

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(Possibly) Earn CEUs/PDUs for reading this article

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And, here’s the full APA citation you many need:

Pergolotti, M., Deal, A. M., Lavery, J., Reeve, B. B., & Muss, H. B. (2015). The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer. Journal of Geriatric Oncology, 6(3), 194–201. doi: 10.1016/j.jgo.2015.01.004

What questions/thoughts does this article raise for you?

[priscilla (Priscilla Santiago)]

I believe one way to improve MDs understanding of benefits of OT is to start with educating MD students. Just like they learn what other MD specialties/referrals are needed when treating certain conditions, we need to get OT in there. This could be done with AOTA or similar entities having booths and talks at universities or better, the OT department at the university. Sometimes we all share the same buildings or even classrooms with MD students at certain colleges. I also think a great resource could be OTs right now working in hospitals or clinics that have interns working there. Demonstrate to them early in their carriers what OT can bring to the table. I also think we lose great opportunities when OT day or month comes. We tend to focus our activities on having fun among us and current patients, where we should take the opportunity to conduct educating and advocacy activities. We need those referrals and for that we need the awareness!!!

[Randi (Randi Bukovac)]

I love the idea of conducting lunch and learns- not only for MDs, but all healthcare professionals. It is so clear how much we need to advocate for the OT profession in order to best provide quality services and help others to achieve the functional outcomes they desire. It is too often in the hospital setting (and I am sure several others) that the purpose of OT gets lost. Evidence-based practice is so important for us to use not only in clinical practice but in our advocacy efforts as well. With an AOTA membership, you are provided with tools and resources to help you with your personal advocacy efforts whether its within your rehab department, the hospital you work at, in the community, to your patient and their family, or in this case to MDs to ensure we are being referred when appropriate. It is also important to understand what functional deficits may be associated with older adults with cancer and being able to explain what we can do as an OT to regain those skills and reduce the likelihood of comorbidities, increased length of hospital stays, or poor tolerance to cancer treatment such as medication management, sleep hygiene, activity modification, health management and maintenance, and much more. Below I have included information from AOTA’s website including tools and an article that can be used as a resource in your personal advocacy efforts that is specific to the importance of occupational therapy for adults experiencing cancer.

References

AOTA. (2016). Advocacy. Retrieved from https://www.aota.org/AboutAOTA/Membership/Advocacy.aspx

Pergolotti, M., Williams, G. R., Campbell, C., Munoz, L. A., & Muss, H. B. (2016). Occupational therapy for adults with cancer: Why it matters. The Oncologist, 21(3), 314–319. https://doi.org/10.1634/theoncologist.2015-0335

[SarahLyon]

Oh wow! I had not seen this article before. I am printing it off now! Can’t wait to read it.

Mackenzi Pergolotti, PhD, OTR/L was an author on this week’s article and the one that you just linked to.

It is so cool to see the type of work that an OT with a PhD accomplishing, and I think that digging into her work would be a great use of time for any OT practitioner who works with (or want to work with) cancer patients.

Here’s all of her published works:
https://scholar.google.com/citations?user=YrLJw3EAAAAJ&hl=en

[matt (Matt Brandenburg)]

I’m currently a student at Washington University in St. Louis and have received training from the medical school’s center for inter-professional practice on the importance of working as an inter-professional team. This training is required for students in every program at WashU (OT, PT, MD, Nursing, Audiology, Pharmacology). Students are put in groups with one or two representatives from each profession and in addition to receiving training in professional communication are asked to learn about each other’s curriculum and training, ask questions about specific roles and to work together on case studies or seeing standardized patients. I agree with previous comments in thinking that this type of training can be very effective in preparing students for inter-professional communication and practice in the field, but recognize these programs may not be widespread.

In a practice setting I think it is important for OT practitioners to demonstrate their unique value to other medical professionals. I think an effective way to demonstrate value can be highlighting our expertise in the roles, habits and routines of our clients. Everyone on a medical team knows that cancer sucks, but not everyone knows how the pain, fatigue, swelling and additional side effects from medication and treatment make it difficult just to get up from the couch, let alone get dressed, go to the bathroom, eat or participate socially. Showing other members of the medical team how we would work with a client to modify their habits, roles, routines and environment to help them complete these difficult tasks can increase the confidence physicians have in their OT referrals and hopefully lead to more.

[SarahLyon]

Hey @matt! It is so great to have you in the Club and hear your perspective as a student!! It is super encouraging for me to hear the emphasis that is being given in your program to inter-professional practice.

We had looked a previous article that alluded to the push to include inter-professional learning requirements, but I hadn’t read anything about how that was actually playing out in programs: https://club.otpotential.com/t/interprofessional-education-accreditation-standards-in-the-usa/40

I personally believe that our future health care teams will be much more collaborative!

[takiyah (Takiyah Smith)]

Wonderful perspective, yes more focus on our role in helping patients get back to life -activities of daily living. There is a need for greater understanding of those impacts to their lives, impacts to their caregivers lives, and how functional deficits affect day to day everyday life doing everyday things.

[monika (Monika Lukasiewicz)]

I love that you mentioned sleep hygiene here too @Randi. I am currently working with a client with cancer working on this area and it has been so rewarding to see the changes OT is making for this woman and her CG (daughter) including now also realizing (via training in energy conservation, how to prioritize what’s important). I think OT is the only profession help. Which, yes, brings us to this great topic (sooooo valuable @SarahLyon) of “referrals.”

To ponder this, it makes me realize we are never really ever done with this. I think I’ve made the mistake of not being as vocal about my profession because I can assume the referrals are coming (in home health). And this is my error and I’m changing it. I think we can all start where ever we are with speaking our stories of success also, to help paint the picture of what OT can do.

Recently, I’ve started advocating by giving ONE key area (i.e. if there are difficulties with showering clients on memory care units) and mention that it is an area OT can help. It has already helped generate not only more referrals but also more appropriate showers for clients who struggle with functional cognitive impairments and their caregivers who often do not understand appropriate strategies.

There are such great ideas here. It’s hopeful to hear of the interdisciplinary work happening in the schools. Cheers to progress in this area and courage to speak up to advocate, share and be a solid team member for the good of our clients.

[sridevi (Sridevi Surampudi)]

I have been advocating and educating MDs, nurses, social workers, d/c planners, case managers, families, caregivers and more, continuously throughout my long career in this profession. In 3 countries and through almost all areas of clinical practice. Tirelessly. And I dare say now with much humility that indeed it has made a difference. You know they have understood when there is that ‘ aa ha ‘ expression on their face !
I have also visited middle schools ( some high schools ) on their career day representing Rehab and introduced them to OT/PT/ST. Explained the difference in a manner that is vivid in order to absorb what OT actually does as a profession to people with injuries, disabilities etc. And why OT is required/ necessary. I made sure that without putting any other profession down, the power and impact of OT was highlighted for any given situation ( could explain more if and as needed )
During OT month we came up with a quiz on OT for doctors, nurses and other staff to participate. ( with prizes of course ). I was stunned how much they loved it. For the MDs I’d leave the quiz sheets in their lounge-they enjoyed competing and coming up with the right answers. Seeing the enthusiasm, the OT quiz became one of our regular activities during OT month.
Regarding adult patients with cancer-I found it hard to break through mainly due to insurance restraints. I did my very best to educate and explain but the mind set was as if the patients required mostly comfort measures. They did not even consider screening to at least consider potential for even slightly increased independence with proper pain management ! How does the patient feel about increased independence for grooming or toileting in a safe environment?? I don’t think they considered what the patient felt. This is especially so in this country. In London, UK referrals to OT and PT was quite common for adult patients with cancer.
So, I have been frustrated about it for a while. However, I think it will change now. I definitely think there is much work OTs can do with this population.
Thanx Sarah

[darnell (Darnell Young)]

Thank you for sharing this article.

[kerri (Kerri Hanger)]

I think a great way to increase the discussion of OT/PT/Speech is to share rehabilitation success stories. One of the hospital’s I work selects one rehabilitation patient a month and showcases their Success Story by placing a picture of the person and their story (usually a paragraph) in a large frame and placing them all around the hospital. The hospital has been doing this for 8 years now so there are many of them. You can find them in the hallways, by the bathrooms, in the elevator so when moving around the hospital you can’t help but read the story and see what helped that person. This also educates all other patients, staff and visitors to recognize what the components of their success were.

[Randi (Randi Bukovac)]

I love the OT quiz idea! What a fun way to advocate for OT!!

[sanchala (Sanchala Sen)]

Thanks Randi for posting this information. It is timely for me. I am including ‘OT in cancer care’ as an emerging area of practice in my Specialized practice class in the spring.

[sanchala (Sanchala Sen)]

Similar to what others have mentioned, we did OT quizzes with small giveaways during OT month. We used to setup tables at the entrance to the hospital and at the nurses station. We also put up banners all around the hospital to announce the OT month and this became a conversation starter.
Our rehab department also showcases a “Rehab case of the year” wherein the interdisciplinary team (OT/PT/ST/RT etc) present a case they have worked through the continuum. The client and his family are usually present at this time. Other disciplines are invited to be come and listen to these stories. It is a great learning experience for all.

[SarahLyon]

I was really inspired by all of the ideas in this comment thread! Thank you all!!

One obvious approach (that I had honestly never thought of until this week) is to reach out to the medical providers we work most closely with, and ASK THEM how they would like to be kept up to date on what the OT department has to offer and new research around OT.

[SarahLyon]

Oh! And, one more thing, this article triggered a distant memory of another referral article I had read years ago, which also found that only about 1/10 of patients who could benefit from rehab, actually went to rehab (it was specifically related to PT and musculoskeletal injuries).

But, I wonder if this 1/10 number is true for many of our practice areas?

Here’s the article: https://www.webpt.com/blog/post/7-thought-provoking-facts-about-physical-therapy-you-cant-ignore

[josephine2 (Josephine Rammel)]

I think what you said about educating MD’s is so important. I recently went on a field trip with my class and we were advocating for our profession at the capitol building in our state. It was interesting to see how many people truly do not know what occupational therapy is about. Most people say we are like PT, but we are so much more and that is why we are our own profession. I think looking for opportunities to advocate or more importantly educate people on our profession will be imperative in growing a general understanding of what OT is within communities. The more people (and MD’s) know about our profession, the more people we will be able to help in the future.