Hospice care and PA- National mixed methods study

Question 1

Pa for patients with incurable disease

Answer 1

• Pa interventions are increasingly being used in hospice care including the adoption of group models of delivery, which can respond to the needs to a growing number of outpatients.
• still remains a lack of evidence on the extent to which Pa is delivered across hospices in England

Question 2

Objective of the study

Answer 2

To determine the extent of and intervention features of physical activity service provision in hospice care in England alongside barriers and facilitators to their delivery.

Question 3

Methodology

Answer 3

• online survey of 70 adults hospice in England
• Understand the services currently being delivered to support physical activity provision
• Focus groups and interviews with health professionals from 18 hospices
• 4 focus groups and 3 interviews with key stakeholders (e.g., physiotherapists, OT, nurses)
  -Explore perspectives on physical activity delivery from a subgroup of survey respondents

Question 4

results of the data

Answer 4

• 147 hospices in England were approached for this study. - From this, 70 (47.62%) completed the online survey.
  Majority of responding hospices (n=47-66%) promoted Pa as part of routine care.
• Pa was typically delivery in seated position (61%) or by standing position (37%) with only a few hospices offering interventions while laying down (10%).
• More hospices in the south east (16%) delivering Pa as part of their care service.
  -Over a third of participants indicated that there was no Pa provisions in their hospice.

Question 5

Barries to PA

Answer 5

low motivation(87%), pain/discomfort , poor functional mobility, low confidence and fear of falling(17%).

Question 6

what is Hospice care ?

Answer 6

• Hospice (Palliative) care aims to improve the quality of life and well-being of adults, children and young people who have terminal illness or long term conditions that cannot be cured, also known as lift-limiting.
• it can include symptoms management and social, practical, emotional and spiritual support .

Question 7

who receives hospice care ?

Answer 7

-Within the UK, hospice care services provide support to approximately 200,000 patients with incurable diseases every year (Hospice UK,2016).
-By 2040, this number is expected o rise by 25-47% as a result of an gaining population (Etkind et al, 2017).

Question 8

what conditions can receive hospice care ?

Answer 8

• dementia , heart, liver and renal failure, respiratory conditions such as chronic obstructive pulmonary disease (COPD), neurological disease.
  -Patients are treated for a wide range of symptoms such as pain fatigue , shortness of breath, depression and anxiety.

Question 9

Recommendations for individuals with incurable diseases.

Answer 9

-Based on the current evidence, patients with advanced incurable disease should be encourage to engage in regular PA (i.e. at least 150 mins of moderate intensity or 75 mins of vigorous-intensity activity, with muscle strengthening on 2 or more days per week) (Oja & Titze, 2011).
-And be advised to move and sit less, as doing some Pa is better than none.

Question 10

what are the benefits of Pa engagement ?

Answer 10

-Pa is cost-effective, non-invasive adjunct therapy that can address the multiple needs of people with advanced, incurable disease.
-Physical well-being – breathlessness, fatigue, pain and functional mobility
-Psychosocial well-being- anxiety, depression, emotional functioning, quality of life, social isolation, peer support.
-Existential well-being- structure and meaning in life, hope for the future.

Question 11

what are the berries to Pa engagement?

Answer 11

-Few adults with advanced, progressive disease in England are active (Elshahat et al, 2021)
Barriers engagement arise from:
-Personal factors e.g. low motivation, poor mobility, apprehension about Pa induced harm
-Social/environmental factors e.g. limited access to interventions

Question 12

Pa within Hospice care

Answer 12

-Hospices can play a vital role in promoting Pa by implementing a Pa pathway that includes systems for assessment, counselling, and monitoring as well as ensuring consistent provision of and access to personalized interventions.
-Evidence suggest that care settings (e.g. primary and secondary care) and health professionals (e.g. GPD, nurses and Physiotherapists) who work with them have considerable influence on patients’ health behaviour and are well-positioned to promote Pa.