Contemporary opportunities for rehabilitation in palliative care
In 2015, Hospice UK published “Rehabilitative Palliative Care: Enabling People to live fully until they die – a challenge for the 21st century” (Tiberini and Richardson).
This was born out of Help the Hospices report into the current and future needs for hospice care (Calanzani et al, 2013) – it identified the need to grow and diversify hospice care provision in order to meet the growing need from an ageing population and Rehabilitative Palliative Care was a timely and positive response to this challenge.
RPC was not a new concept though. Cicely Saunder’s original vision was of living and dying well, and of the whole multi-disciplinary team having a role to play in this
‘All the work of the professional team .. is to enable the dying person to live until he dies, at his own maximal potential performing to the limit of his physical and mental capacity with control and independence whenever possible’
The publication in 2015 brought a fresh and much needed challenge to the sector and introduced a new set of phrases and descriptors.
It explicitly promoted the integration of rehabilitation and palliative care as bed fellows not mutually exclusive as was sometimes the culture.
It helped to establish the notion that RPC is for everyone in the multidisciplinary team. And that it is not necessarily about individual professional roles but about an attitude of respect for a person’s autonomy and choice and empowerment.
In the 5 years since publication though, there have been strides across the sector in increased awareness of and growth of palliative rehabilitation services and many hospices have grown and developed their services and evolved their models of care to reflect this.
Perhaps a gap in that original publication was the lack of acknowledgment of the psychological and emotional as integral to holistic palliative rehabilitation? Now in 2022, the team at St Christopher’s have been developing a contemporary model of rehabilitation to enact truly holistic palliative rehabilitation. And it is our view that this continues to be everyone’s business- extending beyond professionals to families, carers and the broader public.
Our new model draws heavily on previous thinking on rehabilitative palliative care, then reinterprets it to reflect a contemporary context in which hospices and other palliative care providers operate.
We recognise that demographic changes, advances in medicine, the global COVID- 19 pandemic and other societal shifts call for a different approach to support for people who are dying and those close to them.
It positions efforts to preserve someone’s identity and wellbeing at the heart of palliative and end of life care and argues that holistic care is impossible without opportunities for rehabilitation or rehabilitative support.
The model arises from a blend of reflection on practice at St Christopher’s, research evidence and practical advice with an ambition to make rehabilitative efforts available to more people coming to the end of their life.
The authorship is wide – spanning physiotherapists, occupational therapists, dietitian, social work and nursing in acknowledgement of the remit of all professionals to engage in rehabilitation as part of best practice, and in the belief that different professionals bring different perspectives to this vital element of palliative and end of life care.
The overall ambition is of working towards maximised quality of life – the ultimate goal of palliative care. The model has relevance in hospices and the many other contexts in which people will die.
If you would like to know more about the model, it will be launched at our conference on July 1st 2022 – Rehabilitation in Palliative Care: Contemporary Opportunities – Direction, influence and practice. To find out more and to book onto the day go to St Christopher’s | Rehabilitation in Palliative Care: Contemporary Opportunities – St Christopher’s (stchristophers.org.uk)
Helena Talbot Rice – Rehabilitation and Wellbeing Consultant Lead, St Christopher’s Hospice
Heather Richardson – Chief Executive St Christopher’s Hospice