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May 2021
 
Using the COPM in Palliative Care
 
The newsletter this month is a case study submitted by Rachel Cresswell, B.Sc. (Hons), M.Sc. (Advanced OT), who is a Senior Lecturer in Occupational Therapy at the University of Lincoln, in the United Kingdom. It will also be found on the COPM website. COPM Inc. would be very interested in adding more useful case studies to its website. If you would be interested in presenting one of your cases, please contact us.

Janet is a 60-year-old lady who lived with her husband in a static caravan on a residential park. She was diagnosed with Large cell Neuroendocrine Lung Cancer and treated with palliative chemotherapy and supportive care. She was referred to the Community palliative care Occupational therapist after the lung team identified problems with independence and activities of daily living. The initial COPM identified her priorities as being able to use the bath independently, her functional mobility was limited due to shortness of breath as were leisure activities. Her leisure priorities were meeting friends and spending time with her grandchildren, she previously took them to the park and on outings.

picture of wife and husbandOT intervention consisted of fatigue management education, including completing and using a fatigue diary, energy conservation techniques and the provision of adaptive equipment. As part of the intervention a bath lift was fitted, and Janet was shown how to use this and was safe and independent. Alternative leisure activities were explored, such as reading to her grandchildren or sitting with them and listening to talking books together. Seeing her friends with the support of her husband ensuring she limited the time with her friends during the time of day when her fatigue levels were not at their worst.

On re-assessment she was able to bath herself and carry out personal care independently despite deterioration in her physical functioning. She spent time with her grandchildren carrying out quiet activities and she had seen her friends several times with her husband’s support. On scoring the goals at reassessment she felt empowered that despite her having a terminal cancer she was still managing to retain some independence and continue participating in activities that she enjoyed. This gave her the confidence that even though there would be a point when she could no longer do these activities, she had remained independent for as long as possible. From a therapy point of view, I felt satisfied that using the COPM with clients who have deteriorating conditions can still demonstrate positive outcomes and empower them to continue having the best quality of life for as long as possible.

 
Occupational Performance Problem
 
Time 1 Time 2
Performance Satisfaction Performance Satisfaction
Being able to bathe independently 1 1 7 10
Getting around the home (functional mobility) 7 8 8 10
Leisure time with her grandchildren 1 1 5 10
Meeting friends 1 1 5 9
Total Scores: 10 11 25 39
Average Scores (Total Scores/number of problems): 2.5 2.75 6.25 9.75
Change Scores
(Time 2- Time 1):
Performance Satisfaction
                          +3.75                            +7.0
 
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