Research in Occupational Therapy in Oncology and Palliative Care
In honour of Dr. Judith Friedland, former Chair of the Department of Occupational Therapy, the Fund for Research in Occupational Therapy in Oncology and Palliative Care was established. It recognizes Dr. Friedland’s exemplary contributions to the field of occupational therapy, the Department, and the University of Toronto.
The purpose of the Judith Friedland Fund is to support research on how occupational therapy can help individuals with cancer and those in palliative care to pursue their occupational goals. Research proposals should address: 1) challenges presented by living with a diagnosis of cancer, or 2) coping with end of life concerns regarding life roles and relationships.
The Fund provides up to $5,000 awarded annually.
Past Recipients of the Judith Friedland Fund
Brain tumours are the leading cause of cancer death among children and youth aged 19 years and under and it is estimated that 27 Canadians are diagnosed with a brain tumour every day. Currently, there is a paucity of population based information on brain tumours and even fewer on benign brain tumours. However, it is important to recognize that benign brain tumours can still cause serious health problems and negative long term effects that may be improved through rehabilitation. This study will describe the profile and trajectory of all patients with malignant and benign brain tumours in Ontario, Canada. A focus will be placed on patients with brain tumours that receive occupational therapy. Patients with benign and malignant brain tumours will be compared and geographic variation within Ontario will also be examined. Using specified International Classification of Disease Version 10 codes, patients with brain tumours in the emergency department, acute care, and inpatient rehabilitation will be identified in the National Ambulatory Care Reporting System, Discharge Abstract Database, and the National Rehabilitation Reporting System respectively. Patients that receive occupational therapy will be identified in the Home Care Reporting System. Surveillance of brain tumours is crucial to better address the needs of this population and to align resources with needs. As survival rates increase, a greater demand for rehabilitation will emerge. As such, this project will provide the foundation for future research proposals to build upon. Finally, this project will build upon an already established working relationship with knowledge users throughout the project to ensure the data are utilized in planning of occupational therapy for patients with brain tumours.
Rationale: Individuals with cancer are living longer due to medical advances in detection and treatment. Despite adding years to patients’ lives, cancer treatments are associated with adverse health effects. Occupational therapy (OT) can play a key role in rehabilitating cancer survivors, however there is limited research evaluating the effectiveness of OT within oncology rehabilitation to ensure patients receive the most effective rehabilitation.
Objective: The aim of this sequential explanatory study is to examine whether OT as part of an in-patient oncology rehabilitation program at TRI-HC will improve the performance of ADLs for adults above the ages of 18 living with cancer.
Methods: A pre-post mixed methods design will be used. A convenience sample of thirty participants will be recruited from the in-patient oncology program being evaluated. Participants will complete the RNLI, KPSS and GAS measures before and after participating in the OT oncology rehabilitation program. One month post-discharge, participants will complete the RNLI and a qualitative semi-structured interview aimed at understanding their experiences and perceptions of the program. Assessment data will be analyzed using a t-test for paired comparison and interviews will be analyzed through directed content analysis.
Practice implications: The evaluation of the OT oncology rehabilitation program will provide rationale for the inclusion of the OT within oncology rehabilitation teams and contribute to future evidence-based oncology program development.
Conclusion: The findings from this study will continue to provide evidence regarding the effectiveness of OT and its impact on patient satisfaction in achieving self-identified goals and improving ADL performance within an oncology rehabilitation program.
Background: Only 60% of individuals who are diagnosed with cancer have returned to work 1-2 years following cancer treatment. An understanding of the processes (most commonly identified in qualitative research) that can facilitate successful return to work can enhance return to work rates.
Purpose: In this study we propose to complete a meta-synthesis of the qualitative research to investigate how cancer survivors themselves experience the return to work process, the challenges they identify, and the supports that facilitate both a positive return to work process and outcome.
Method: We will employ a systematic process utilizing the following five steps: 1) identify relevant research question(s) [as indicated above]; 2) establish study inclusion and exclusion criteria; 3) establish search strategies and select relevant studies; 4) appraise study quality; 5) extract, analyze and synthesize the findings across studies. A meta-ethnographic approach will be used to analyze and synthesis the data.
Anticipated Outcomes: Results from this meta-synthesis will be used to:
- Develop a databank of qualitative studies and evidence tables
- Gain a deeper understanding of the processes individuals engage in to return to work and maintain their employment following cancer survivorship
- Develop best practice recommendations for supporting cancers survivors’ abilities to return to work
- Identify elements within the individual, work, workplace, and environment that may either challenge or facilitate successful return to work.
Stergiou-Kita, M., Grigorovich, A., Tseung, V., Milosevic, E., Hebert, D., Phan, S., Jones, J. (2014). Qualitative Meta-synthesis of Survivors’ Work Experiences and the Development of Strategies to Facilitate Return to Work. Journal of Cancer Survivorship: Research and Practice. 28(2), 1-14.
Introduction: Physician Assisted Suicide (PAS) is the process in which physicians provide the means for terminally ill patients to end their lives (Carlson, 2014). Euthanasia involves more active engagement with the process of bringing about death. While the two are distinct, the likelihood is that legislation in Canada will embrace both options. With the Supreme Court of Canada soon to rule on the Carter appeal, the prospect of decriminalization across Canada is real and imminent. While studies have examined opinions of certain healthcare providers (Levy, Azar, Huberfeld, Siegel & Strous, 2013), little is known about Occupational Therapists’ (OTs’) attitudes towards PAS and euthanasia. OTs’ client-centred perspective potentially enables them to explore a patient’s wish to die (Carlson, 2014), and contribute to discussion around PAS and euthanasia.
Objective: OT-PASE-Canada will survey the perspectives of OTs and Student OTs in Canada on the legalization of PAS and euthanasia and inform discussions on a position statement from the Canadian Association of Occupational Therapists. This will potentially assist with identifying any emergent best practices for clients requesting PAS or euthanasia whenever it may become legal.
Methods: We aim to recruit 100-200 participants for our concurrent, mixed-methods study. We will use an online anonymous survey, with quantitative and qualitative questions. To analyze the data, we will use an online survey tool to generate descriptive statistics of the quantitative responses and the research team will engage in a triangulated thematic analysis of the qualitative responses.
Dr. Mary Stergiou-Kita; Kim Adlard
Background and Relevance: With improvements in screening, diagnostic and treatment techniques, the number of individuals who are surviving cancer is increasing.1 American statistics indicate that two thirds of individuals diagnosed with cancer have a life expectancy of at least 5 years.2 In Canada there were an estimated 171, 000 new cases of cancer in 2009 with an accompanying five year survival rate of 82.5%.3 The number of adults of working age surviving cancer has also increased with almost half of cancer survivors currently representing individuals under the age of 65.4-5 Individuals who have survived cancer report a desire to re-engage in paid employment in relation to productivity needs, a sign of recovery and return to their normal lives and ability to financially self-sustain oneself and re-enter the labour force.1, 5-6 However, despite the importance of work to their well-being, survivors are 1.4 times more likely to be unemployed than individuals without health concerns.2 In addition, only 60% of individuals who are diagnosed with cancer have returned to work 1-2 years following cancer treatment.1 These individuals are in the prime of their work lives and if unable to return to work, pose health care costs and financial losses at the individual, family and societal levels. Returning to work following cancer diagnosis and treatment can be challenging. Cancer survivors must contend with persistent symptoms (e.g. pain, fatigue, cognitive dysfunction, anxiety and depression) that affect their ability to re-engage and maintain employment. 1,5, 9-11 Survivors may also find it challenging to access supports from health or vocational service providers (e.g. vocational counseling services, vocational training/re-training, job replacement, job search and job maintenance assistance).1-11 Poor workplace supports, limited access to workplace accommodations and experiences of stigma and discrimination can lead to job separation following cancer. 5-7, 9, 11-15 For individuals who were either unemployed prior to their cancer or experience loss of their pre-illness job following cancer, navigating the journey back to work can be particularly challenging. While some community services exist for individuals who are returning to their pre-cancer work with established employers (e.g. Wellspring), there are no vocational programs that assist cancer survivors in re-establishing vocational goals, searching for new work, accessing training opportunities, and securing a job with a new employer.
Project Objectives: To fill this gap, we propose to develop a modular self-management tool that survivors can utilize when planning and returning to work following cancer. This pilot work will also serve as a catalyst for developing further vocational programming for cancer survivors. Modules will address the following areas: work readiness; understanding how on-going symptoms can affect my work; identifying work interests, aptitudes and work goals; income replacement benefits information; job search skills; disclosure to future employers and at the workplace; and accessing government support for employment services.
Methods: We will use the following methods to develop the tool and garner feedback on its applicability:
- A review of best practice evidence and identification of the knowledge, skills and supports required by cancer survivors to plan, navigate and negotiate their labour market re-entry, if job separation has occurred. This will include reviews of vocational service delivery models/approaches in cancer and meta-syntheses examining strategies for facilitating return to work (as previously completed by the principal investigator).
- A review of vocational services provided in cancer and other populations (e.g. HIV, mental health, physical disabilities) to identify relevant elements for a vocational self-management modular tool (e.g. Canadian Partners against Cancer reports on return to work programs in Canada, relevant websites such as Cancer and Careers and websites and resources from other disability groups who have developed vocational counseling self-management tools such as. Employment ACTion Toronto.
- Focus groups with cancers survivors and expert cancer rehabilitation vocational service providers to garner their feedback on the modules created, and the tools’ comprehensiveness, clarity, utility and ease of use.
Knowledge Transfer Plan: Once developed we will disseminate information regard the tool through a publication in the Journal of Cancer Survivorship, local and national presentations through the Cancer Research Consortium and Canadian Partnership against Cancer and vocational programs that assist cancer survivors with work-related goals (e.g. Princess Margaret Hospital, ELLICSR, Sunnybrook Odette Centre, WellSpring).