Occupational engagement at the end-of-life : occupational therapists' perceptions

Introduction: Occupational therapists provide unique care to meet the varied needs of people with life-limiting illnesses. However, there is limited evidence as to therapists’ current practices as to which occupations they enable clients to engage in after receiving a life-limiting diagnosis. Objectives: This study aimed to describe occupational therapists’ perceptions of what occupations their clients chose to engage in after receiving a life-limiting diagnosis. Methods: A national survey of Australian occupational therapists working with people with a life-limiting illness was completed. Recruitment occurred over a one month period in April 2012 using a purposive, snowball sampling technique, leading to 171 survey responses. Qualitative analysis of survey responses was completed using grounded theory methods. Results: Two inter-related categories and four sub-categories were identified during analysis. The first category, focusing on life has two sub-categories: prioritised engagement and altered engagement. Focusing on life centres on therapists’ perceptions of how clients continue to focus on living post diagnosis by remaining engaged in their chosen occupations. The second category, preparing for death has two sub-categories: practical preparation for death and ‘facilitating closure’. The category of preparing for death focuses on therapists’ perceptions of what clients do to practically prepare for death and how they find closure as their illness progresses. Conclusion: Therapists perceive clients’ priorities change from focusing on life, to preparing for death, as their occupational performance level decreases over time.