Identifying Facilitators of and Barriers to Referrals to Occupational Therapy Services by Israeli Cancer Health Care Professionals: A Qualitative Study.

IMPORTANCE: Persons living with and beyond cancer (PLWBC) are rarely referred to occupational therapy services despite their functional difficulties. An understanding of the barriers to and facilitators of occupational therapy referrals from the perspective of cancer health care professionals could help minimize referral gaps. OBJECTIVE: To explore cancer health care professionals' perspectives on and knowledge of occupational therapy's role in cancer care, identify the barriers, and explore solutions to optimize referrals. DESIGN: Multiexplanatory qualitative case study. SETTING: Community and hospital cancer clinics in Israel. PARTICIPANTS: Six in-person focus groups of cancer care Israeli nurses and social workers, totaling 28 participants. RESULTS: Two main themes were identified: (1) barriers to occupational therapy referrals and (2) partial facilitators of occupational therapy referrals. The four barriers subthemes were (1) gaps in knowledge about symptoms' effects on daily functioning, (2) gaps in knowledge regarding occupational therapy's role in cancer care, (3) bureaucratic and organizational barriers, and (4) unavailability of occupational therapy services. The two facilitators subthemes were (1) collaborations and communication with occupational therapists and (2) awareness of occupational therapy services. Participants suggested practical solutions for improving occupational therapy referrals, interdisciplinary collaboration and communication, and integrating occupational therapy into cancer care. CONCLUSIONS AND RELEVANCE: Barriers to referrals included gaps in participants' knowledge that link side effects to functional difficulties indicating a need for referral to occupational therapy. Participants' suggestions to bolster referrals can be implemented by occupational therapists to reduce patients' unmet needs and bridge existing gaps in cancer care. Plain-Language Summary: This research helped to identify barriers and facilitators regarding insufficient knowledge about occupational therapy's role in cancer care and adds a better understanding of gaps in referrals to occupational therapy. In addition, cancer health care professionals who participated in the study suggested practical solutions for reducing barriers and maximizing support for referral. With these nuances, occupational therapy practitioners can work with medical cancer care units (i.e., acute care hospitals, medical cancer centers, and community health care clinics) to target the use of strategies that work for their units to ensure that persons living with and beyond cancer receive needed occupational therapy services.

Occupational Therapy After Breast Cancer Reconstructive Surgery: A Predictor for Opioid Prescriptions.

Occupational therapy practitioners have a unique and vital role among interprofessional health care teams toward facilitating occupational participation among breast cancer survivors. This study investigated the relationship between acute medicine occupational therapy services after breast cancer reconstructive surgeries (BCRS) and a number of prescription refills 90 days after surgery. This retrospective study ran binary logistic regression analyses on 562 women after BCRS for refills of opioid and non-opioid medication. Both models were statistically significant, χ2(7df) = 23.001, p = .002; χ2(7df) = 32.312, p < .001, indicating the ability to distinguish who received opioid or non-opioid refills, respectively. While younger age was a significant predictor across both models, occupational therapy was only significant for opioid refills; each was associated with fewer refills. Early occupational therapy treatment after BCRS is associated with fewer opioid prescriptions 90 days after surgery, therefore enhancing occupation throughout this timeframe is beneficial.

Interventions to Address Cancer-Related Cognitive Impairment (2018-2022).

Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings related to cancer-related cognitive impairment in adults living with and beyond cancer.

Supporting Physical Activity in Adults Living With and Beyond Cancer (2018-2022).

Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings from the systematic review on the effectiveness of interventions addressing physical activity in adults living with and beyond cancer.

Cancer-Related Fatigue (2018-2022).

Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings related to interventions addressing cancer-related fatigue in adults living with and beyond cancer.

Interventions to Improve Sleep for People Living With or Beyond Cancer (2018-2022).

Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings related to physical activity interventions and cognitive behavioral therapy-insomnia to improve sleep for people living with and beyond cancer.

Building a Screen for Cancer Survivorship-Occupational Therapy Services (SOCS-OTS): a classical Delphi study.

PURPOSE: The purpose of this study was to develop and validate items for the Screen of Cancer. Survivorship - Occupational Therapy Services (SOCS-OTS), a patient-driven screening tool to be used by frontline workers and filled out by cancer survivors that can indicate a need for appropriate occupational therapy (OT) referral. METHODS: Five rounds of a classical Delphi study were conducted to determine item inclusion. Expert panelists in rounds 1 and 2 consisted of adults LWBC who verified proposed items relevant to issues in activities of daily living (ADLs). Expert panelists in rounds 3-5 consisted of expert OTs who determined item relevance through consensus and item modification. RESULTS: Forty-five adults living with and beyond cancer (LWBC) and 14 expert oncology occupational  therapists and researchers participated in five rounds of surveys. A total of 20 items reached consensus at 80% with a "check all that apply" format. Items included address ADLs meaningful to adults LWBC. CONCLUSIONS: The SOCS-OTS is an innovative content-valid screening tool designed to identify problems with ADLs relevant to OT referral. IMPLICATIONS FOR CANCER SURVIVORS: The SOCS-OTS can empower cancer survivors and cancer care teams by indicating when daily activities are impacted enough to refer to OT services. This could ensure that cancer survivors receive the rehabilitation services they need.

Exploring the Impact of the Occupational Therapy Health and Wellness Program (OT-HAWP) on Performance and the Health-Related Quality of Life of Cancer Survivors.

Creating innovative community-based programs for those living with and beyond cancer has the potential to improve outcomes; however, little has been done to explore these programs with participants that have various cancer diagnoses. We evaluated the impact of a 4-week community Occupational Therapy Health and Wellness Program (OT-HAWP) on self-perceived satisfaction and performance of daily activities, health-related quality of life, sleep quality, and fatigue among adults living with and beyond various cancer diagnoses. An uncontrolled, prospective, one-group pretest-posttest design was used. Participants completed patient reported measures of occupational performance and satisfaction (Canadian Occupational Performance Measure [COPM]), global health related quality of life (Patient-Reported Outcomes Measurement Information System-Global Health [PROMIS® Global Health]), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), and the effect of fatigue on activities (Multidimensional Assessment of Fatigue [MAF]) before and after the program completion. Data was fully collected on 34 participants with various cancer diagnoses. For all outcomes, there was a statistically significant improvement after participating in the OT-HAWP program. Effect sizes range from small (0.46) to large (1.28). The OT-HAWP has the potential to improve self-reported occupational performance and satisfaction, global health-related quality of life, sleep quality, and fatigue in adults living with and beyond cancer in the community. Efficacy studies exploring community-based interventions are warranted to support legislation for improved access to care.

Occupational Therapy's Role in Cancer Survivorship as a Chronic Condition.

Improved medical care has resulted in a documented increase in cancer survivors in the United States. Cancer survivors face challenges in participation across all facets of life as a result of the cancer and subsequent cancer treatments. Long-term and late-term sequelae can result in impairments in neurological systems, decreased stamina, loss of range of motion, and changes in sensation and cognition. These impairments are often long lasting, which categorizes cancer survivorship as a chronic condition. This categorization presents treatment challenges, especially in creating rehabilitation and habilitation service options that support cancer survivors. Occupational therapy provides a unique focus that can benefit cancer survivors as they face limitations in participation in all aspects of daily living. Research, advocacy, and education efforts are needed to focus on the specific rehabilitation and habilitation needs of cancer survivors to increase access to occupational therapy's distinct value.

Taking Our Seat at the Table: Community Cancer Survivorship.

Cancer survivors are at risk for occupational performance issues related to activities of daily living, instrumental activities of daily living, work, and social and community participation. Occupational therapy practitioners can address these performance issues by offering services within existing community cancer survivorship programs that focus on adaptive and compensatory strategies to facilitate meaningful lifestyles and optimize health and well-being. Occupational therapy services do not currently exist at these community sites, nor are occupational therapy practitioners recognized as providers in existing community cancer survivorship programs. Recognition of practitioners' distinct value in cancer survivorship, advocacy for occupational therapy services in the community, development of supporting documentation for occupational therapy's role in community survivorship, and research on the efficacy of interventions in community cancer survivorship are needed to expand occupational therapy's role with this growing population.

Interventions to Promote Diabetes Self-Management in Children and Youth: A Scoping Review.

As children and youth with diabetes grow up, they become increasingly responsible for controlling and monitoring their condition. We conducted a scoping review to explore the research literature on self-management interventions for children and youth with diabetes. Eleven studies met the inclusion criteria. Some of the studies reviewed combined the participant population so that children with Type 1 as well as children with Type 2 diabetes were included. The majority of the studies focused on children age 14 yr or older and provided self-management education, self-management support, or both. Parent involvement was a key component of the majority of the interventions, and the use of technology was evident in 3 studies. The findings highlight factors that occupational therapy practitioners should consider when working with pediatric diabetes teams to select self-management interventions.

Does botulinum toxin type A decrease pain and lessen disability in hemiplegic survivors of stroke with shoulder pain and spasticity?: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: The aim of this study was to assess the efficacy of botulinum toxin type A injections in reducing pain, impairment, and disability in patients who have had a stroke with shoulder pain and spasticity. DESIGN: In this prospective randomized, double-blind, placebo-controlled trial, adults (n = 37) with post-stroke shoulder spasticity were screened for preinjection spasticity, rated 3 or 4 on the Modified Ashworth Scale for the shoulder adductors/internal rotators and shoulder pain. After the baseline screening, 21 subjects were randomized to receive either onabotulinumtoxinA (Botox; 140-200 units), into the pectoralis major with or without injections to the teres major, or placebo (saline) injections. Daily pain ratings using visual analog scales of best and worst pain and Disability Assessment Scale for dressing, hygiene, pain, and cosmesis; McGill Pain Questionnaire-Short Form; Fugl-Meyer Scale; upper limb range of motion; and Modified Ashworth Scale scores were assessed at baseline and 2, 4, and 12 wks after injection. Primary outcomes were assessed at week 4. RESULTS: The subject groups were well matched at baseline. Both the botulinum toxin type A and placebo groups showed decreased pain scores at 4 wks (P's < 0.05), with no significant differences between the groups found for any of the daily pain ratings (P's > 0.05). Significant improvement (P < 0.05) in change scores for hygiene on the Disability Assessment Scale was found in the botulinum toxin type A group compared with the placebo group at week 4, and there was a similar trend toward significance for improvement on the Disability Assessment Scale dressing scale (P = 0.061). CONCLUSIONS: Although botulinum toxin type A shoulder muscle injections in patients who have had a stroke with spasticity and shoulder pain resulted in improvement in selected disability measures, the observed pain reduction was not greater than that found for placebo.