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Japanese Journal of Comprehensive Rehabilitation Science (2020)

Original Article

The role of occupational therapists in palliative care teams:
differences of rehabilitation occupations expected by other occupations
Yoshiaki Ikechi, OTR, MS,1,2 Keiko Inoue, OTR, PhD,3 Masahiko Ishimaru, MD, PhD4
Doctoral Program in Rehabilitation, Graduate School of Health Science and Technology, Kawasaki University of
Medical Welfare, Kurashiki, Okayama, Japan
2Kagawa Prefectural Marugame Hospital, Marugame, Kagawa, Japan3
Department of Occupational Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare,Kurashiki, Okayama, Japan
4
The Open University of Japan, Faculty of Liberal Arts, Chiba, Chiba, Japan1

ABSTRACT
Ikechi Y, Inoue K, Ishimaru M. The role of occupational
therapists in palliative care teams: differences ofrehabilitation occupations expected by other occupations.
Jpn J Compr Rehabil Sci 2020; 11: 98-101.
Objective: This study aimed to compare the role ofoccupational therapy (OT) with that of rehabilitation
occupations in palliative care teams (PCT).
Methods: A questionnaire survey was conducted on
PCT representatives and OT department managers at
cancer hospitals.
Results: Approximately 40% of facilities had an
occupational therapist registered (OTR) in the PCT.
Differences among the roles of each rehabilitation
occupation were not found. Regarding the role of theOTR in the PCT, items that had significantly higherscores in the responses of PCT representatives were
“support for transition and selection of treatment places”
and “care for outpatient/home care patients.” Items that
had significantly higher scores in the responses of OT
department managers were assessment approaches formental distress, patient decision support, and family care.
Conclusions: It is necessary to clarify the role of not
only OT but also all rehabilitation occupations in thePCT. It is also important for OTRs to take advantageof their own strengths and focus on the roles requiredby other occupations.
Key words: palliative care team, rehabilitation,
occupational therapy, role

Correspondence: Yoshiaki Ikechi, OTR, MS
Kagawa Prefectural Marugame Hospital, 9-291
Dokichohigashi, Marugame, Kagawa 763-0082, Japan.
E-mail: ikechiwawa0705@yahoo.co.jp
Accepted: July 7, 2020.
Conflicts of interest: The author has no conflict of interest
directly relevant to the content of this article.
©Kaifukuki Rehabilitation Ward Association 2020
doi.org/10.11336/jjcrs.11.98

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Introduction
In 2002, the World Health Organization (WHO)defined palliative care as “Palliative care is anapproach that improves the quality of life of patientsand their families facing the problem associated withlife-threatening illness, through the prevention andrelief of suffering by means of early identification and
impeccable assessment and treatment of pain andother problems, physical, psychosocial and spiritual”[1]. Since this definition was made, palliative careteams (PCT) have been established at cancer hospitals
in Japan. The establishment of a PCT is one of therequirements of a cancer hospital, and the team consistsof the physician in charge of physical symptoms,
physician in charge of psychiatric symptoms, full-timenurse, pharmacist, and psychologist [2]. Individuals withrehabilitation occupations were excluded. However, theJapanese Society for Palliative Medicine considered
individuals with rehabilitation occupations as part of theteam members in the PCT [3]. Individuals withrehabilitation occupations are Registered Physical
Therapist (RPT), Occupational Therapist Registered(OTR), and Registered Speech-Language-Hearing
Therapist (RST). No previous studies havesystematically investigated the differences in the rolesof the RPT, OTR, and RST. Therefore, this study
aimed to clarify the role of the OTR in comparison
with individuals with other rehabilitation occupations.
We determined the role of the OTR in the PCT in thisstudy, to provide action guidelines for the OTR in thePCT and to lead to smooth cooperation with otheroccupations.
Methods
1. Subjects
We targeted cancer hospitals in Japan, and conducteda self-administered questionnaire survey by mail. WeJpn J Compr Rehabil Sci Vol 11, 2020

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Ikechi Y et al.: The role of occupational therapists in palliative care teams

extracted 335 hospitals of 400 cancer hospitals thatwere listed in the 2015 Japan Association of
Occupational Therapists Members (April 1, 2017).
The subjects were the PCT representatives andoccupational therapy (OT) department managers of
the target facilities.
2. Questionnaire
The questionnaire asked about the attributes of thesubjects, basic information about PCT (participatingoccupations, etc.), and roles in the PCT. Regarding theroles in the PCT, Morita et al. had investigated thepurpose of clarifying the activities of the PCT in many
cancer hospitals [4], and so we used the results of thatstudy. The 12 items listed in Tables 1 and 2 were ratedusing a 5-point scale (1: not applicable to 5: very
applicable). We asked the PCT representatives
regarding the roles of the RPT, OTR, and RST, and theOT department managers regarding the role of theOTR.
3. Implementation period
The questionnaire was mailed to the subjects on
November 1, 2017. The deadline for responding wasNovember 20, and a reminder postcard was posted on
November 16. The forms that were collected from
November 7 to December 22, 2017 were analyzed.
4. Statistical analysis
The Mann-Whitney U test was used to compare the99

two groups, and the Kruskal-Wallis test (Scheffe’s
method for multiple comparisons) was used tocompare the three groups. The significance level wasset at 5%.
5. Ethical considerations
The study was approved by the Research Ethics
Committee of The Open University of Japan(Notification No. 32).
Results
The recovery rate was 53.4% for PCT representatives
and 52.5% for OT department managers.
1. Basic information
The breakdown of PCT representatives (n=179)
was as follows: 80 physicians (44.7%), 89 nurses(49.7%), 9 RPTs (5.0%), and 1 blank (0.6%). Of theoccupations (n=179) belonging to the PCT, there were
175 physicians (97.8%), 178 nurses (99.4%), and 175
pharmacists (97.8%). There were a total of 135 socialworkers (75.4%), 119 psychologists (66.5%), 114
registered dietitians (63.7%), 102 RPTs (57.0%), and71 OTRs (39.7%). Moreover, 30% of the targetfacilities did not have rehabilitation occupations in thePCT. The following distribution was found: RPT +OTR 25%, RPT 21%, and OTR 16%.

Table 1. Roles of individuals with rehabilitation occupations in the PCT considered by the PCT representatives.
RPT(n=178)OTR(n=174)

RST(n=164)

p-Value4.22±0.70

4.22±0.71

4.07±0.75

0.07

3.93±0.80

3.94±0.81

3.84±0.820.42

4.25±0.64

4.16±0.69

3.97±0.73

4. Assessment approach for mental distress
5. Assessment approach for social distress
6. Assessment approach for spiritual distress
7. Patient decision support
8. 
Support for transition and selection oftreatment places3.80±0.89
3.60±0.92
3.66±0.90
3.47±0.89
3.97±0.82

3.90±0.85
3.75±0.87
3.76±0.88
3.50±0.93
3.89±0.84

3.80±0.79
3.63±0.84
3.65±0.85
3.45±0.92
3.51±0.93

9. Care for outpatient/home care patient
10. Family care
11. Support of other staff
12. Making adjustments within the palliative
care team

3.72±0.99
3.48±0.87
3.72±0.89
2.75±1.01

3.71±0.98
3.55±0.88
3.63±0.93
2.80±1.02

3.58±0.98
3.54±0.89
3.53±0.96
2.76±1.01   <0.01**
RPT-RST : <0.01**
OTR-RST : <0.05*
0.37
0.26
0.35
0.92
   <0.01**
RPT-RST : <0.01**
OTR-RST : <0.01**
0.26
0.70
0.18
0.80

1. Identification of patient problems, worries,
and needs
2. Identification of family problems, worries,
and needs
3. Assessment approach for physical distress5-point scale (1: Not applicable at all to 5: Very applicable).
Kruskal-Wallis Test (Scheffe’s method for multiple comparisons), significance level is 5%. *p<0.05, **p<0.01.
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2. Role of individuals with rehabilitation occupationsin PCT considered by the PCT representatives(Table 1)
The score of the RPT was significantly higher thanthat of the RST in the two items of “assessment
approach for physical distress” and “support fortransition and selection of treatment places” (both p <0.01). The score of the OTR was significantly higher
than that of the RST in the “assessment approach forphysical distress” (p < 0.05) and “supporting thetransition of treatment site selection” (p < 0.01).
However, in other items, no significant difference wasobserved among RPT, OTR, and RST. Particularly, nosignificant difference was observed between RPT andOTR. The average scores for most items were in thelatter half of the third to the first half of the fourth.
3. Comparison of the role of the OTR in PCT between
PCT representatives and OT representatives(Table 2)
Items that had significantly higher scores in the
responses of PCT representatives were “support fortransition and selection of treatment places” (p < 0.01)
and “care for outpatient/home care patients” (p <0.05). Items that had significantly higher scores in the
responses of OT department managers were“assessment approach for mental distress” (p < 0.01),“patient decision support” (p < 0.01), and “familycare” (p < 0.01). The average scores of most items
were in the latter half of the third to the first half of thefourth.

Discussion
1. Basic information
Generally, 30% of the facilities had no rehabilitation
occupations in the PCT. As one of the factors, theparticipation of individuals with rehabilitation
occupations in the PCT seems to be unnecessary in thesystem, and there is no preferential treatment in terms ofhealth care fees even if individuals with rehabilitation
occupations participate in the PCT. However, webelieve that individuals with rehabilitation occupations
should also participate in the PCT to provide highquality palliative care to meet the diverse wishes ofpatients and their families. In the future, it will benecessary to clarify the role and effectiveness of eachrehabilitation occupation in the PCT. Approximately
40% of the facilities had an OTR in the PCT. Nishikori
et al [5]. reported that a shortage of OTRs was thereason why OT was not performed for patients withcancer. They also revealed that it is necessary for otheroccupations to understand the role of the OTR. In thisstudy, the causes of the small number of OTRs in thePCT may be the shortage of OTRs and a lack ofunderstanding of OT specialty.
2. Role of each rehabilitation occupation in PCT
considered by the PCT representatives
Focusing on the role of the OTR, the scores for“assessment approach for physical distress” and“support for selection and transition of medical
treatment place” were higher than those of the RST,
but no other significant difference was observed. Thissuggests that PCT representatives may not be aware of
the differences in the role of each rehabilitation
occupation. However, the average score for each item

Table 2. Comparison of the roles of the OTR in the PCT between PCT representatives and OT department managers.
PCT representatives OT department managers(n=174)(n=166)
1. Patient problems, worries, need identification
2. Family problems, worries, need identification
3. Assessment approach of physical distress
4. Assessment approach of mental distress
5. Assessment approach of social distress
6. Assessment approach of spiritual distress
7. Patient decision support
8. Support for transition and selection of treatment
places
9. Care for outpatient/home care patient
10. Family care
11. Support of other staff
12. Make adjustments within the palliative careteam

p-Value4.22±0.71
3.94±0.81
4.16±0.69
3.90±0.85
3.75±0.87
3.76±0.88
3.50±0.93
3.89±0.84

4.25±0.68
4.11±0.69
4.24±0.63
4.29±0.59
3.87±0.79
3.73±0.79
3.86±0.86
3.53±0.84

0.81
0.06
0.27
   <0.01**
0.22
0.45
   <0.01**   <0.01**

3.71±0.98
3.55±0.88
3.63±0.93
2.80±1.02

3.48±0.93
3.80±0.71
3.69±0.72
2.86±0.88   0.01*   <0.01**
0.680.53

5-point scale (1: Not applicable at all to 5: Very applicable).
Mann-Whitney U test, significance level is 5%. *p<0.05, **p<0.01.
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was in the latter half of the third to the first half of thefourth, and many subjects answered 3 or 4. Each item
was expressed abstractly. The items used in this study
were the job contents of the PCT, so it could beconsidered that any PCT staff would be more or lessinvolved in any job category, which may also haveinfluenced the results of this study.
3. Role of the OTR in PCT considered by PCT
representatives and OT department managers
Items that had significantly higher scores in theresponses of the OT department managers were“assessment approach for mental distress,” “patientdecision support,” and “family care.” This indicatesthat OTRs were more aware of their role, and could be
the strength of the OTR. In addition, items that hadsignificantly higher scores in the responses of the PCT
representatives were “support for transition andselection of treatment places” and “care for outpatient/home care patients.” This indicates that these items
were the roles required from other occupations. We
believe that these points should be considered when
an OTR is involved in patients receiving PCTintervention. In the future, when an OTR is involvedin patients with cancer in the palliative period, it will
be necessary to take advantage of the OTR’s own
strengths and provide interventions focusing on thepoints required by other occupations.
ConclusionThis study aimed to clarify the role of OT from that ofeach rehabilitation occupation in the PCT. Aquestionnaire survey was conducted on the PCT
representatives and OT department managers of cancer
hospitals. As a result, 30% of the facilities had no
rehabilitation occupation in the PCT. Approximately
40% of the facilities had an OTR in the PCT. Differencesin the roles of each rehabilitation occupation were notfound. The OT department managers believed that theroles of the OTR in the PCT were support for mental
distress, patient decision support, and family care.
These could be considered the strengths of the OTR.
PCT representatives believed that the roles of the OTR
in the PCT were support for selecting and shifting
treatment sites and care for home care patients. Thesecould be considered as the roles required from otheroccupations. In the future, it will be necessary toclarify the role of each rehabilitation occupation in not
only OT but also PCT. It is necessary for OTRs to takeadvantage of their own strengths and to focus on theroles expected from other occupations. This study
provides basic information for establishing the roles ofrehabilitation occupations in PCT. However, webelieve it will be necessary to formulate more specificroles for the OTR and to prepare a questionnaire.
Limitations of this study
Since the questionnaire survey was conducted bymail, it was not possible to confirm whether thesubjects fully understood and answered the questions.
Some items were omitted. Therefore, it cannot beconfirmed that the results of this study reflect theactual conditions of PCTs in Japan.
Acknowledgments
We would like to thank all the participants for theircooperation in this study, and Professor Keiko Inoueand Masahiko Ishimaru for instructing in this study.

References

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