I chose the profession with my mindset very much focused on the most typical form of Physiotherapy, the speciality that most people think of when they think about this profession; sports injuries, back pain, rehabilitation post-orthopaedic surgery etcetera, etcetera.

I quickly realised that the majority of co-students on the degree course had similar pre-conceived ideas.

As we moved through the 3-year degree course, I learnt of the wide-ranging fields of expertise we could branch out into.

We studied and had work experience in areas such as neurology, respiratory, care of the elderly, oncology, mental health, musculoskeletal, pain management, women’s health and so many more.

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So Much More Than Just Meeting A Patient’s “Physical” Needs

I soon learnt that, as a “physical” therapist, our work is, in fact, largely psychological.

This aspect of the profession really interested me.

During my placements in hospitals, I worked alongside so many inspiring practitioners who taught me that communication skills, goal setting, imagery, personality theories and effective inter-disciplinary practices were key.

Learning to really listen and empathise with clients meant increased clinical effectiveness (i.e. our treatments worked and had a lasting positive impact on a patient’s health and well-being) and thus greater job satisfaction.

When I was introduced to Palliative care, I felt that I had found my calling as this speciality focused strongly on the holistic needs of the client, caring for their physical, emotional, psychological and spiritual well-being.

As a Physiotherapist, you have so much to offer in end-of-life care.

This often surprises people as they wonder what scope for rehabilitation there is at this stage in someone’s life.

Defining Palliative Care

Dame Cicely Saunders, Founder of the Modern Hospice Movement

Let us first understand what Palliative care is.

The word palliative comes from the Latin word ‘pallium’ and means ‘cloak’, something in which you wrap yourself or another human being.

This cloak symbolises the care of the dying person and their family.

The World Health Organization’s definition of palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, psychological, psychosocial and spiritual.

Palliative care:

- Provides relief from pain and other distressing symptoms

- Affirms life and regards dying as a normal process

- Intends to neither hasten or postpone death

- Integrates the psychosocial and spiritual aspects of patient care

- Offers a support system to help patients live as actively as possible until death

- Uses a multidisciplinary team (MDT) approach to address the needs of patients and their families

- Palliative care may include chemotherapy and radiotherapy to manage distressing symptoms

The Multi-Disciplinary Approach To Palliative Care

The MDT usually consists of different professionals e.g. Physician, Nurse, Physiotherapist, Occupational Therapist, Social Worker, Dietician, Chaplain and Complementary Therapists.

To be able to provide holistic care there is need for the whole team.

Palliative care has its roots in the modern hospice movement initiated by Dame Cicely Saunders.

She was an English Nurse, Social Worker and later Physician who, in her work found that the patients did not have just physical pain but also psychological, social and existential problems.

She founded St Christopher’s Hospice in London in 1967.

Apart from being the first hospice it was also the first educational and research unit in this subject and continues to be.

The Role Of The Physiotherapist

In Palliative Care As a Physiotherapist, you can help people to remain as active and independent for as long as their disease progression allows as well as assisting in symptom management alongside the client’s healthcare team.

It is much easier to maintain function, than regain it once it has been lost, therefore an assessment focusing on function (i.e; walking ability, getting in-out of chair etc) is best done proactively.

It’s often very supportive to set person-centred, realistic short-term, flexible goals with clients which can help them maintain a sense of control and purpose.

Maintaining the ability to dress one’s self, walk short distances, manage the stairs etc can be very important goals to work towards, even if the goal isn’t achieved due to disease progression.

The main aims of the Physiotherapist working along-side the MDT will be:

- To maintain or improve independence, reducing dependence on carers and encourage self-management and a sense of control

- Non-pharmacological management symptom interventions for pain, breathlessness, fatigue, and lymphoedema alongside Nursing and medical care

- Exercise prescription: individual programmes aimed at improving muscle strength, flexibility, balance and mobility

- A key part role is being watchful for deterioration in their mobility and providing mobility aids when necessary

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Supporting People To Achieve Their Dying Wishes

As a Physiotherapist you may be pivotal in supporting people to achieve their final wishes, for example, I have supported an elderly train enthusiast to have one final ride on a steam train with his wife, another lady to walk on the beach and dip her toes in the sea one last time.

In my experience it’s a real privilege to be and support people at this time in their lives.

My work as a Palliative care Physiotherapist was very variable on a day-to-day basis, never a moment to get bored.

Some days I would be running an acupuncture clinic for symptom management, the next day assessing a patient with Motor Neurone disease and setting up devices that could support their ability to cough and clear secretions from their lungs, another day providing walking aids for someone whose mobility had deteriorated.

Obviously, there can be days that are very distressing. You can create meaningful relationships with people and then at some point they die.

This is why in Palliative Care, clinical supervision is very important.

A time to talk about your case load and how you are feeling.

It is also worth noting that if you have had a recent bereavement, it’s important to take time for your own grieving process before entering the speciality, I learnt this first-hand.

Final Thoughts

Palliative care is most certainly a less well-known specialty in Physiotherapy, I was always shocked that so few people knew about it and also the low numbers of people who wanted to specialise in it.

For me, it was a role that of course was sometimes deeply saddening but ultimately a huge privilege and a job with meaning.

Finding My Niche: Palliative Care Physiotherapy