Multidisciplinary approaches to moving and handling for formal and informal carers in community palliative care.

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Multidisciplinary approaches to moving and handling for formal and informal carers in community palliative care Carol Bartley, Jo-Anne Webb, Joanne Bayly

© 2015 MA Healthcare Ltd

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c c o r d i n g t o t h e Wo r l d H e a l t h Organisation (WHO, 2002), palliative care should be holistic and delivered by a multidisciplinary team (MDT) approach to both the patient and their family (Hudson et al, 2008). Each member of the MDT, including nurse, occupational therapist (OT), physiotherapist (PT), doctor and social worker, has an important role to play in delivering collaborative and holistic patient-centred treatment (Strong et al, 2012). Alongside expertise in symptom management and psychological support, nurses are able to facilitate interventions when needed through the coordination of practical assistance, advice and individualised packages of care (Corner, 2003). One important aspect of this involves enabling patients and their informal carers, such as family members to maintain dignity in a safe environment during activities of daily living (ADL) through well-planned moving and handling strategies. An understanding of the varying trajectories of functional decline experienced by patients in the last days of life is essential for all team members, in particular nurses who are usually the first point of contact (Harris et al, 2013). Knowing and anticipating functional decline trajectories can help health professionals plan safe and appropriate moving and handling interventions with patients and carers to minimise risk (Murray et al, 2005). Palliative care patients experience a range of symptoms, including but not limited to: reduced mobility, anxiety, incontinence, decubitus ulcers, pain, breathlessness and fatigue (Chaudhry et al, 2013). The impact of a person's symptoms on functional independence will vary between diseases and individuals (Solano et al, 2006). People with cancer may retain high levels of function until the last months of life, when a steep deterioration may occur. However, it should to be remembered that patients can retain some functional and cognitive independence up until the last days of life (Lunney et al, 2003). Patients with chronic organ failure such

International Journal of Palliative Nursing 2015, Vol 21, No 1

Abstract

Health professionals such as nurses, physiotherapists and occupational therapists provide a wealth of support in the community to patients and their carers receiving palliative care. Moving and handling is one such support that needs careful consideration and assessment including risk, by appropriately qualified professionals. A combination of skills are required as well as knowledge of up to date equipment to assist the health professional in deciding how to formulate safe moving and handling interventions in a timely way. Patients with palliative care needs and their carers should be given the appropriate care and support necessary using a holistic, flexible and patient-centred approach to service delivery. Key words: Moving and handling l Palliative care l Multidisciplinary l Community l Carer This article has been subject to double-blind peer review. as chronic obstructive pulmonary disease (COPD) or renal failure may experience fluctuating functional ability, with patterns of exacerbation and then recovery. Others, such as elderly frail people and those with degenerative neurological conditions may experience an ongoing and sometimes relentless decline in function. People may fear being a burden to their loved ones, yet desire to remain involved in normal everyday activities (Eva and Wee, 2010). Contributing factors to this existential distress can include comorbidities, polypharmacy, visual impairment and social and environmental isolation (Rolls et al, 2011). Together these factors place patients at a greater risk of activity avoidance, deconditioning, falls and the development of pressure ulcers, resulting in an increased dependence on others (Gillespie et al, 2012). Supporting carers to care for their loved ones is as important as supporting the patient themsleves. Such is the awareness and importance attributed to supporting informal carers that some countries, including the UK, have developed standards and legislation to address their specific needs (Hudson et al, 2009). In the

Carol Bartley MSc Pg Cert Dip COT, Lecturer Occupational Therapy, School of Health Sciences, Frederick Rd Campus, University of Salford, Manchester; Jo-Anne Webb MSc Dip COT PG CAP, Senior Lecturer Occupational Therapy School of Health Sciences Frederick Rd Campus, University of Salford, Manchester; Joanne Bayly MRes GradDipPhys Specialist Physiotherapist, Woodlands Hospice Charitable Trust, Longmoore Lane, Liverpool Correspondence to: Carol Bartley c.a.bartley@salford. ac.uk

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onal Journal of Palliative Nursing. Downloaded from magonlinelibrary.com by 193.061.135.112 on November 18, 2015. For personal use only. No other uses without permission. . All rights r

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UK, the Carers Recognition and Services Act (1995) makes provision for carers to request an assessment of need in their own right in order to help them continue to care (Department of Health (DH), 1995). More recently introduced in the UK, the Care Act (DH, 2014) puts emphasis on providing mechanisms for carers to receive support before a crisis develops. For example, assessment of a carers’ ability to perform moving and handling tasks and supplying the necessary equipment and training at the right stage to assist them in caring for their loved one. This article seeks to outline factors health professionals need to consider when planning and implementing moving and handling strategies with patients, and formal and informal carers in the community. The role of palliative rehabilitation services in the delivery of moving and handling strategies will be discussed, and key pieces of equipment to support moving and handling strategies with be described.

Factors to consider for moving and handling palliative care patients Moving and handling risk assessments should be carried out to identify the patient’s physical and cognitive limitations on a required manoeuvre, such as moving from bed to bathroom and also assess the carer's ability to perform moving and handling tasks. Some risk assessment models published and commonly used in the UK such as those by the Health and Safety Executive (HSE, 2005), National Back Exchange (Ruszala et al, 2010) and The Royal College of Nursing (RCN, 2000) focus on four areas referred to as ‘TILE’: task, individual, load, environment. The risk assessment model equates the patient to a ‘load’, in terms of the patient's weight, cooperativeness and receptiveness. This approach may be seen as impersonal, as it potentially fails to address other significant contextual factors; these may include multiple losses and suffering experienced by the patient and their carers, maintaining usual relationships, a sense of control and feelings of safety (Wrubel et al, 2009). As part of the MDT, nurses are well-placed to identify these contextual factors when planning and delivering moving and handling strategies and interventions. Collaboration with other relevant team members such as the OT and PT, whose role involves supporting patients in ADL, transfers and mobility ensures a seamless approach to care. All health professionals involved in the patients care need to consider these other important contextual factors which will be discussed in this section.

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Suffering and loss Patients living with a palliative disease may experience grieving responses to loss of normality, independence, safety and control (Wrubel et al, 2009). While moving and handling strategies are practical solutions to physical limitations, the meaning for patients associated with these strategies can lead to increased psychological distress. For example, suggesting moving the patient’s bed downstairs to enhance safety or compensate for reduced mobility and enable care to continue to be provided in the home environment may be received positively by some patients (Exley and Allen, 2007), but for others it may be perceived as a loss of independence and an unwanted change to lifestyle, leading to distress for the patient which which must be acknowledged. The answer to some of these complex issues lies, in part, in the communication skills of the health professional. Using techniques such as advanced communication, active listening and asking openended questions to engage with the patient and carer can be of great help (Moore and Reynolds, 2013). If the introduction of an intervention is not communicated thoughtfully to the patient, it may be percieved by the patient and their carer as the health professional delivering ‘bad news’. This has been defined by (Buckman, 2005: 138) as ‘any news that adversely and seriously affects an individual’s view of his or her future’. Sexton (2013) recognises that these ‘bad news conversations’ in health care are among the most difficult clinical tasks that a health professional has to undertake, often impacting upon the therapeutic relationship. For example, introducing the use of a hoist or a wheelchair can be interpreted negatively as it could imply a loss of independence. The introduction of any piece of moving and handling equipment or strategy to compensate for loss of function should be introduced to the patient gradually and needs to be communicated skillfully and thoughtfully and in a positive light. In order for equipment to be introduced successfully, it is essential to develop a ‘culture of compassionate care’ (DH, 2012) with meaningful, effective and collaborative relationships between patients and health professionals and individualised, culturally sensitive practice (Cole and McLean, 2003).

Patient and family support Deciding appropriate moving and handling strategies for the patient requires the occupational therapist or physiotherapist to collaborate with the patient and carer to ensure a timely assessment and outcome is achieved. Caring for a relative who is at the end of life is a demanding task,


❛In order for equipment to be introduced successfully, it is essential to develop a ‘culture of compassionate care’❜




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which can cause high levels of stress (Blum and Sherman, 2010), and psychological problems such as depression and anxiety (McNamara and Rosenwax, 2010). One of the underlying contributors to the stressful situations faced by the carer is the lack of information given regarding the patient’s care. This was highlighted by Jansma et al (2005), who found that after communication, practical information was the most important support required for carers. Nursing skills, information about medical aids, employment, social support and methods of obtaining information about the patient’s disease were also of concern to carers. This is supported by Kealey and McIntyre (2005), who reported that the physical difficulties faced by the patient in carrying out essential ADL impacted significantly on the carer. Their study also found that the burden of stress and anxiety was alleviated with the provision of equipment to address such issues. Analogous research suggests that carers place great importnace on the need for information relating to nonmedical interventions such as moving and handling for positioning and bathing (Bee et al, 2008). They asserted that for carers, inconsistent access to technical equipment and a lack of practical guidance on how to use it was a source of frustration. Much of the literature regarding carer support focuses on gaps in palliative care services in both physical and psychological aspects. A detailed search of the literature found limited studies to illustrate improvements in moving and handling when carers were trained and informed. One notable exception was a study carried out by Roberts et al (2012), who found that carers who received training in moving the patient using a wheelchair complained of less pain in the shoulders, arms and wrists than those that did not receive training. Successful strategies already being employed by patients and their carers to maintain functional independence in the home environment should be considered and included as part of the care planning. Those identified strategies can then be affirmed, thus empowering patients and families throughout processes of the disease and treatment (Eva and Wee, 2010). The resources required by caregivers are determined by patient requirements and the carer’s ability to sustain the unremitting demands placed upon them, such as physical tasks, financial costs, emotional burdens and mental and physical health risks (Rabow et al, 2004). Carers’ needs are as relevant as those of the patient, thus identification of difficulties and support will help them to navigate a complex and stressful journey with their loved one. Nurses and health professionals need


to be aware not only of practical ways of assisting carers with moving and handling strategies, but also knowing where to suggest they can go for support, e.g. charitable organisations and social media websites.

Palliative rehabilitation The earlier stages of anticipated and actual functional decline require referral to physiotherapy, occupational therapy and falls management services for advice, strategies and interventions (see Figure 1). These services support ongoing functional independence for the patient and may defer the need for moving and handling equipment. Rapid deterioration may not be inevitable for all patients. Planning safe movement strategies with patients and their carers, prescribing home exercises (Lowe, 2011), and teaching breathlessness and fatigue management may delay or minimise the impact of symptoms on functional activities (Eva and Wee, 2010). When ongoing decline is anticipated, equipment introduced for symptom control purposes, can be reassessed by members of the MDT who have knowledge of the patient in their home environment. MDTs working in close liaison with patients and their families can facilitate sensitive introduction of formal packages of care to maintain ongoing safe moving and handling practices.

❛...after communication, practical information was the most important support required for carers.❜

Moving and handling equipment in palliative care Recommendations for equipment early in the patient’s care can maintain independent function for ADL and enhance comfort (Bentley et al, 2013). Figure 1 shows the different pieces of equipment and interventions used by members of the MDT in palliative care. Glendinning et al (2006) advocate the importance of maintaining a patient-centred approach when prescribing equipment, acknowledging the patient as the centre of any assessment and collaboration. Working in partnership with the patient and carer to facilitate safe moving and handling can allow the patient to remain in their own home and reduce the need for complex care packages (Mickel, 2010). Any piece of equipment or minor adaptation should be introduced gradually and only when the patient feels ready to accept them emotionally (O’Neill and Rodway, 1998). It is important in the early stage of the patient’s illness for the health professional to acknowledge future possibilities of the availability of future moving and handling support and equipment and possible environmental modifications. Skilled assessment and training for the patient and carers by OTs and PTs

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Early stage of patient’s illness

Middle stage of patient’s illness

Late stage of patient’s illness

- ADL assessment - Wheelchair assessment - Transfers: glide sheet, transfer board - Fatigue management - Home adaptations e.g. grab rails - Access, environment - Advice provided for carer and patient for safe moving/transfers - Toileting/bathing equipment

- Stand aid - Mobile hoist - Anxiety management - Risk assessment - Tissue viability management e.g. cushions - Positioning - Splinting - Home adaptations - Quality of life issues - Training in moving and handling with carers and patient

- Profiling bed - Riser-recliner chair - Pressure cushion - In-bed management system - Gantry hoist - Seating in wheelchair - Review of home adaptations - Reassessment of moving and handling equipment and techniques - Further training and advice to patient and carers in moving and handling techniques and equipment

PT

- Prescription of active/passive exercises to maintain muscle strength, joint range of motion, soft tissue flexibility and balance reactions to assist in moving and handling strategies. - Non-pharmacological interventions e.g. fatigue, pain and breathlessness management to minimise impact of symptoms on movement

- Movement strategies and falls management e.g. safe sit to stand - Supporting informal and formal carers in use of moving and handling equipment e.g. wheelchair, standing turner, transfer board - Provision and education in use of safe walking aids e.g. stick, walking frame and 3-wheeled walker

- Postural comfort and positioning i.e. passive movements to maintain ankle range and calf soft tissue length to allow feet to rest flat on the ground or wheel chair footplates - For inpatients confined to bed, passive movements ameliorate the impact of bed rest on tissue viability

Nurse

- Pharmacology - maintain good symptom control - Refer to PT/OT for specialist rehabilitation assessment and interventions including moving and handling and mobility - Tissue viability assessment and interventions - Continence issues-may impact on safe ambulation and transfers

- Ongoing maintenance of good symptom control - Tissue viability assessment – pressure sores impact negatively on bed mobility and transfers. - Supporting informal and formal carers in use of moving and handling equipment

- Continence strategies - Supporting informal and formal carers in use of moving and handling equipment e.g. hospital bed, hoist - Ongoing tissue viability assessment and provision e.g. pressure mattress

OT

Arrows indicate the need for continuous psychological support throughout moving and handling interventions

regarding the use of appropriate equipment is required for safety and effectiveness (Pushpangadan and Burns, 1996). This must be carried out without overloading the home with equipment, which may make it feel like a clinical environment. Early equipment solutions to facilitate safe moving and handling procedures

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can be as minimal as the provision of a simple glide sheet or transfer board, bed lever or stand aid. An individualised risk assessment must precede provision of equipment, with regular and appropriate training to facilitate active involvement of the service user (DH, 2000). Timely provision of such interventions can be highly


Figure 1. Multidisciplinary interventions and equipment for palliative care at early, middle and late stages of disease progression



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effective in preventing health problems associated with reduced mobility, while also benefitting the physical and mental health of carers by improving the environment and reducing stress levels (Heywood and Turner, 2007). If equipment provision is left until late in the disease progression, the patient might view this negatively as reinforcing the progress of their decline (Cooper, 2006).

Key pieces of equipment to facilitate safe moving and handling

Glide sheets and transfer boards

Glide sheets and transfer boards are relatively simple, inexpensive pieces of equipment which are issued to the patient to facilitate transfers within the home with two main functions: maintenance of independence in transfers and reduction of risk to carers (Hutfield and Tracey, 2011). Transfer boards can be used effectively to enable patients to move from bed to wheelchair or commode with or without assistance. They may be able to do this transfer themselves using their arms and legs to shuffle across the board sideways, therefore encouraging them to remain active and engaged in daily living, social and leisure activities (Brooks and Orchard, 2011)


Profiling beds Beds are essential items of equipment, yet the importance of providing the right bed to meet moving and handling needs of the patient and carer is sometimes overlooked. Well-designed electric profiling beds offer many advantages, including reduced risk of injury to carers and patients, increased independence and improved cost-effectiveness in providing care (Corr, 2005). Timing of this provision should be approached with sensitivity and is dependent upon the patient’s disease progression. The patient can be encouraged to alter their own position in bed at the touch of a button, promoting independence, maintaining function over time, encouraging better posture and facilitating ease of transfer in and out of bed, either independently or with assistance. The introduction of equipment such as inbed management systems, e.g. the four-way glide system, enable patients to be moved safely by a reduced number of carers. It also reduces shearing and friction and the reported reduction in physical exertion and encourages family members to reposition the patient inbetween formal carer visits. Palliative care patients with pain management and tissue viability problems have reported that the four-way system helps them to move themselves freely on the bed, reducing reliance on others (Sturman-Floyd, 2011: 11).


Wheelchairs Early discussions are essential to introduce the idea of a wheelchair as a method of energy conservation in order to maintain active participation in positive experiences of family and social events outside the home. These discussions may be initiated by the nurse, as the first point of contact who may then liaise with the OT in order to prevent delays in assessment and provision. Wheelchairs can enable safe movement and participation in ADL within the home while also encouraging continued engagement in routines and relationship roles such as spouse, parent, friend. Successful wheelchair provision requires matching the patient’s needs with their environment via an individualised assessment considering patient history and functional difficulties. The physical aspects of the assessment include access within the home for using the wheelchair and social aspects include support from family carers and the carers’ ability to operate a wheelchair (Batavia, 2010). Assessment of risk is essential to balance the benefits of providing a wheelchair to improve the patient’s quality of life against the risks. These risks may include extended periods of sitting, the susceptibility to pressure ulcer development and multiple pathology impacting upon the ability to self-propel or carers having difficulties managing the wheelchair. Health professionals should work collaboratively with patients, focusing on enabling activities and encouraging patients to accept support from others (Cooper, 2006).

❛If equipment provision is left until late in the disease progression, the patient might view this negatively as reinforcing the progress of their decline...❜

Standing equipment When the patient’s standing and walking are assessed by the PT as being unreliable, but weight bearing is possible, the introduction of a standing aid to assist transfers can offer many physical and psychological advantages. The standing aid can be prescribed by the OT or PT. Bracher and Brooks (2010) reported that standing regularly reduces the risk of contractures and pressure ulcers and promotes other physical benefits, such as improved circulation, digestion, bowel function and breathlessness. Regular standing can also help to improve psychological wellbeing and allows the patient to remain active in the process, rather than being passively lifted in a hoist and sling. Manual stand aids actively encourage the patient to pull themselves into standing on a platform while electric standing hoists facilitate a standing position with the patient supported by a sling (Bracher and Brooks, 2010). These slings, specifically designed for use with stand aids are often easier to manage than passive hoist slings and are particularly useful for toileting, and

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might allow family carers to develop confidence in handling techniques as a prelude to the introduction of a passive hoisting system.

Hoists A mobile (or portable) hoist is often the first type of hoist issued to the patient at home as it can be delivered quickly from statutory equipment stores and can provide an immediate solution to the patient being unable to weight bear in transfers. Issuing of a hoist should follow a detailed risk assessment by the nurse or OT to address environmental issues such as space within the room and manoeuvring the hoist (Phillips et al, 2014). An alternative to a mobile hoist is the provision of a floor-standing gantry hoist. This might be useful as a short-term aid as it can be positioned almost anywhere, can be moved from one position to another and be removed very quickly when no longer required (Hutfield and Tracey, 2011). Installation, following manufacturer’s instructions is usually completed by technical personnel at the local authority loan store. Training and instruction in how to use the equipment safely, along with regular review should be part of the support given to the patient and carer (HSE, 2010). Track hoists can be fitted if the patient’s medical condition will be stabilised over a longer period of time. This type of hoist can be used to transport the patient from bed to bathroom in one simple movement allowing access to toilet and bathing facilities. This reduces the number of transfers required, and when introduced in a sensitive and timely manner can contribute to fatigue and pain management and reduce the physical strain on carers. In situ slings can be used to limit handling of patients and reduce the risk of pressure ulcer development. This was reported in research by Mellson and Richardson (2012) who identified spacer fabric slings as the most effective in minimising the risk of pressure ulcer development. They further acknowledged the importance of regular repositioning of the patient to help reduce risk. Towards the end of life, family involvement in transfers and personal care can be a very personal choice.

Conclusion A number of important factors to consider for moving and handling palliative care patients in the community have been discussed. The available equipment has been highlighted which may help health professionals decide how to formulate safe, timely interventions to assist both the patient and their carer. Regular support and training with the right equipment from the

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appropriate health professional can ensure that carers feel confident and able to assist with moving and handling and reducing their reliance on statutory services. This can offer more flexibility and choice for the patient in their daily routine. Further consideration is needed to ensure people with palliative care needs and their carers are given appropriate support at the right time to ensure that truly patient-centred care is delivered. Declaration of interests The authors have no conflicts of interest to declare. Batavia M (2010) The Wheelchair Evaluation: A Clinician’s Guide. 2nd edn. Jones and Bartlett Publishers, Sudbury, Massachusetts MA Bee PE, Barnes P, Luker KA (2008) A systematic review of informal caregivers’ needs in providing home-based, endof-life care to people with cancer. J Clin Nurs 18(10): 1379-93. doi: 10.1111/j.1365-2702.2008.02405.x Bentley R, Hussain A, Maddocks M, Wilcock A (2013) Occupational therapy needs of patients with thoracic cancer at the time of diagnosis: findings of a dedicated rehabilitation service. Support Care Cancer 21(6):1519–24 Blum K, Sherman DW (2010) Understanding the experience of caregivers: a focus on transitions. Semin Oncol Nurs 6(4): 243–58 Bracher M, Brooks A (2010) Moving and Handling Strategies. In: Curtin M, Molineux M, Supyk-Mellson J, eds. Occupational Therapy and Physical Dysfunction: Enabling Occupation. Elsevier, London Brooks A, Orchard S (2011) Core Person Handling Skills. In: Smith J ed. The Guide to the Handling of People; A Systems Approach. Backcare, Middlesex. Buckman R (2005) Breaking bad news: the S-P-I-K-E-S strategy. Community Oncology. http://tiny.cc/4fh4qx (accessed 19 December) Chaudhry SI, Murphy TE et al (2013). Restricting symptoms in the last year of life a prospective cohort study. JAMA 173(16):1534–40 Cole MB, McLean (2003) Therapeutic relationships re-defined. Occupational Therapy in Mental Health 19(2): 33 Cooper J (2006) Occupational Therapy in Oncology and Palliative Care. 2nd Edn. Wiley, London Corner J (2003) Nursing management in palliative care. European J Oncol Nurs 7(2): 83–90 Corr J (2005) Electric profiling beds will improve care and save money in the long term. Nursing Times 101(48): 13 Department of Health (1995) Carers (Recognition and Services) Act 1995. http://tiny.cc/gyhzrx (accessed 1 January 2015) Department of Health (2000) Domiciliary Care: National Minimum Standards. http://tiny.cc/5cizrx (accessed 5 January) Department of Health (2012) Compassion in Practice. http://tiny.cc/f0h4qx (accessed 22 December 2014) Department of Health (2014) The Care Act 2014. http:// tiny.cc/c2h4qx (accessed 19 December 2014) Eva G, Wee B (2010) Rehabilitation in end-of-life management. Current opinion in supportive and palliative care 4(3): 158–62 Exley C, Allen D (2007) A critical examination of home care: end of life care as an illustrative case. Soc Sci Med, 65(11): 2317–27 Gillespie LD, Robertson MC, Gillespie WJ et al (2012) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev (2): CD007146. doi: 10.1002/14651858.CD007146.pub2 Glendinning C, Clarke S, Hare P et al (2006) Outcomes-focused service for older people. http://tiny.cc/x4h4qx (ac-


❛Issuing of a hoist should follow a detailed risk assessment by the nurse or OT to address environmental issues such as space within the room...❜



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cessed 19 December 2014) Harris P, Wong E, Farrington S et al (2013) Patterns of functional decline in hospice: what can individuals and their families expect? Journal of the American Geriatrics Society 61(3): 413–7 Health and Safety Executive (2005) Risk factors associated with pushing and pulling loads. http://tiny.cc/j592rx (accessed 20 December 2014) Health and Safety Executive (2010) Risks to Service users known to self-hoist and transfers using ceiling track hoists. http://tiny.cc/lei4qx (accessed 19 December 2014) Heywood F, Turner L (2007) Better Outcomes, lower costs: implications for health and social care budgets of investment in housing adaptations, improvements and equipment: a review of the evidence. http://tiny.cc/hgi4qx (accessed 19 December 2014) Hudson P, Thomas T, Quinn, K et al (2009) Teaching family carers about home based palliative care: final results from a group education programme. J Pain Symptom Manage 38(2): 299–308 Hudson P, Quinn K, O’Hanlon B, Aranda S (2008). Family meetings in palliative care: Multidisciplinary clinical practice guidelines. BMC Palliat Care 7(12) doi: 10.1186/1472-684X-7-12 Hutfield J, Tracey C (2011) Equipment Strategies. In: Smith, J The Guide to the Handling of People; A Systems Approach. Backcare, Middlesex Jansma FFI, Chure LM, Meyboom De Jong M (2005) Support requirements for caregivers of patients with palliative cancer. Patient Educ Couns 58(2): 182–6 Kealey P, McIntyre I (2005) An evaluation of the domiciliary occupational therapy service in palliative cancer care in a community trust: a patient and carers perspective. Eur J Cancer Care 14(3): 232–43 Lowe SS (2011) Physical Activity and Palliative Cancer Care. In: Courneya KS, Friedenreich CM, editors. Physical Activity and Cancer. Springer, Berlin. Vol 186, 349–65 Lunney JR, Lynn J, Foley DJ et al (2003) Patterns of functional decline at the end of life. JAMA 289(18): 2387–92 McNamara B, Rosenwax L (2010) Which carers of family members at end of life need more support from health services and why? Soc Sci Med 70(7): 1035–41 Mellson J, Richardson N (2012.) The impact of hoist sling fabrics on gluteal interface pressure while sitting in healthy individuals: A controlled pre-post-test study. The American Journal of Safer Patient Handling and Movement 2(3): 79–86 Mickel A (2010) ‘A ticking time bomb.’ Occupational Therapy News 18(5): 38–9

Moore CD, Reynolds AM (2013) Clinical update: communication issues and advanced care planning. Semin Oncol Nurs 29(4): e1–e12 Murray SA, Kendall M, Boyd K, Sheikh A (2005) Illness trajectories and palliative care. BMJ 330(7498): 1007–11 O’Neill B, Rodway A (1998) ABC of palliative care: care in the community. BMJ 316(7128): 373–7 Phillips J, Mellson J, Richardson N (2014) It Takes Two? Exploring the Manual Handling Myth. HfH Consulting Limited, Chippenham, Wiltshire Pushpangadan M, Burns E (1996) Caring for Older people. Community Services: health. BMJ 313(7060): 805–8 Rabow MW, Hauser JM, Adams J (2004) Supporting family caregivers at the end of life: “they don’t know what they don’t know” JAMA 291(4): 483–91 Rolls L, Seymour JE, Froggatt KA, Hanratty B (2011) Older people living alone at the end of life in the U.K.: research and policy challenges. Palliat Med 25(6): 650–7 Roberts J, Young H, Andrew K et al (2012) The needs of carers who push wheelchairs. Journal of Integrated Care 20(1): 23–34 Royal College of Nursing (2000) Safer Staff, Better Care. RCN Manual Handling Training Guidance. http://tiny.cc/ blj4qx (accessed 19 December 2014) Ruszala S, Hall, J, Alexandra P (2010) Standards in Manual Handling Training. 3rd edn. National Back Exchange, Northamptonshire Sexton D (2013) “As good as it’s going to get”. Bad news conversations in neurology: challenges for occupational therapists. British Journal of Occupational Therapy, 76(6): 270–8 Solano JP, Gomes B, Higginson IJ (2006) A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manage 31(1): 58–69 Strong S, Blencowe NS, Fox T et al (2012). The role of multidisciplinary teams in decision making for patients with recurrent malignant disease. Palliat Med 26(7): 95–8 Sturman-Floyd M (2011) Reducing the incidence and risk of pressure sores, manual handling loading and carer costs using “In-bed systems”. http://tiny.cc/ppj4qx (accessed 19 December 2014) World Health Organisation (2002) The Solid Facts: Palliative care. http://tiny.cc/arj4qx (accessed 19 December 2014) Wrubel J, Acree M, Goodman S, Folkman S (2009) End of living: maintaining a lifeworld during terminal illness. Psychology and Health 24(10): 1229–43

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Rural dementia carers: formal and informal sources of support.

Dementia care: intersecting informal family care and formal care systems.

Informal and formal care of older people in Iceland.

Residence differences in formal and informal long-term care.

Rural palliative care transitions from home to hospital: carers' experiences.

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Informal carers, paramedics, chronic pain, and Twitter.

Balancing formal and informal care for older persons: how case managers respond.

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Estimating service demand for respite care among informal carers of people with psychological disabilities in Australia.

[Discussion between informal and formal caregivers of community-dwelling older adults].

Combining Formal and Informal Caregiving Roles: The Psychosocial Implications of Double- and Triple-Duty Care.

Informal and Formal Help Seeking Among Older Black Male Foster Care Youth and Alumni.

Experiences and Preferences for End-of-Life Care for Young Adults with Cancer and Their Informal Carers: A Narrative Synthesis.

Transitions in formal and informal care utilisation amongst older Europeans: the impact of national contexts.

Effects of stroke on informal carers.

Palliative Radiotherapy with or without Additional Care by a Multidisciplinary Palliative Care Team: A Retrospective Comparison.

Costs of formal and informal home care and quality of life for patients with multiple sclerosis in sweden.

Informal carers' health-related quality of life and patient experience in primary care: evidence from 195,364 carers in England responding to a national survey.

patients and palliative care workers.

The impact of assistive technologies on formal and informal home care.

The use of formal and informal home care by the disabled elderly.

Extending virtual wards to palliative care delivered in the community.

Pediatric palliative care in the community.