For more information, visit https://www.timberlandmedical.com
Timberland Medical Centre is a private hospital that has been in operation since 1994. We are strategically located at the 3rd Mile roundabout on Jalan Rock, Kuching, Sarawak, East Malaysia. Our hospital is 10 minutes from the Kuching International Airport and 15 minutes from the Central Bus Terminal. We continually seek to improve and upgrade our services and facilities, as we strive to provide the best medical care for our patients and customers.
5. Defini9ons
of
rehabilita9on
-‐
service
in
cancer
and
pallia9ve
care
• 1.
Structure
• 2.
process
• 3.
outcome
Wade DT, de Jong BA: Recent advances in rehabilitation. Br Med J 2000; 320:
1385-8
Wade DT, de Jong BA: Recent advances in rehabilitation. Br Med J 2000; 320: 1385-8
6. Structure
The
opera9onal
characteris9cs
of
a
rehabilita9on
service
.
A
rehab.
Services
comprises
a
mul$disciplinary
team
of
people
8. Process
–
how
to
work
Rehab.
is
a
reitera$ve,
ac$ve,
educa$onal,
problem-‐solving
process,
following:
§ Assessment
§ Goal
–
se-ng
§ Interven2on
:
(a)
treatments,
which
affect
the
process
of
change.
(b)
support,
which
maintains
the
p’t
QOL
and
safety.
§ Re-‐evalua2on
9. Outcome
Aims
to:
• Maximize
the
par9cipa9on
of
the
p’t
in
his
social
se7ng
• Minimize
the
pain
and
distress
experienced
by
the
p’t
• Minimize
the
distress
of,
and
stress
on,
the
p’t
carers.
10. Classifica9ons
of
rehabilita9on
in
cancer
care
–
Dietz
1981
• Preventa9ve
rehabilita9on
• Restora9ve
rehabilita9on
• Suppor9ve
rehabilita9on
• Pallia9ve
rehabilita9on
Dietz JH (eds): Rehabilitation Oncology. New York: John Wiley, 1981: 35-8
11. Preventa9ve
rehabilita9on
• Designed
to
reduce
the
impact
and
severity
of
expected
disabili$es
and
designed
to
assist
the
p’t
and
carers
with
coping.
12. Restora9ve
rehabilita9on
• Restores
p’t
to
their
pre-‐illness
states.
Likely
to
move
from
acute
to
OPD
or
domiciliary
se7ng
as
p’t
returns
to
valued
roles.
13. Suppor9ve
rehabilita9on
• Goal
is
to
limit
func$onal
changes
provide
support
to
reduce
any
disability
or
loss
of
func$on
to
allow
the
individual
to
overcome
handicap.
• Focus
is
on
adapta$on
to
changed
circumstance
rather
than
restora$on.
14. Pallia9ve
rehabilita9on
• Goal
is
to
limit
the
impact
of
the
advancing
disease
process.
Symptom
control
is
plays
an
increasingly
important
role,
promo9ng
independence
wherever
possible.
15. Rehabilita$ve
approach
is
delivered
in
• Hospital
• Community
• Hospice/specialist
pallia9ve
seng
• Day
care
center
19. 癌症末期病人常見症狀與問題-疼痛
• 生理疼痛的治療目標:
改善疼痛引起的睡眠障礙
→減輕身體靜止時的疼痛
→減輕身體移動時的疼痛
• 疼痛治療:WHO之三B原則
*
By
the
mouth
(口服)
*
By
the
clock(定時投藥)
*By
the
ladder(依三階段給藥):非鴉片類→弱鴉
片類→強鴉片類
安寧緩和醫療臨床工作指引 2009
34. Clinical
pathway
in
interven$on
個人
生理情況
想要從事
的活動
環境背景
或
情境
患者的需求
及
餘生期待
Follow by COPM - Law 1994
Client- center approach:
35. 臨床介入
• Ques9ons
for
pa9ent
*
What
are
the
most
important
things
that
your
illness
has
prevented
you
from
doing
?
*
At
the
present
9me
what
brings
you
the
most
pleasure?
*
what
would
you
most
like
to
do
tomorrow,
if
you
could
?
(Guideline for occupational therapy service in hospice, 1987 )
36. 臨床介入
• Ques9ons
for
primary
caregiver
*
What
are
you
most
concerned
about
in
caring
for
the
physical
needs
of
the
p’t
?
*
What
are
you
allowing
the
p’t
to
do
independence
?
(Guideline for occupational therapy service in hospice, 1987 )
63. Home
Adapta9on
Die in the Home
Patient surveys indicates that the majority
of cancer patients would prefer to die in
their own home.
T’s have a key role in the treatment of
terminally ill patients in the community as
evidence from both patient and carer.
Townsend et al. 1990;Griffin 1991;Tong 2000;McClements 2001