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Occupational therapy is a health profession which enables people to participate in everyday life activities to the best of their ability despite their condition, illness progression, activity limitations or participation restrictions. In palliative care this premise does not change, as occupational therapists are skilled in enabling people to adapt to their changing ability levels, and helping people to continue living until they die, just as Dame Cicely Sanders famously quoted. However, the role that occupational therapists play is often misunderstood and under-utilised, resulting in the role being limited to discharge planning, home assessments, and equipment prescription. While these are important parts of the occupational therapy role, palliative care occupational therapists can offer so much more to their clients to enable them to keep living and remained engaged in everyday activities for as long as possible. To do this, occupational therapists follow a process which helps them to assess, intervene and evaluate their treatment plans.

Whilst there seems to be numerous barriers to overcoming anxiety, palliative clients, predictably, often have a vivid imagination and astute focus. The paradox is that some of the traits that can cause suffering can be used very productively on the other end of the spectrum to create a great sense of calm and well-being. Changing the focus from imagining what the future holds to noticing comfort in the present moment and redirecting attention to a space of safety and comfort is usually the key to decreasing anxiety [1]. Music therapy interventions, specifically the use of music based relaxation programs, can provide an anxious person the opportunity to experience peace in the moment [2].
After completing an assessment session, the client usually agrees to a live music relaxation trial. At this point I have ascertained the issues, problems, patterns and needs. Generally, I have identified the purpose for relaxation (e.g. to encourage sleep, to increase energy/vitality, clarity). The length of the intervention is discussed.
 

As a registered music therapist working in palliative care, [1-2] one of the most common referrals is to address client anxiety.  Anxiety can present itself in many forms; loss of sleep, foggy thinking, or inability to focus. Anxiety amplifies many physiological symptoms such as shortness of breath, dizziness, and pain.

Psychologically, a client can be caught in a spiral of thinking about what lies in the future (reinforced by a schedule of medical appointments, treatment, scans, outcomes, follow-ups) and pondering questions that cannot be answered with any degree of certainty. So much focus is placed on the person's physical response to medical interventions while there is an unbalanced proportion of attention to the health of the mind. In addition, these clients can be living in an overstimulating environment or have a history of limited resilience building.
 

When someone has an incurable disease like advanced cancer or motor neurone disease, they experience many changes, one of which is functional decline. Although functional decline is inevitable at the end-of-life, the drive for people to remain as independent as possible is actually heightened at this time. The occupational therapist (OT) has two key roles to play here. Firstly, they play an active role in optimising a person’s independence and participation as function declines. Secondly, by supporting active participation in everyday activities to the best of a person’s ability, the OT can support people to come to terms with bodily deterioration and pending death. I’ll look at these two concepts in more detail.  
 

Move it or lose it, as the saying goes, is relevant to the field of palliative care. In fact, evidence suggests that up to 30% of muscle weakness in advanced illness can be due to inactivity itself.

Physiotherapists are in a prime position to make a difference to how patients experience end of life by helping them maximise their independence at each stage. Expertise in functional assessment combined with an understanding of the impact of symptoms on the lived experience enables therapists to work closely with patients to improve their quality of life (QOL).