At the heart of art therapy is the belief that engaging in purposeful activity can enrich and add meaning to life, even during treatment for a palliative illness. [1] Art therapy creates meaning, allows for self-expression and communication of feelings and can enhance emotional wellbeing. It has been linked to improving self-awareness, reality orientation, increasing self-esteem and quality of life, and managing anxiety. Art therapy is used in palliative care to compliment a holistic approach to care and to augment traditional clinical and medical approaches.
Allied health clinicians play an active role in physical, social, psychological and spiritual care of older palliative care patients and carers. In recognition of these benefits, the Central Adelaide Palliative Care Service (CAPCS) secured the services of Art Therapist Estelle Chapple to support the holistic care of palliative patients and their families with funding through the Centre for Creative Health. Based at the Queen Elizabeth Hospital and working on site and in the community, Estelle works with patients and their families and has initiated numerous projects which have had a positive impact.
Three key projects relevant to older adults in palliative care settings include:
Putting Patients First – Patient Orientation Boards are a non-pharmacological, person-centred strategy for improving patient experience of delirium. Orientation Boards in the patient’s room list names of attending doctors and nurses, scheduled appointments, Allied Health sessions and family meetings. These give patients a sense of knowledge and control about their day to day experience. In the centre of the boards is space for patient expression and communication of self and identity using written word, selected images and photographs.
The boards assist with patient orientation in potentially unfamiliar environments; help staff communicate with the patient and build a therapeutic relationship; enable patients to express aspects of themselves and their lives unrelated to their clinical diagnosis; and assist staff to integrate important patient non-medical information into treatment and care plans.
Palliative Art Library – Feedback from patients and families revealed concern about sombre and negative moods emoted by art work in their rooms. Estelle developed an art library offering opportunities for patients to select art for their room, reflecting personal taste. Selecting works gives patients’ a sense of control over their environments, has led to meaningful and unexpected interactions between patients, staff and volunteers and allowed patients to tell their stories.
Connection through COVID-19 – Connecting at end of life during COVID-19 has meant embracing rapid transition to social distancing and new ways of engaging and supporting patients to continue high level care. Estelle developed art packs funded by the Centre for Creative Health and delivered to community palliative patients by CAPCS volunteers.
Once received, the patient is supported using Health Direct to access art therapy sessions. The initial focus is on mindfulness and relaxation, supporting the patient to express their emotional situation and providing a supported space to express other aspects that may be causing concern. Increased feelings of isolation and fear, especially for loved ones, have been addressed specifically with art processes aimed at strengthening a sense of connection and promoting grounding techniques. Some participants have created message postcards for a loved one they cannot see; others simple paper chains that help the person express who and how they are connected to loved ones or supports.
Limitations to this service may occur if the palliative patient resides in an aged care facility that does not have capacity to support with personnel or technology. However, art packs can be sourced for palliative patients who are supported at their residence. This is an example of the Palliative Care SA 2020 motto ‘Better Together: Connecting Palliative and Aged Care’ in action showing the benefits of working together.
Providing innovative and effective palliative care as part of the person-centred care will be further developed as needs change. The recent challenges of COVID-19 have been a catalyst to highlight areas that have been untapped but may be expanded on to further meet patient care needs with the use of creative therapies.
References
- Leonard L. The Healing Arts in Palliative Care [Internet]. Cranbury (US): CURE Media Group; 2017 Nov 8 [cited 2020 Jun 24].
Estelle Chapple, Art Therapist, Central Adelaide Palliative Care
Michelle Cripps, Director, Centre for Creative Health
This blog is part of series of blogs commissioned by ELDAC to support aged care health professionals and care providers in providing end of life care. For more information on working together to provide best practice palliative care, visit ELDAC’s Working Together toolkit. Additionally, the ELDAC Helpline is available 9am – 5pm, Monday – Friday (CST) 1800 870 155 or email at ELDAC.Helpline@flinders.edu.au