Career moves: so you want to work in...palliative care?

The role of physiotherapists in the lives of hospice patients is highly specialised and deeply rewarding, as Julie Penfold reports.

The role of physiotherapy in palliative care and oncology is often misunderstood by professionals and the public. Rehabilitation is invaluable for this patient group as it reduces the impact of pain and anxiety, increases functional status and improves quality of life. Rehabilitative palliative care is patient-centred and can help people to adapt to their changing condition. Specialist physiotherapists work as part of multidisciplinary teams within the NHS, private sector and charitable sector. 

St Ann’s Hospice

Bobby Magee is an advanced physiotherapist at St Ann’s Hospice in Greater Manchester, one of the biggest hospices outside London. Mr Magee leads the physiotherapy service across three sites: Heald Green (main site), Little Hulton and the Neil Cliffe Centre, which is based at Wythenshawe Hospital. Heald Green and Little Hulton have inpatient units, a medical outpatient facility and offer community services, while Neil Cliffe provides a supportive outpatient service. 
‘Rehabilitation can be all-encompassing,’ says Mr Magee. ‘We can help to improve people’s quality of life and the symptoms they experience such as breathlessness, pain and loss of mobility. We also help with conditions such as lymphoedema. We see a wide variety of patients with life-limiting illnesses. This can also include patients with cardiovascular disease, chronic obstructive pulmonary disease (COPD) and neurological diseases such as Parkinson’s, stroke, Alzheimer’s and motor neurone disease (MND). We also run a monthly MND outpatient clinic. 
‘We are trying to debunk the myth that hospice and palliative care is all about death and dying. It really is not. We can help people to thrive when they are perhaps at their lowest point in life by supporting them through those physical changes.’
Unusually, Mr Magee started his career within this field as a junior physiotherapist. ‘I was lucky to get my first role at the Christie NHS Trust. I knew from the beginning that I wanted to remain in palliative care and oncology. Working in a hospice, you have time to build a rapport with patients. It can be challenging to experience the highs and lows patients go through, as you live and breathe everything they do. Sometimes it is the simplest and smallest things you do that make a difference, such as giving someone a hug when they need one, having a laugh together or just listening and being a shoulder to cry on.’
Having emotional resilience and building that into your own daily life is important for physiotherapists working in hospices, he says. Mr Magee practises mindfulness meditation and exercises regularly. ‘I feel privileged to work in palliative care. People feel it must be sad to work in a hospice but it is very rewarding. We are helping patients to have a better quality of life, even when their prognosis is poor.’
A good grounding in core skills is important, Mr Magee advises. He also suggests completing a lymphoedema or myofascial release course. ‘Good communication is also key – look into advanced communication courses near you.’  

St Vincent’s Hospice

Sarah Mitchell is a specialist physiotherapist at St Vincent’s Hospice in Johnstone, Renfrewshire. There is an eight-bed inpatient unit, a day hospice and community services. Ms Mitchell is the only physiotherapist and leads the service. In addition to working three days a week, she manages the day hospice service and works one day a week in her management role.
‘Before joining the hospice as its first physiotherapist, I worked in the NHS as a respiratory physiotherapist and that knowledge is invaluable in palliative care,’ says Ms Mitchell. ‘My role is really varied. I could be carrying out mobility assessments in the inpatient unit, supporting patients with respiratory issues such as breathing control, relaxation and assisting with getting rid of secretions, or advising on patient transfers.’
Physiotherapist-led exercise classes are also part of the day hospice programme and are held twice weekly. Ms Mitchell is supported in the running of these hour-long classes by two volunteer physios. In the last 18 months, the hospice has set up a weekly support group to share practical skills with carers. Each group meets for six weeks. In April 2017, Ms Mitchell launched the first physiotherapist-led wellbeing group in response to patients’ needs. 
‘We are getting more younger people referred to us and also have patients who are relatively stable symptom-wise who don’t want to come into the hospice for the full day,’ she explains. ‘The wellbeing group is a two-hour, eight-week outpatient programme that has been hugely successful. We use five functional exercise tests including the 30-second sit-to-stand test. In the first group, all patients improved in at least one aspect of fitness, such as improved balance or general mobility. Patients also had more confidence and it helped them to do more. 
‘We repeated the wellbeing group in autumn and had similar results. We are offering a combination of exercise and self-management education in a hospice and seeing the power of exercise in palliative care is particularly rewarding.’
Being the only physiotherapist can be challenging at times, she says. ‘I do sometimes miss being part of a physio department. To help with this, I keep in regular touch with other palliative care physiotherapists in Glasgow and Clyde and have close links with the hospital where I used to work so I can contact them if I have any questions. You are asked all sorts of questions. Making and maintaining links is important. For me, they have been a lifeline. 
‘Combining physiotherapy and management can be challenging but it can also be a bonus as you can influence where your organisation is going and fly the flag for physiotherapy within palliative care.’  

Top tips

The Association of Chartered Physiotherapists in Oncology and Palliative Care (ACPOPC) is one of the CSP’s smaller professional networks. It aims to provide peer support and facilitate the exchange of ideas and evidence-based knowledge, while providing opportunities for continuing professional development. The network is research active and influences cancer policy and strategy at both local and national level, including clinical guidelines for NICE.

What experience do I need? 

I feel strongly that having broad professional experience and the professional confidence you gain from this is needed to work in palliative care. It is a specialist area where your knowledge base is key.

What postgraduate training is there?

There are masters level courses that cover palliative rehabilitation or exercise and lifestyle in cancer. There is also an excellent network of postgraduate courses through Macmillan Cancer Support and via a number of academic institutions. 

Who would pay?

This depends on your circumstances. However, physiotherapists are highly motivated and may be able to demonstrate why they should be funded for specialist training by their employer. Alternatively, you may have to pay – I paid for a lot of my postgraduate training.

Are there student placements?

I’m exceptionally passionate about student placements within palliative care. We as a profession need to enrich the undergraduate curriculum by offering more placements in palliative care. One of the ACPOPC’s objectives is to encourage members to take students in oncology and palliative care settings to promote interest at undergraduate level.  

To sum up …

In a hospice, healthcare workers are helping to create a five-star experience for patients. In this specialist field, you have the gift of time and the palliative person-centred approach is key. 

Julie Penfold

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