Clinical Decision Making for Physical Therapists in Patient-Centered End-of-Life Care

Effective physical therapy intervention with persons approaching end of life requires a patient-centered model for clinical decision making. Unpredictable trajectories of short-term gain and inevitable decline challenge the therapist to carefully listen to the patient and family to understand their needs, assess pertinent physical and functional parameters, and initiate intervention within a palliative care or hospice reimbursement framework. This article describes 4 specific clinical decision-making models that can be effectively used to guide optimal physical therapy outcomes in end-of-life care. These include first, the Hypothesis-Oriented Algorithm for Clinicians II (Rothstein JM, Echternach JL, Riddle DL. The Hypothesis-Oriented Algorithm for Clinicians II (HOAC II): a guide for patient management. Phys Ther. 2003;83:455-470), second, a Framework for Rehabilitation of Neurodegenerative Diseases (Dal Bello-Haas V. A framework for rehabilitation of neurodegenerative diseases: Planning care and maximizing quality of life. Neurology Report. 2002;26;3:115-129), third, a Framework for Assessment in Oncology Rehabilitation (Gilchrist LS, Galantino ML, Wampler M, et al A framework for assessment in oncology rehabilitation. Phys Ther. 2009;89:286-306), and fourth, Models of Practice in Palliative Care (Briggs R. Models for physical therapy practice in palliative medicine. Rehabilitation Oncology. 2000;18(2):18-19). The applicability of each of these models will be detailed as they pertain to optimal physical therapy intervention in palliative care and hospice settings.