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51 Rehabilitative palliative care as a health promoting approach: a participatory action research study
  1. Karen L Clarke
  1. St Michael’s Hospice


Background Health promoting palliative care (HPPC) considers dying and death as a social phenomenon where communities play an integral role. The dominant interpretation of HPPC in the UK has been through community engagement activities but there is a disconnect between this and the support provided in the hospice in-patient setting.

Aim To assess whether rehabilitative palliative care (RPC) enables HPPC to be integrated in the in-patient setting.

Method Using participatory action research, a co-operative inquiry group planned how to integrate RPC in a UK Hospice in-patient unit paying attention to the facilitators and barriers.

The findings from this study and the literature were examined to identify the alignment and dissonance between HPPC and RPC.

Results A post intervention review indicated that RPC had been implemented, but there was conflict, also identified in the literature, between a model perceived to be focused on caring (palliative), and one based on enabling (rehabilitation).

Factors demonstrating the similarities between HPPC and RPC were presented:

  • democracy, empowerment and participation were underpinning principles

  • focused on enablement, control, choice and independence where self–esteem, self–determination and self–reliance co–existed with high levels of physical dependence

  • participatory models with an emphasis on social interaction

  • encouraged health care professionals to relinquish an expert–led approach to enable patients to become active participants in their care

  • interdisciplinary – involving all health and social care professionals, patients, families, communities and volunteers.

Claims challenging whether RPC could be considered as HPPC, e.g. lack of community involvement, a failure to address death education, RPC was death denying and perpetuated a clinical model of death and dying were discussed and alternative perspectives presented.

Conclusion Despite its close associations with community initiatives, the principles of HPPC can be integrated in a hospice in-patient setting using RPC.

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