FLPD

Focusing on Life: Preparing for Death (FLPD)

Focusing on Life: Preparing for Death (FLPD) is a conceptual framework developed by Australian OTs Kathrine Hammill, Rosalind Bye, and Catherine Cook (2019) using data from the authors’ mixed methods survey of Australian OTs working with clients with life-limiting illness. This work builds off of Bye’s 1998 qualitative study into OTs’ experiences from which a provisional version of the framework was developed, then called Affirming Life: Preparing for Death. Bye’s provisional framework was perhaps the first of its kind, an OT framework specific to working with clients at the end of life. Following research into the experiences of Australian OT practitioners working in end-of-life care, Hammill et al. (2019) published an updated version of the framework, now called the Focusing on Life: Preparing for Death framework.

The FLPD framework emphasizes a dual focus in which a client’s occupational engagement is balanced between “focusing on life” and “preparing for death” (Hammill et al., 2019, p. 152). At time of diagnosis, people living with a life-limiting illness are more likely to focus on life and maximize their ability to engage in occupations. In this stage, the role of OT practitioners was described as one of facilitating continued engagement in everyday life by following the client’s lead, adapting occupations and modifying the environment to maximize participation, and assisting the client in “reprioritising engagement towards things that [matter]” (Hammill et al., 2019, p. 148) to promote a sense of control over life.

As the disease progresses, there is an inevitable shift toward maintaining comfort and preparing for death (Bye, 1998). The role of OT practitioners in this stage was described as one of facilitating closure and assisting the client in making practical preparations for death. “Practical preparations,” as defined by one study participant, was used by the authors to mean “completing tasks to make life easier for families post death” (Hammill et al., 2019, p. 149) and included such tasks as getting financial affairs in order, funerary planning, writing eulogies, and sorting through and gifting personal belongings.

Figure. One visualization of the Focusing on Life: Preparing for Death framework and its relationship to the OT process.

References. (Bye, 1998; Hammill et al., 2019)

Graphic by OTpall using Canva Pro (2023)

Though this framework uses a lens of progressive functional decline, it is applicable to all stages of serious illness, including those for whom curative treatment succeeds and no longer require hospice or palliative care services. Clients’ needs and priorities change with treatment and disease progression, and OT must necessarily be flexible and responsive to reflect the changing nature of their needs. Additionally, this framework views occupations as being especially meaningful since it may (or may not) be the last time someone performs them. Mills and Payne (2015) expanded on this, stating that even seemingly mundane occupations may become significant or special. 

OT practitioners can use this framework to meet clients where they are at to develop and/or redefine client-centered goals and better understand the client’s priorities for care, for life, and for death. Using this framework, OT practitioners can determine where on the FLPD continuum clients are located to help them articulate or identify specific priorities. This can serve to empower their clients as decision makers and facilitate maintained autonomy over their lives and bodies, which is made all the more important given the loss of control many seriously ill persons experience. Moreover, the client is humanized as a person with goals and desires rather than a diseased body requiring treatment.

References

Bye, R. A. (1998). When clients are dying: Occupational therapists' perspectives. Occupational Therapy Journal of Research, 18(1), 3-24. https://doi.org/10.1177/153944929801800101 

Hammill, K., Bye, R., & Cook, C. (2019). Occupational engagement of people living with a life‐limiting illness: Occupational therapists’ perceptions. Australian Occupational Therapy Journal, 66(2), 145–153. https://doi.org/10.1111/1440-1630.12557 

Mills, K., & Payne, A. (2015). Enabling occupation at the end of life: A literature review. Palliative & Supportive Care, 13(6), 1755-1769. https://doi.org/10.1017/S1478951515000772 

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