MOB-PC

Model of Occupation-Based Palliative Care (MOB-PC)

The Model for Occupation-Based Palliative Care (MOB-PC) was developed in 2019 by Hsin-Hsiu Essential Yeh and Mary Ann McColl based on five themes that emerged in their scoping review of 74 papers. Essential Yeh and McColl (2019) found that the benefits of OT in palliative care are poorly understood, not only by clients, families, and caregivers “but also by other health professionals and occupational therapists themselves” (p. 108). Consistent with the literature, the authors noted that OT practitioners typically feel underprepared to serve seriously ill clients, especially those at the end of life, and asserted that education is essential for increasing confidence and competence. To begin addressing this need, Essential Yeh and McColl (2019) sought to “explore occupational therapy’s professional concepts and corresponding interventions in palliative care and [propose] a practical model to guide intervention based on occupation” (p. 109). MOB-PC is the resulting model.

Figure. One visualization of the relationship between the emergent themes from the Model of Occupation-Based Palliative Care (MOB-PC).

References. (Bye, 1998; Essential Yeh & McColl, 2019; Hammill et al., 2019; Wilcock, 2007)

Graphic by OTpall using Canva Pro (2023) 

MOB-PC is based on five major conceptual themes that emerged from the authors’ research:

• First, is valued occupations. Using a client-centered approach, OT practitioners can uncover their clients’ values and priorities, which in turn affirms the client’s role as a decision maker and promotes a sense of control over one’s life and body. 

• Second, is Doing, Being, Belonging, Becoming. Occupations throughout the literature were consistently found to be categorized using Wilcock’s (1999; 2007) taxonomy. (More information on the Doing-Being-Belonging-Becoming framework can be found here.) This indicates a general acceptance and understanding of the framework within the OT profession, as well as the framework’s relevance to OT practice in palliative care. 

• Third, is that occupation changes over time. A client’s condition and needs will fluctuate and change over the course of their disease trajectory and affect occupation. 

• Fourth, is “focusing on life and preparing for death.” At the time of diagnosis, clients are more likely to focus on life, but as their disease progresses, there is an inevitable shift toward preparing for death (Bye, 1998; Hammill et al., 2019). (More information on the Focusing on Life: Preparing for Death framework can be found here.) 

• Fifth, and finally, is a safe and supportive environment. Wherever the client is located, creating an environment that is safe and supportive means attending to both human and non-human elements, making modifications or adaptations as needed, and educating and training family and caregivers.

Essential Yeh and McColl (2019) combined these five themes to envision MOB-PC as a ship’s steering wheel, stating “the model needs to be seen as a dynamic state with the entire circle moving forward or backward depending on the trajectory of life-threatening disease” (p. 116). Although this model is still in the development phase and in need of additional research, it is one of the few occupation-based OT models designed especially for palliative care settings and can provide a starting point for OT practitioners who are unsure what their role should be when working with seriously ill clients. 

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 

Essential Yeh, H-H., & McColl, M. A. (2019). A model for occupation-based palliative care. Occupational Therapy in Health Care, 33(1), 108-123. https://doi.org/10.1080/07380577.2018.1544428 

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 

Wilcock, A. A. (1999). Reflections on doing, being and becoming. Australian Occupational Therapy Journal, 46(1), 1–11. https://doi.org/10.1046/j.1440-1630.1999.00174.x 

Wilcock, A. A. (2007). Occupation and health: Are they one and the same? Journal of Occupational Science, 14(1), 3–8. https://doi.org/10.1080/14427591.2007.9686577 

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