Interventions for Improving Leisure for Older Adults on the Palliative Pathway Living With Advanced Cancer: A Qualitative Systematic Review.
Collette Crilly, Sureshkumar Kamalakannan
PMID 42079352WHAT IT FOUND
Patients with advanced cancer described wanting to keep doing the things that made them feel like themselves (gardening, cooking, being with others) and said adapting those activities let them stay engaged.
OTs in the same studies reported their role was reduced to equipment provision.
Key findings
01Patients described shifting their priorities toward leisure and social participation as they neared the end of life, and said losing those activities made them feel their identity was being taken away.
02OTs across multiple studies reported their role was being narrowed to prescribing equipment, and that staff shortages, workloads, and a lack of understanding from the wider team left them no time to work on meaningful occupation.
03Patients described adjusting how they did activities — doing less, doing it differently, doing it with others — and said this let them keep a sense of control and dignity rather than giving up the activity entirely.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
All seven studies were conducted in high-income countries (Australia, Denmark, Japan, US, Canada); no UK or low- and middle-income country studies were found, so the findings may not reflect the 78% of palliative-care patients who live in LMICs. The search was limited to English-language publications, which the authors acknowledge may have excluded relevant work. Only 7 studies met the inclusion criteria, and one scored 29% on the MMAT quality appraisal. In 43% of the included studies the sampling method was not stated, so it is unclear whether participants were a convenience sample. In 67% of the mixed-methods studies, the differences between qualitative and quantitative data were not adequately addressed. This is a qualitative review: the findings are themes from what people said and felt, not measured effects. There are no outcome scores, no before-and-after comparisons, and no evidence that any specific intervention improves quality of life.
Declared interests
The authors declared no conflicts of interest and no financial support for the research, authorship, or publication.
The easy way to misread this
Do not read the 'impact of interventions' theme as evidence that grading, adapting, or equipment provision improves quality of life. These are patients' own accounts of what helped them feel in control; the review contains no outcome measures, no control group, and no before-and-after data. The finding is that patients valued these adjustments, not that they were shown to work.