By Dave DeFusco
At the 2025 AOTA Annual Conference, students in the Katz School’s Occupational Therapy Doctorate unveiled a powerful and timely analysis of how practitioners support people in their final stages of life—highlighting both the field’s untapped potential and its often-overlooked role in palliative settings.
“This work is important because it fills a knowledge gap not only in the literature but in clinical practice,” said Melanie Evangelista, a clinical associate professor in the Occupational Therapy Doctorate who led the project. “Occupational therapy has a unique ability to improve quality of life through client-centered care. By identifying the barriers and the underutilization of OT in end-of-life settings, these students are helping shape a future in which more people can experience autonomy, dignity and connection even at the end of life.”
The review sought to answer a pivotal question: What is the nature and scope of occupational therapy services provided to individuals in end-of-life care settings that contribute to improving their overall well-being?
“End-of-life care is not just about dying,” said Rachel Celestin, one of four third-year Occupational Therapy Doctorate students. “It’s about living with meaning, comfort and dignity in the time that remains. Occupational therapists are uniquely trained to support this, yet our roles are often misunderstood or overlooked in these settings.”
The team reviewed 248 articles, ultimately selecting 23 studies published between 2013 and 2023, which explored OT involvement with adult patients in hospice and palliative care settings. The review excluded pediatric end of life care and other meta-reviews, ensuring a tight focus on original research centered on adults and their occupational needs.
The findings underscored the breadth of interventions occupational therapists can offer at end of life, from energy conservation and adaptive technology to legacy building, funeral planning and environmental modifications that support dignity and autonomy.
“Legacy-building and life review may seem unconventional to those outside our field,” said Tamara Henry, “but these interventions can profoundly enhance a person’s sense of purpose and peace as they approach life’s end. They’re not just therapeutic—they’re humanizing.”
Despite these benefits, the scoping review revealed a significant gap between potential and practice. According to the literature, OT remains underutilized in end-of-life settings due to a variety of systemic challenges: referral timing, financial and reimbursement constraints, misconceptions among other healthcare providers and regional differences in care delivery.
“There’s a kind of invisibility,” said Chasstity Smith-Brown. “Even when we’re trained and willing to provide support, systemic barriers often keep us on the sidelines. It’s frustrating because we know we can make a difference.”
One of the starkest findings was that none of the reviewed studies addressed the burden on informal caregivers, a population that frequently experiences emotional and functional strain.
“OTs are trained not just to treat individuals, but to support the people around them—spouses, children, friends,” said Tameka Sumter. “Ignoring caregiver burden is a blind spot we need to correct.”
The research team advocate for OT’s inclusion throughout the entire palliative care continuum, from early diagnosis to bereavement support. They recommend integrating end of life care-specific training into entry-level coursework, fieldwork placements and continuing education, arguing that earlier exposure will build a more confident and competent workforce ready to meet growing demographic needs.
“This work is exactly the kind of scholarship we strive to foster,” said Dr. Amiya Waldman-Levi, director of scholarship and research of occupational therapy. “It’s rooted in community and scientific need, guided by pedagogical best practices and made possible by a culture of mentorship. It represents the future of occupational therapy—responsive, collaborative and impactful.”
