Authors: (including presenting author): :
Cheng, W.S.(1), Wong, S.K. (1), Chan, Y.P.(1), Tam, K.F.S.(2), Yau, WS. .C. (2), Leung, K.C.A. (3), Hui, W.M. (4)
Affiliation: :
(1) Occupational Therapy Department, Hong Kong Buddhist Hospital, (2) Department of Medicine, Hong Kong Buddhist Hospital, , (3) Department of Clinical Oncology, Queen Elizabeth Hospital, (4) Nursing Department, Hong Kong Buddhist Hospital
Keyword 1: :
Therapeutic Horticulture
Keyword 2: :
Palliative care
Keyword 3: :
quality of life
Keyword 5: :
psychosocial
Introduction: :
Occupational therapists (OT) are critical in facilitating patient's participation in meaningful activities in palliative care settings,. This therapeutic engagement improves overall quality of life, maintain independence, and help managing pain and symptoms. OT promote beneficial social interaction, which facilitate patients to maintain relationships with family and friends. By supporting autonomy and independence in meaningful activities, OT can potentially foster hope and psychological well being. OT in palliative care ward of HKBH focuses on activities of daily living (ADL) training, cognitive rehabilitation, breathlessness management and fatigue management. However, current practice shows limited incorporation of interventions addressing spiritual well being and holistic quality of life domains that hold universal relevance for palliative care patients in creating meaningful experiences and living legacies. The potential to expand OT’s modality to better address patients' core existential needs is significant. Horticultural Therapy (HT) is an evidence based modality extensively utilized in rehabilitation, vocational, and community settings. As an activity based intervention, HT has demonstrated efficacy in pain reduction, anxiety management, and quality of life enhancement. Toyoda's (2012) conceptual framework positions HT as a rehabilitative modality that harnesses the therapeutic potential of plants, gardening activities, and humanity's innate biophilic connection with nature. This approach comprises three interdependent components: participants, plants, and environment. Through horticultural engagement, participants may nurture living plants or transform botanical materials into creative products. The distinctive characteristics of HT include multi sensory stimulation, provision of tangible accomplishments, opportunities for nurturing plant life, facilitated access to outdoor environments, and cultivation of empathic capacities through caregiving roles. Ra et al.'s controlled study established HT's significant effects on pain alleviation and sleep improvement in hospice populations. The experimental group exhibited markedly reduced pain intensity compared to controls (p< 0.05), with parallel improvements in sleep satisfaction scores (p < 0.01). Similar benefits were observed in mental health outcomes: HT significantly decreased depression severity in hospice patients, as evidenced by reductions in Geriatric Depression Scale scores and elevated Subjective Happiness Scale ratings. Furthermore, HT enhances spiritual well being by fostering self affirmation recovery and mitigating existential distress. Engagement in HT induces measurable biopsychosocial benefits. Masel et al. confirmed that adapted indoor HT protocols still significantly improve terminal patients' social connectedness and overall well being in palliative care wards. The limited robust psychosocial and spiritual interventions in OT services highlights a critical research gap. Therefore, it is valuable to investigate the effectiveness of ward based HT in palliative care patients.
Objectives: :
The objectives of this study is to investigate The Effectiveness of Therapeutic Horticulture Program in palliative care patients in terms of physical, psychological, spiritual and quality of life perspectives: A Pilot Study.
Methodology: :
This pilot study employed a single-blind, randomized controlled trial design with 30 participants recruited. The experimental group receives the Therapeutic Horticulture (TH) program, while Control Group receives treatment-as-usual (TAU). Both interventions will be delivered by OT to ensure treatment fidelity. Recruitment occurred at palliative care ward of Hong Kong Buddhist Hospital between December 2024 and April 2025. Eligible participants were recruited in the palliative care ward who followed simple commands, maintained a Palliative Performance Scale version 2 score of at least 40%, and possessed adequate upper limb mobility. Informed consent was signed prior to enrolment. Exclusion criteria included patients with blindness, those diagnosed with active mental illness, with known allergies to pollen, plants, seeds, soil or fertilizers, and who have previously participated in HT interventions. This study utilizes the Sequentially Numbered, Opaque Sealed Envelopes (SNOSE) method for participant allocation. Physical domain outcomes were assessed through objective and subjective measures. Pain intensity was assessed using numeric rating scale (NRS) (0-10), while physiological parameters including blood pressure, pulse rate, and respiratory rate were measured using medical equipment and the Masimo MightySat fingertip pulse oximeter. Sleep satisfaction were evaluated through NRS. These physical measures were collected immediately before and after each TH session. Physical symptoms was assessed by McGill Quality of Life Index – Hong Kong version (MQOL-HK). Psychological outcomes were evaluated by Generalized Anxiety Disorder scale (GAD-7) and MQOL-HK. GAD-7 assessed anxiety symptoms over two weeks. Spiritual wellbeing was measured through the Herth Hope Index (HHI) and MQOL-HK. Quality of life assessment will incorporate both single-item quality of life score and total score from the MQOL-HK. This 16-item instrument evaluates fivedomains of MQOL-HK. All instruments were administered in validated Chinese versions to ensure linguistic and cultural appropriateness for participants. Assessment will occur at pre-intervention and post-intervention. Qualitative data were collected through participants’ feedback throughout TH program. The experimental intervention consists of a structured four-session TH program delivered twice weekly, with each session lasting thirty minutes. This intervention was administered in addition to TAU. The therapeutic horticulture sessions will be implemented either at the patient's bedside or ward's common area, with the modality (individual or group) determined by patients’ condition and infection control requirements. All TH activities were designed to comply with local infection control protocols while maintaining minimal mobility demands appropriate for the palliative care patients.
Result & Outcome: :
47 eligible participants underwent randomization, resulting in 26 patients allocated to the experimental group and 21 to the control group. Before program completion, 17 participants were excluded from final analysis due to 8 deaths and 9 discharges. Consequently, the final analytical sample consisted of 15 participants in each group who completed the full intervention protocol and corresponding assessments. The therapeutic horticulture intervention demonstrated statistically significant improvements in respiratory rate and pain scores of physical domain. The statistically significant improvement in anxiety symptoms as measured by the Generalized Anxiety Disorder scale was also indicated. statistically significant improvements The two key spiritual measures which is Herth Hope Index and the spiritual domain of the McGill Quality of Life Index - Hong Kong version demonstrated satisically significant improvements in experimental group Therapeutic horticulture intervention was statistically improved both the single score of quality of life and the total score of the McGill Quality of Life Index - Hong Kong version In contrast, the control group exhibited no significant changes in all domains.
