Comment: How does one learn from reading an article?
Carol Davis
pp 5-5
I have been Deputy Editor of the European Journal of Palliative Care for a few years now. I have edited many articles and do the final read of alternate issues. I am very aware that I employ different reading styles depending on whether the task in hand is to edit an article or to learn from it. It strikes me that the phrase ‘active reading’ might embrace what I do when my goal is to achieve learning. This prompts me to ask whether active reading and editing are conflicting or synergistic arts? More importantly, how does one learn from reading an article?
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Managing fungating wounds: a multifactorial approach
Diane Laverty
pp 6-9
When a patient suffering from metastatic cancer has a complex fungating wound, their case management creates many challenges for the medical and nursing staff who care for them. The patient’s needs are multifactorial and must be addressed in a sensitive, tactful and understanding manner. The aim of this article is to examine some of the multiple physical symptoms that may occur and their management, and to consider the psychological and emotional aspects of living with a fungating wound.
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Dealing with barriers to cancer pain control in Egypt
Samy A Alsirafy
pp 10-11
Shortly after the establishment of the palliative care medicine unit (PCMU) at the Kasr Al-Aini Center of Clinical Oncology and Nuclear Medicine (NEMROCK) at Cairo University in Egypt in 2008, the palliative care team faced a challenging case, which we called the ‘ferry case’. To give the patient appropriate pain relief, we had to overcome many barriers. The management ofthe ‘ferry case’ had a significant impact on the way we now deal with cancer pain control at the NEMROCK. This case discussion may be useful for those aiming to improve cancer pain control in similar settings.
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Case study masterclass 48: Complex clinical decision-making: a duty of care
Anna Hume and Carol Davis
pp 14-14
Joy is 58 and works as a healthcare assistant in a care home. She has been married to Larry, a fire officer, aged 52, for 18 years. This is her second marriage: her first husband died of a heart attack 20 years ago. She and Larry have a son, Tom, who is 17 and has a significant learning disability associated with trisomy 21. Joy has five sisters in Ireland and a brother who lives locally. Although they do not see each other often, they are a close-knit family and keep in touch by telephone and post. The last time they were all together was at a niece’s wedding, in Ireland, the previous summer. Six weeks ago, Joy was diagnosed with metastatic cancer of the pancreas. She is now very unwell.
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Case study masterclass 47 answers: Flying home to die: repatriation of a terminally ill patient
Eileen Andrews, Rachel Sharkey and Tony White
pp 16-16
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The meaning of suffering anddeath in the Catholic faith
Vivian Boland
pp 18-21
Suffering is not unbearable as long as there is meaning to it. Viktor Frankl showed this many years ago with his reflections on the concentration camps of World War II. People will endure pain, discomfort, loss and embarrassment, even to extreme degrees, as long as they see a point to such endurance. An athlete preparing to run a marathon, for example, willingly endures a lot of pain, discomfort, loss and perhaps embarrassment for the sake of his/her goal. A patient undergoing radical surgery does the same, again because there is a point to his/her suffering.
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White Paper on standards and norms for hospice and palliative care in Europe: part 2
Lukas Radbruch and Sheila Payne
pp 22-33
In part 2 of this official position paper of the European Association for Palliative Care (EAPC), Lukas Radbruch, Sheila Payne and the EAPC Board of Directors outline general requirements for palliative care services and the specific requirements for each service type.
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A day in the life of Stephanie Stiel, Psychology Research Assistant
Stephanie Stiel
pp 34-35
7.15 am. Sitting on the bus on the way to work, I mentally prepare my day’s schedule. Once I arrive, I boot-up my PC and disconnect the telephone answering machine. I empty the dishwasher and clean the coffee machine. I drink my first coffee at work while going through my emails and answering the most important and urgent.
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How to make palliative care services financially viable
Katherine Hauser and Declan Walsh
pp 36-40
Intensive, costly medical care in advanced disease does not improve outcomes or patient satisfaction, nor support patients’ wishes. Palliative care, however, can improve outcomes and reduce costs. US states in which patients have good access to hospital palliative care services spend less per Medicare patient. Provision of palliative care is associated with significant reductions in pharmacy, laboratory and intensive care costs. It also results in fewer acute hospital admissions, fewer patient-days in intensive care units (ICUs), shorter patient stays and fewer attempted resuscitations. Regardless of the healthcare model they use, most countries are facing rising healthcare costs. Therefore, to be sustainable, palliative care has to be economically viable. This article looks at how this can be achieved.
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Qualitative research and its role in palliative care
Marianne Dees and Myrra Vernooij-Dassen
pp 42-45
The World Health Organization defines palliative care as ‘an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual’.
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European insight: Switzerland: palliative ch is taking a giant step forward
Claude Fuchs
pp 46-28
In Switzerland, the most prominent pioneer of the palliative care movement is the late Dr Elisabeth Kübler-Ross. She grew up near Zurich and, although in the 1950s she moved to the USA to work, whenever she came home to Switzerland, which she did often, she strongly advocated for what she believed. Thanks to her, a large number of associations for the care of terminally ill and dying patients were already being set up around 1980, mostly in the German-speaking part of the country.
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