Comment: Why spiritual care is best left to a chaplain
Rev Alistair McCulloch
pp 109-109
I think Jacqueline H Watts and Claudia Psaila, in their article Spiritual care at the end of life: whose job is it?, may have a point. If ‘spiritual care’ for the dying were to be undertaken as part of a tick-box exercise, it could easily result in what Randall and Downie term ‘harassment by questioning in the name of compassion’. I am sure it is also true that ‘spiritual care’ at the end of life (by which the authors mean a time for ‘reflection and reviewing life’) is probably best left in ‘the context of valued relationships’ (which I take to mean close family and friends). However, I believe there is a middle way; spiritual care that is neither a tick-box exercise by well-meaning professionals, nor the intimate sharing with close family and friends. There are many professional men and women working as chaplains who do indeed embrace ‘empathic and compassionate attitudes and skills’ in their care of the dying. In my experience, they can often provide the patient with a great deal more than what Watts and Psaila refer to as a ‘spiritual moment’.
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The relevance of symptom clusters in cancer care
Aynur Aktas and Declan Walsh
pp 110-115
Research into the symptoms of diseases has begun to focus on symptom clusters, in an effort to identify interrelationships between symptoms. Cluster research is particularly important in palliative medicine. This article describes how the cluster concept can be applied to clinical practice and what the potential benefits are.
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How the otolaryngologist can play a role in palliative care
Eimear Phelan and Michael Walsh
pp 117-120
The WHO defined palliative care as an approach that improves the quality of life of patients and their families facing the problems associated with a life-threatening illness. It aims to provide relief from pain and other distressing symptoms, but intends neither to hasten nor delay death. Ideally, palliative care uses a team approach to address the needs of the patient, enhancing their quality of life and, in some cases, positively influencing the course of their illness. The association of death with failure has probably been the most profound psychological barrier to the successful incorporation of a palliative philosophy into surgical practice. The perception that death equals failure has been a disincentive for many surgeons to ‘take on’ patients with end-stage disease for operative, or non-operative, palliation. However, there is a wide spectrum of opportunities for otolaryngologists to participate in the multidisciplinary palliative care team, particularly in dealing with complicated problems presented by patients with head and neck cancer.
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Case study masterclass 50: Feeding issues and venting gastrostomy in malignant bowel obstruction
Jennifer Clare, Steinunn Boyce and Sabrina Bajwah
pp 122-123
Laura, a 47-year-old married, and previously independent, woman with metastatic ovarian cancer, has been admitted to hospital with a two-day history of vomiting, increasing abdominal distension and colicky abdominal pain. She has not opened her bowels for four days. She is admitted under the care of the medical oncologists and, as part of the palliative care team, you are asked to review her.
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Case study masterclass 49 answers: Rapidly progressive carcinomatous meningitis following breast cancer
Carol Davis
pp 124-124
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Spiritual care in the end of life: whose job is it?
Jacqueline H Watts and Claudia Psaila
pp 126-129
There has been a growing recognition of the role that religion and spirituality can play in helping patients to adjust to serious illness. In particular, there has been increasing awareness of the importance of understanding and valuing patients’ spirituality as part of the provision of appropriate support, especially in nursing practice. In part, this has arisen as a result of the influence and application of palliative care principles in a range of care settings outside the hospice. Four decades of professional rhetoric have emphasised the importance of care for the ‘whole’ person in terms of spiritual as well as psychological, physical and social needs. Yet there has been no evaluation of the impact of spiritual care on patients, or consideration of whether this approach is realistic in every case. Professional ideology within palliative care has been dominant in influencing a culture of openness between the healthcare professionals and the dying patients in their care, with attention to spiritual needs an increasing part of the professionals’ remit.
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Health-promoting palliative care arrives in Scotland
Erna Haraldsdottir, Pam Clark and Scott A Murray
pp 130-132
Openness about death and dying has been seen as beneficial for dying patients and their families ever since the pioneering work of Cicely Saunders in the 1960s. Despite this, death and dying is still a taboo subject in most European countries. In 2003, a survey of the Scottish public reported that most people felt society did not discuss death and dying in a ‘realistic way’ and considered the subject of death as taboo. The survey called for further engagement with the public to promote open discussion about death and dying.
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The place of the pharmacist on the palliative care team
Andrew Dickman
pp 133-135
The pharmacist’s role has changed dramatically in the past 30 years in the UK through the introduction of clinical pharmacy services and pharmaceutical care. Before, their role consisted solely of the procurement, formulation and dispensing of medicines, and they had little direct contact with patients. These roles have now largely been adopted by pharmacy technicians and other support staff.
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Update on the EPCRC project on pain, depression and fatigue
Dagny Faksvåg Haugen and Stein Kasa
pp 136-140
For many years, the European Association for Palliative Care Research Network (EAPCRN) has brought together European palliative care researchers and research groups. It has provided a platform for collaboration and exchange of ideas, and several multicentre initiatives have been carried out. While the EAPC recommendations and guidelines have gained worldwide recognition, the long-term goal of the EAPCRN has been to conduct prospective intervention studies. Over the years, experiences and results from projects initiated both inside and outside the EAPCRN prompted several of the partners to consider extending and formalising their co-operation. In 2006, a group of leading palliative care researchers formed the European Palliative Care Research Collaborative, in response to a request for proposals within the European Commission’s Sixth Framework Programme.
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A day in the life of Ulla Frymark, Physiotherapist working in palliative home care
Ulla Frymark
pp 142-143
John meets me at the door to his flat. He is a 64-year-old man who was diagnosed with metastatic prostate cancer two years ago. A month ago, he was referred to Stockholms Sjukhem, where I work as a physiotherapist in the advanced home care team. Our team consists of a physician, nurses, a physiotherapist (myself), an occupational therapist and a social worker. We have a team meeting every week at which we discuss current patients. The physician had asked me to find out if there is anything I can do to help John with his pain.
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Hospice care in US nursing homes: benefits and barriers
Todd B Monroe and Michael A Carter
pp 144-149
About a quarter of adult deaths in the USA occur in nursing homes. Previous research has concluded that the residents of these homes do not receive adequate pain management or high-quality palliative care at the end of life. Dementia can make the provision of adequate pain management difficult, in that residents with dementia may have difficulty in reporting their pain. Magaziner et al found that almost 50% of all nursing home residents had dementia. Another study found that 83% of nursing home residents with dementia had painful conditions.
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European insight: Sweden: the SFPM battles to make palliative care a medical specialty
Eva Thoren Toudoulos
pp 152-154
Palliative care in Sweden has its roots in homecare services. The first palliative day-care team was set up in Linköping, Östergötland, in 1963, operating from Monday to Friday. Inspired by the home-care idea, the first comprehensive homecare team with 24-hour access to doctors and nurses began in 1977 in Motala. The pioneer behind these initiatives was Barbro Beck-Friis, ‘the grand old lady’ of palliative care in the country.
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