Comment: Equity of access
Andrew Hoy
pp 5-5
‘Equity of access’ has become a popular slogan of many governments concerning the healthcare sector. When such equity of access is applied to palliative care, it is worth examining the phrase in greater detail. This first issue of the European Journal of Palliative Care in 2008 is an attempt to do that in several ways.
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Pain and the use of opioids in treating elderly patients
Natasha Michael
pp 6-10
Palliative care physicians now more than ever are facing the impact of an aging population. Cancer remains a disease of the elderly, and demographic shifts are bringing about changes in the epidemiology of diseases. Cardiovascular and respiratory
diseases are now the major cause of death and it is possible that increased longevity in populations is accompanied by longer periods of disability. Studies have confirmed that the burden of symptoms experienced in the last year of life increases with age, and the burden of non-malignant
disease is similar to that of cancer. Pain, fatigue and breathlessness have been cited as being universal, with pain recognised as a major symptom.
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Paracetamol allergy in a patient with advanced cancer
Sue Morgan and Helen Walsh
pp 11-13
The key principles of palliative care can be summarised as a team approach to patient care aimed at relieving pain and other distressing symptoms. Indeed, although an accurate assessment is a prerequisite for the management of physical, psychosocial and spiritual problems, an experienced multiprofessional team is fundamental to the delivery of specialist palliative care (SPC). However, the SPC team cannot work in isolation and must liaise closely with other teams caring for the patient, be they in primary, secondary or tertiary care.
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Case study masterclass 36: A complex patient with a thymoma and severe paraneoplastic cerebellar syndrome
Jane Grant and Carol Davis
pp 14-15
A 61-year-old woman with a long-standing diagnosis of carcinoma of the thymus and a rapid onset of neurological weakness on a background of presumed paraneoplastic cerebellar syndrome is admitted. The hospital palliative care team (HPCT) receives a referral from the oncology team requesting advice on symptom control for the patient and support for her husband and family.
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Case study masterclass 35 answers: Dealing with spinal cord compression as an emergency in a palliative day care patient
Jacqueline S Nicol and Isabel Dosser
pp 16-16
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Making sense of end-of-life distress
Chitra Venkateswaran, Manoj Kumar, Parvez Thekkumpurath and Michael Bennett
pp 17-21
The experience of cancer is complex and the factors that determine whether people can carry on with their normal lives are often emotional or psychological. A significant level of emotional distress is experienced by nearly 60% of palliative care patients. Therefore, the priority in end-of-life care should be not only to relieve their physical symptoms but also to reduce their emotional distress. Evidence suggests that we are a long way from achieving this goal.
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Is specialist palliative care social work being neglected?
Peter Beresford, Suzy Croft and Lesley Adshead
pp 22-25
Specialist palliative care social work has tended to be a marginalised field in both palliative care and social work practice. The National Institute for Health and Clinical Excellence (NICE), for example, did not identify social workers as members of the core palliative care team in its draft and subsequent guidelines for supportive and palliative care. Palliative care social work rarely features in social work literature or textbooks. Yet the first national study of service users’ views, which this article draws on, shows that it is highly valued by those who use it and is perceived as having a distinct contribution to make.
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Using the concept of speed dating in research into illness
Elizabeth Lank, Alison Donaldson and Jane Maher
pp 26-29
When evaluating novel interventions in healthcare and refining research questions, it is clearly valuable to involve patients and carers and to call on the experience of members of the multidisciplinary medical team. However, the practical difficulties of getting ideas from such a diverse group of people are so great that, sometimes, their input is simply not sought and, instead, the research process is driven entirely by professional researchers.
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Diversity in palliative care between the UK and Germany
Eva Katharina Herrmann and Claudia Bausewein
pp 30-33
To gain experience in palliative care, more and more German doctors are working for a while in the UK, where it originated, so that they can then help to implement it in the German healthcare system. However, transferring what they have learned in a British hospice or palliative care unit to a German hospital can be a major challenge.
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Making it real: advances in palliative care in Africa
Lukas Radbruch and Anke Brunsch-Radbruch
pp 34-37
Eunice Garanganga, a palliative care nurse in Zimbabwe, was talking about a little boy with AIDS. His parents did not want him to be told about his disease and she had respected their wishes. However, when she came to see him at home one day, he was alone. She asked him what he knew about his disease. He told her that he did not know what it was. She asked whether he knew anybody with the same disease. ‘Yes,’ he said. ‘All my friends.’ ‘Where are your friends?,’ she asked. ‘They have died,’ he replied.
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End-of-life care for Muslims and Christians in Lebanon
Jouhayna Bejjani-Gebara, Hera Tashjian and Huda Abu-Saad Huijer
pp 38-43
It is true that death is inevitable; however, the journey towards it can be modified to make it as decent and peaceful as possible. The 20th-century American novelist Thomas Wolfe went further, saying: ‘[Death is] the last voyage, the longest and the best’. The irony of death lies in the fact that it is common to all and thus binds humans, but also vividly illustrates their differences in beliefs, values and religious practices.
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