Comment: A chance for end-of-life care to become mainstream
Andrew Hoy
pp 265-265
Palliative care has been associated with several euphemisms over the years. End-of-life care (EOLC) is one of these. It has the merit of honesty and does not seek to obscure the true nature of the activity. Earlier this year, the Department of Health published its long-awaited End of Life Care Strategy, which had been delayed to coincide with Lord Darzi’s NHS Next Stage Review.
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Can palliative sedation be a solution when a patient requests active euthanasia?
Lukas Radbruch, Norbert Krumm and Frank Elsner
pp 266-267
There is ongoing discussion on the legalisation of active euthanasia in Germany. Whereas discontinuation of treatment and symptom control are encouraged by German legal and medical regulations, active euthanasia – or hastened death – is not allowed. Someone assisting suicide (not precipitating death but merely providing the means to it) is not liable to prosecution. But a physician providing a patient with the means to end their life could be accused, under criminal law, of failure to give assistance, and also face heavy sanctions from the board of physicians and the licensing authority.
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Symptom control for patients dying with advanced CKD
Claire Douglas, Fliss Murtagh and John Ellershaw
pp 268-271
Despite the common belief that uraemic death is relatively symptom-free, the evidence does not support this. A systematic review of literature has shown that symptom prevalence is high in dialysis patients, and that those managed conservatively (without dialysis) also have a high symptom burden. Common symptoms include pain, fatigue, dyspnoea and anxiety.
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End-of-life care in the UK: a wider picture of service provision and initiatives
Scott A Murray, Kirsty Boyd, Jo Hockley and Aziz Sheikh
pp 272-275
Despite more than 40 years of hospice developments and associated efforts to promote palliative care, both in the community and in hospitals, the current UK mix of health and social services often fails dying patients, especially those who wish to die at home. At the time of diagnosis of a life-threatening illness, 50–90% of patients say that they wish to die at home, but less than 20% actually do so.
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Re-emphasising the social side: a new model of care
Felicity Hearn, Eve Jackman, Trudy Lake, Sarah Popplestone-Helm and Annie Young
pp 276-278
Psychosocial care is widely recognised as an integral aspect of holistic palliative care, interlinking with physical, practical and spiritual care to create a jigsaw of support for the patient. However, Field identifies the fact that the social aspects of psychosocial care tend to be underemphasised in favour of psychological ones: ‘In practice, the term psychosocial is usually interpreted in terms of the psychological needs of patients and, to a lesser extent, their families’.
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Case study masterclass 41: A patient with advanced oesophageal malignancy who requires tracheal stenting
Dwipaj Datta and Andrew Hoy
pp 279-280
Grace, a 62-year-old retired publisher, was admitted to the hospice for symptom control. Over the last six weeks, she had developed increasing difficulty in breathing and also in speaking and swallowing. She had a history of oesophageal carcinoma, having presented 18 months earlier with difficulty in swallowing, particularly solid foods. An upper gastrointestinal endoscopy at the time demonstrated a lesion at 28 cm, extending for a distance of 5 cm. At the time of diagnosis, Grace had palpable nodal disease in the right supraclavicular region. She underwent positron emission tomography with radiolabelled [18F]-2-fluorodeoxy-D-glucose (PET-FDG) scanning, which demonstrated the tumour to be in the region of the bifurcation of the trachea, with mediastinal and supraclavicular lymphadenopathy (see Figure 1). Biopsy confirmed a poorly differentiated squamous carcinoma.
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Case study masterclass 40 answers: A lung cancer patient with caring responsibilities making hospitalisation difficult
Jacqueline S Nicol and Isabel Dosser
pp 281-281
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Palliative care patients: what services do they really want?
Sophie Barrow and Patrick Blossfeldt
pp 282-287
The World Health Organization has defined 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’. The importance of palliative care is increasingly being recognised, and it has been highlighted in the National Institute for Health and Clinical Excellence (NICE) guidelines as an area for improvement.
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Complementary medicine can benefit palliative care – part 2
Moshe Frenkel and Vaishali Shah
pp 288-293
The use of complementary and integrative medicine (CIM) in patients with cancer is increasing. CIM and palliative cancer care share the goals of promoting the wellbeing and improving the quality of life of patients. In the first part of this article, we looked at the effect various CIMs had on fatigue and pain. Below, we look at their role in alleviating other symptoms commonly experienced by patients with cancer.
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Dutch GPs get 24-hour telephone advice on how to treat nausea and vomiting
Florien van Heest, Ilora Finlay, Ineke van der Ven, Renée Otter and Betty Meyboom-de Jong
pp 294-298
Michael Balint’s assertion that the doctor is a drug – meaning that the doctor herself/himself is a powerful medication – has not lost its significance. Palliative care means more than simply giving the right medical treatment for the relief of symptoms. The quality of the contact between the patient and the doctor, as well as the doctor’s sensitivity and ability to anticipate adequately, are important factors in determining the patient’s wellbeing.
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Children’s needs: key figures from the Veneto region, Italy
Franca Benini, Anna Ferrante, Laura Visonà Dalla Pozza, Manuela Trapanotto and Paola Facchin
pp 299-304
Medical and technological advances have enabled infants, children and adolescents with life-limiting and life-threatening disease to survive, but without always succeeding in curing them. The rise in the number of children living with lifelimiting and life-threatening disease has led to an increase in the number of young people needing palliative care, sometimes for long periods and at different stages of their lives, from infancy to adolescence and into adulthood. In the past, these patients would have been likely to experience numerous and prolonged hospital stays, which could even have lasted for years.
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