Comment: Buildings that will change the face of palliative care
Julia Riley
pp 161-161
Just over a year ago, I wrote my first editorial comment in this journal. I said that, for as long as I could remember, palliative care had been the Cinderella specialty, but pointed out that things were changing, at a local, national and international level. Nothing, however, prepared me for how true this might be. Recently, I visited the new Cicely Saunders Institute of Palliative Care, which opened in London in early 2010, and I was completely overwhelmed.
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Palliation of breathlessness: a combined approach is needed
Anne-Louise Jennings
pp 162-166
Over the past 20 years palliative care practitioners have witnessed an improvement for patients in many areas. Cancer treatments have advanced, cure rates are better and treatments are less toxic. Symptom control has improved greatly, with better pain control, more analgesic drugs and different ways of delivering medications. Furthermore, it is now recognised that palliation may be an end in itself, and palliative medicine is a well-recognised specialty. All a far cry from a time when patients with advanced disease were merely sent home, with no further outpatient appointments, to cope as best they could on their own.
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Palliative medications: drugs for neuropathic pain
Michael I Bennett
pp 167-169
Damage or pathological change in the peripheral or central nervous system can result in changes to normal pain transmission; clinically, this state is called neuropathic pain. These changes can be summarised as increased peripheral nociceptive activity, with excitation and reduced inhibition in the spinal cord and brain. Neuropathic pain occurs in up to 40% of patients with painful cancers, but it is common too in patients with HIV/AIDS. It is also common in other patients with advanced disease, who can suffer from comorbid conditions, such as postherpetic neuralgia or painful peripheral neuropathy caused by diabetes, surgery or drug treatment.
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Case study masterclass 51: Low albumin in a woman with metastatic malignancy
Claire Magee
pp 170-171
Susan, a 62-year-old retired cleaner, is divorced and lives alone. She has two daughters who live nearby. She has never smoked. Three months ago, she developed a dry cough and nocturnal rib pain. She lost a stone in weight. She was referred urgently to the lung cancer clinic under the government’s ‘two-week wait’ rule. A chest X-ray showed widespread pulmonary metastases. A CT scan showed a large renal mass arising from the upper pole of the left kidney with para-aortic lymphadenopathy. It was explained to Susan that this was almost certainly cancer that had spread to her lungs, and that she would need a biopsy to confirm the diagnosis.
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Case study masterclass 50 answers: Feeding issues and venting gastrostomy in malignant bowel obstruction
Jennifer Clare, Steinunn Boyce and Sabrina Bajwah
pp 172-172
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Building a life beyond cancer: Maggie's Centres
Laura Lee
pp 174-177
The main aim of Maggie’s Cancer Caring Centres has remained unchanged since the blueprint for a cancer caring centre was first mooted in 1994 by Maggie Keswick Jencks, the woman whose vision inspired the centres. The centres exist to help people help themselves as they deal with the impact of a cancer diagnosis. Their philosophy is based on an appreciation of the fact that people hold within themselves the most extraordinary strength. The centres are places where anyone affected by cancer can go to discover that strength and learn new skills and strategies to cope.
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Paving the way for definitive end-of-life care quality care markers
Maureen McGinn
pp 178-180
In July 2008, the Department of Health published the End of Life Care Strategy, which was the first comprehensive framework aimed at promoting high-quality care across England for all adults approaching the end of life. The strategy set out an ambitious vision of how end-of-life care should be experienced by all, patients and carers, and the mechanisms by which that care should be delivered. But how are we to measure progress towards its successful implementation?
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PRISMA: share best practice in end-of-life cancer care research and management
Richard Harding and Irene J Higginson
pp 182-185
The provision of appropriate, effective and well-planned end-of-life cancer care is a public health priority for Europe. However, despite demographic projections showing significant increases in the need for palliative care provision, the development and evaluation of quality care at the end of life has, to date, been severely neglected.
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Tales of volunteers practising 'gentle touch'
Elizabeth Baines
pp 186-189
Those of us who work in palliative care teams often say that we could not do the work we do without the support of volunteers. Indeed, palliative care services would be very different without volunteers. Studies looking at the experiences of doctors and nurses working in palliative care are plentiful, but how often do we explore the volunteers’ stories? Having trained some volunteers to use ‘gentle touch’ with patients and carers, I became mindful of the stories they told me at their supervision sessions. This prompted me to look again at the training programme and ongoing support mechanisms. This article highlights aspects that emerged during this review process.
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Visiting a hospice in Jaffna, northern Sri Lanka
Anonymous
pp 190-193
Sri Lanka is a small Southern Asian island that lies in the Indian Ocean and has a population of around 21 million. In 1983, civil war broke out between the Singhalese majority and a group of Tamil separatists known as the Tamil Tigers. Despite a formal ceasefire in 2002, fighting continued until May 2009, when the government announced that it had defeated the Tamil Tigers and killed their leader. The areas most affected by the conflict were the north and east.
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How to write an effective application for a research grant
Jason Boland
pp 194-196
Palliative care research is in its infancy, but it is expanding rapidly. The essential foundations for a good research proposal are a sound and preferably novel idea, the expertise to execute it and the money to fund it. Although most individuals wishing to begin a programme of research are not short of ideas, competition for the limited amount of available funding is intense. Research across all aspects of palliative care is becoming more common, and funding for such research is increasingly sought after.
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Meeting the need for palliative care in Malawi: the story so far
Lameck Thambo, Suave Gombwa, Vicky Lavy, Tim Wiggin and Gillian Chowns
pp 197-200
In a continent as large and diverse as Africa, the development of palliative care has taken many paths, and its spread may be characterised as sporadic, uneven and beset by challenges. This article presents an example of good practice in pioneering and consolidating palliative care in a resource-poor African country, namely Malawi. While policy-makers can devise strategic plans for establishing palliative care, the reality may be that its development is much more like the spread of a contagious disease. This article traces the genesis of the ‘infection’, its transmission by committed palliateurs, the gradual spread of the ‘disease’ among the healthcare professions, and the challenges of achieving nationwide coverage. Commonalities and differences between the Malawi experience and the WHO public health strategy model are considered, and some lessons for the future are identified. While other African countries wishing to establish palliative care will each face unique challenges, there may be much from the Malawi experience that is transferable.
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European insight: How the IAPC has helped Ireland to transform its palliative care
Mary Ainscough
pp 202-204
Ireland has had a rich culture of hospice and palliative care organisations since the 1800s. These organisations, together with the Irish Cancer Society and the Irish Hospice Foundation, have championed the holistic approach that is the hallmark of palliative care and have been instrumental in advocating improved service provision and in raising public awareness. The voluntary hospice movement has been vital in the establishment of specialist palliative care services.
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