Comment: A platform for ideas
Lukas Radbruch
pp 40-40
A commitment to research and the best use of available resources is essential if palliative medicine is to develop as a separate speciality. Politicians and administrators involved in healthcare will begin to recognise the need for palliative medicine only when its efficacy has been proven. The UK is far ahead of most other European countries in this respect – palliative medicine is a recognised speciality and the need for research is accepted by staff and patients.
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Acupuncture in palliative care
Jacqueline Filshie
pp 41-44
Acupuncture has its origins in prehistory, and has been used in China for over 2,000 years. However, the last 30 years has seen mounting interest in acupuncture in the West. This is partly a result of disenchantment with traditional drug therapies and their catalogue of side-effects, and partly because there is increasingly solid neurophysiological evidence for its effectiveness.
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The use of bisphosphonates in palliative care
Paul Walker
pp 46-49
A new class of drugs has appeared in the field of palliative care. The bisphosphonates have been used to treat tumour-induced hypercalcaemia and are now being used increasingly for their newly discovered palliative benefits. Bisphosphonates are analogues of inorganic pyrophosphate. Their mechanism of action is via inhibition of osteoclast-mediated bone resorption. Their use is well established for the treatment of osteoporosis and Paget’s disease.
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Palliative care history: a ritual process?
David Clark
pp 50-55
At the beginning of the 19th century, the French anthropologist Arnold van Gennep described the rites of passage which accompany aspects of our daily lives. Each ritual, he argued, has three phases: separation, transition and incorporation. Their special features assist in the journey from one social state to another. More recently, these ideas have expanded to the analysis of social movements and provide a useful way of looking at the history of palliative care. They tell us something about the rituals and transformations accompanying the development of terminal and palliative care and give some indication about directions in the future.
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Team dynamics and the difficult patient
Kyriaki Mystakidou and Elein Tsilika
pp 56-59
The primary task of the therapeutic team in palliative care is providing care and support to dying people and their families. However, while it is easy to achieve consensus on an overall objective to improve quality of life, agreement on how to accomplish it in individual cases is more complex. The palliative care team includes various groups such as doctors, nurses, psychologists and social workers. The patient and family are considered integral parts of the team: they participate in setting goals and priorities, are affected by education and training, research and administration.
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Meeting the spiritual needs of patients through holistic practice
Ann Hopper
pp 60-62
Spiritual care is an elusive concept for palliative care practitioners. It raises questions about the response of those not facing life-limiting illness to others struggling to find a meaningful path through suffering. Conscientious attention to detail in daily practice is more than an exercise in the techniques of care. If practitioners want to reach out to patients’ spiritual needs, they can best do so through the activities of their everyday practice, since the concept of spiritual care is inherent in the practice of holistic palliative care.
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Using music as a spiritual tool in palliative care
Theresa Foxglove and Barbara Tyas
pp 63-65
The Sufi master Hazrat Inayat Khan tells us, ‘There is no better way of getting closer to God, of rising higher towards the spirit, of attaining spiritual perfection than music, if only it is rightly understood.’ Dying patients are often caught up in the struggle both to ‘hold on’ to life as they have always known it and to ‘let go’ of a body that is relentlessly deteriorating. This tug-of-war can make them feel hopelessly trapped on a spiritual treadmill of inner conflict, suffering and loss.
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The EAPC Geneva conference revisited
pp 67-70
The EAPC conference in Geneva captured many prominent medical and educational palliative care advances. The following selection of abstracts and presentations are taken from a German symposium and reflect the high standard of papers given.
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