Comment: New year, new direction?
Eva Garland
pp 47-47
I am writing this on New Year’s Day, which invariably encourages a degree of reflection on what has happened in palliative care over the last year and possible changes during the coming year. At The Princess Alice Hospice, we completed a major rebuild in June 2006. Since then, we have been settling in to the new building and working systems, and are now ready to greet 2007 in a ‘state of- the-art’, modern hospice.
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The diagnosis and treatment of bone metastases
Seema Mishra and Sushma Bhatnagar
pp 49-52
Bone metastasis is a major cause of morbidity in cancer patients and is the most common cause of cancer pain. It is the third most common metastatic site after the lung and liver. Metastatic tumours are especially prevalent in the breast (73%), prostate (68%) and lung (36%). These three types of tumour account for 80% of patients with bone metastasis. Bone metastases are distributed to the axial skeleton, particularly the spine, pelvis and ribs.
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Irritant contact dermatitis and stomas in palliative care
Johnny Loughnane, Sinead Donnelly and Regina McQuillan
pp 53-56
Irritant dermatitis can be painful, distressing and difficult to treat. In the palliative care setting, it can commonly occur as a complication of stoma and fistula formation, or as a side-effect of radiotherapy treatment. This article will mainly focus on the treatment of skin problems associated with stomas, but will also consider the treatment of other causes of irritant dermatitis seen in palliative care patients.
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Case study masterclass 31: A palliative care emergency: neuroleptic malignant syndrome
Kumaraja Chandrarajan and Craig Gannon
pp 57-58
Helen* is a 52-year-old widow who was diagnosed with breast cancer in 1998. After surgery, adjuvant radiotherapy and hormonal therapy, she was believed to be ‘cured’. However, eight months ago she re-presented with right-sided sciatica and was found to have widespread metastatic bone disease. An MRI scan showed all her lumbosacral vertebrae to be involved.
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Case study masterclass 30 answers: And baby came too: Lucy’s story
Carol Davis
pp 58-58
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Quality of life measures: practical considerations
Marit S Jordhøy
pp 59-63
In accordance with the WHO definition, improving quality of life (QoL) is one of the main aims of all palliative care interventions. Consequently, QoL is an obvious palliative care outcome, and adequate and reliable assessment is required. QoL assessment is, however, connected with many challenges, both to those who want to apply measures in clinical work or research and to those interpreting results from such measurements.
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Interdisciplinary teamworking in paediatric palliative care
Patricia McNeilly and Jayne Price
pp 64-67
Paediatric palliative care has emerged as a distinct specialty over recent years in the UK, with the development of the Macmillan paediatric service, the advent of the children’s hospice movement and the increased emphasis on caring for children with lifelimiting, life-threatening and terminal conditions. Paediatric palliative care is most commonly defined as ‘an active and total approach to care, embracing physical, emotional, social and spiritual elements.
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An audit of respite provision in a palliative care setting
Gill Satterley
pp 68-69
It is often assumed that patients admitted for respite care probably need less medical or nursing intervention than those admitted to the hospice for other reasons, such as symptom control. However, this is not always the case. Hicks et al, when reviewing patients with motor neurone disease admitted to hospice for respite care, found that symptom control was a problem. Eighty-one per cent of patients received changes to their medication during their stay. Mortality may also be a factor. Rees surveyed 156 patients referred to hospices for respite care. Of these, 11% died while awaiting admission and a further 12% died during admission to the hospice.
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Must we accept death? A philosopher’s view
Lars Johan Materstvedt
pp 70-72
In one of his many essays with the interesting title, Our Friend Death, Norwegian writer Henrik Groth claimed that in the Western world, we are no longer used to dying. By that he meant that revolutionary, medical and technological advances in the post- World War II period had led many to view death as a ‘solved problem’ or, at least, as something not to worry too much about, since there seemed to be a cure for nearly every illness.
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How do hospital palliative care teams liaise with their colleagues?
Patricia Sealey and David Feuer
pp 75-77
Hospital palliative care teams (HPCTs) have existed in the UK in various forms since the late 1970s. They endeavour to act as their patients’ advocates and often cover a wide range of issues, including current physical and psychological symptoms, coping mechanisms, family support and expected prognosis.Although other specialists within the hospital may well be proficient in the multidisciplinary patient-centred approach, the palliative care specialist brings a unique perspective to assessment and management.
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Overcoming language barriers in palliative care
Mark Taubert
pp 78-79
Communicating with our patients is one of the major challenges faced by healthcare professionals across Europe and the world, not just in the field of palliative care. We use language as one of our main forms of communication, together with a variety of modalities, such as the volume at which we speak and facial expressions. The aim is to convey a message to others. There are many approaches to overcoming patient–physician miscommunication and they are often geared at modification of the doctor’s language and behaviour.
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A holistic approach to palliative care in Poland
Wojciech Leppert and Jacek Luczak
pp 80-83
Every year in Poland (a country with 38.2 million inhabitants), 320,000 patients die from chronic diseases, of which 88,000 are from cancer. Patients and their families need palliative care to alleviate their psychosocial suffering, as well as that brought about by their physical symptoms. Each year, about 200,000 patients suffer from cancer pain and need appropriate treatment.
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