Comment: Need for increased evidence in palliative care
Eduardo Bruera
pp 160-160
Modern palliative care was first developed in the UK in the 1960s as a response to the needs of terminally ill patients and their families. It soon became a global movement. Original programmes emphasised the management of pain and other symptoms with simple measures, avoiding unnecessary, painful diagnostic and therapeutic interventions, in addition to providing psychosocial and spiritual support to both patients and families.
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Dyspnoea and cough
Fiona Rawlinson
pp 161-164
Dyspnoea and cough are common multidimensional problems that continue to present a challenge to interdisciplinary teams in palliative care. A holistic approach involving the patient, family and carers is central to their management. It is important to choose investigations and treatments that are appropriate to the prognosis, and include specific drugs as well as general and non-drug measures.
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A new 24-hour morphine hydrogel suppository
Carol Davis
pp 165-167
Pain is experienced by 20–50% of cancer patients at diagnosis and by up to 75% with advanced cancer, and it is moderate or severe in 40–50% of patients. The European Association for Palliative Care (EAPC) and the World Health Organization (WHO) recommend morphine as the strong opioid of choice for the management of moderate to severe cancer pain. Treatment with morphine (or another strong opioid) and a non-opioid analgesic (step 3 in the WHO analgesic ladder) gives satisfactory pain relief in about 80% of patients who require step 3 treatment.
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Videoconferencing and palliative care
Claud Regnard
pp 168-171
Videoconferencing was first imagined in science fiction films in the late 1920s. Early forms of videoconferencing were being used in 1975, but it is only in the past ten years that true videoconferencing has become a reality. Advances in technology and reducing costs have meant that good quality videoconferencing has become available with a desktop computer.
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Redefining the role of the clinical nurse specialist
Sarah Folland
pp 172-174
Nurses, like other professionals within healthcare provision, have faced a period of increasing change over the past decade. As the healthcare delivery system in the UK changes yet again, nursing continues to strive to change its organisational structures to accommodate new and expanding roles. Bowles suggests that within the specialist palliative care field such developments should provide nurses with the opportunity to redefine their contribution within an increasingly outcomes-conscious, multiprofessional healthcare environment.
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The status of hospice and palliative care in New Zealand
Rod MacLeod and Ann Martin
pp 175-177
Palliative care is a developing multidisciplinary specialty in New Zealand, as in many other countries. Despite the recognition of various key issues in the funding and organisation of hospices in New Zealand as long ago as 19871 the development of palliative care services has predominantly been driven by public interest. As in the UK and Australia that development has been somewhat haphazard and unregulated.
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Morphine – doctors' beliefs and the myths
Jean-Pierre Valera and Regis Aubry
pp 178-182
Most patients suffering from incurable diseases would like to spend their final days at home. With the aim of making their wishes possible, an experimental palliative care network has been set up in Franche-Comté in France. One aspect of this experiment is based on the premise that, if doctors were better educated about palliative care, it would be easier to allow these patients to end their days in their own homes. As a consequence, a continuous training programme for carers has been set up along these lines and ‘mandatory’ university education at Besançon has included palliative care since 1994.
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Investigating genetic predisposition to cancer
Fiona Lalloo, Gareth Evans and Penelope Hopwood
pp 183-184
Palliative care not only encompasses the medical management of the end-stages of life, but also the psychological aspects of coping. Concerns about the family are among the most common in hospice patients1 and one of the wider aspects of this is to consider the implication of the risk of malignancy in other members of the family. While a formal discussion of risks and screening for relatives may be left until a more appropriate time, it is important to consider a number of issues before the death of the patient.
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Request for euthanasia: time to ask, time to listen
Catherine Diricq
pp 186-189
The attempts of western society to master time often create the illusion that by controlling time we can control life, and therefore death. Time has acquired an economic value that is often devoid of humanity. Palliative care allows us to reconsider the end of life, and thus human life with its temporal and relational dimensions. It lends social and therapeutic values to time.
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