Comment: Risk of learning?
Carol Davis
pp 95-95
Anyone who has sat next to me at a scientific meeting or conference will know that I have a well-used, but not very well developed, assessment tool for use at these events. It is not validated but seems reliable for a sole user and is repeatable. It takes into account both my expectations of the meeting and the reality of it.
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Serotonin syndrome: a hidden danger in palliative care
Tracy Anderson, Max Watson and Ken Marr
pp 97-100
Serotonin syndrome is an increasingly recognised syndrome in patients who have received one or more serotonergic drugs. It is characterised by cognitive/ behavioural, autonomic and neuromuscular changes and is caused by excess serotonin in the central and peripheral nervous system, resulting in stimulation of the 5-HT1a receptor. Although the incidence is low and the syndrome is usually mild and reversible, fatalities and severe complications are a recognised outcome.
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The assessment and management of depression in the terminally ill
Barry Laird and John Mitchell
pp 101-104
Depression is the most common psychiatric condition in palliative care. One study found that 47% of cancer patients had psychiatric disorders and, of this group, 68% had a depressed or anxious mood and 13% had major depression. However, it is underdiagnosed in palliative care and reasons include difficulty in diagnosis and lack of physician knowledge.
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Case study masterclass 20: Symptom control in a patient with carcinoid tumour
Sabrina Bajwah and Bernadette Lee,
pp 106-107
Evelyn Smith,* a 67-year-old who was married and had two children, was referred to the colorectal surgeons with a right-sided abdominal mass and a six-month history of increasing diarrhoea, leading to incontinence. A barium enema showed a defect in the terminal ileum and caecum. A staging CT scan showed multiple hepatic metastases.
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Case study masterclass 19 answers: A complex patient with metastatic renal cell carcinoma
Jane Grant
pp 107-107
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Patients deciding to forgo or stop active treatment for cancer
Lea Kacen, Irena Madjar, James Denham, Stephen Ackland and Samuel Ariad
pp 108-111
Patients with a diagnosis of cancer face the prospect of surgery and/or adjuvant therapy, which can have profound consequences for them. Their experience is often one of uncertainty, yet within a very short time, often within the first consultation with a medical specialist, patients must decide what treatment to accept, or (in some cases) whether to forgo the recommended treatment. As the majority of patients accept the recommendations for treatment, the complex nature of their decision-making (and its psychosocial, cultural, and moral dimensions) may remain hidden and is seldom called into question.
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Patient transport: another source of pain
Jean-Marie Nebbak and Marie-Cécile Le Deley
pp 112-114
Asurvey involving hospital porters was carried out by the Anti-Pain League at the Institut Gustave Roussy (IGR) Cancer Centre in April 2004, to investigate the pain suffered by patients who are transported inside the hospital by porters. The survey was conducted because there has been no previous study on this topic.
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Palliative care for people with learning disabilities
Jackie Saunders
pp 117-119
When St Nicholas’ Hospice reflected on the success of its general palliative care education, it noted the lack of topics covering the dying and bereavement of people with learning disabilities. A literature search and clinical observations highlighted specific issues around the delivery of appropriate palliative care to this client group.
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Going to the theatre to talk about cancer
Irene Tuffrey-Wijne and Jane Bernal
pp 120-121
People who work in palliative care services often have concerns when someone with intellectual disabilities is affected by cancer.
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Turning to palliative care
Isabelle Moley-Massol
pp 122-123
There is no good way to break bad news, but some ways are worse than others. Some doctors do not give patients sufficient information about their illness and this prevents them from coming to terms with it; other doctors tell the patient the harsh truth and the patient may be unable to cope with this. The doctor has to gauge what a particular patient wants to hear and is capable of absorbing, at every stage of the illness. Giving a diagnosis of cancer is a gradual process: there is the announcement of the illness, its treatment, remission, a cure and palliative care.
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Does truth-telling influence patients’ psychological distress?
Susie Wilkinson, Deborah Fellowes and Chrysi Leliopoulou
pp 124-126
Psychological distress is estimated to affect 25–30% of patients when given a cancer diagnosis and/or told of recurrence.1 It has been suggested that this distress could be lessened if healthcare professionals (HCPs) were truthful and open with patients about their diagnosis and prognosis. However, disclosure is complex and is compounded by the ethnicity and culture of the patient and/or HCP.2 Death also remains a taboo subject in many cultures and many HCPs find it difficult to give patients honest answers to their questions.
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Palliative care in Croatia – an international collaboration
David Oliver, Fliss Murtagh and Anica Jusic
pp 127-129
Croatia is a small country with a population of 4.3 million. Over the last 15 years, it has undergone a great transition, from being part of the federal Yugoslavia under communism, to an independent country struggling for its existence. As a result of the civil war and the post-war economic and moral crisis, healthcare has not progressed as effectively as in some other central and eastern European countries. The palliative care services are only now starting to develop.
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