Comment: Losing the label of elitism
Andrew Hoy
pp 135-135
The palliative care, or hospice, movement provides demonstrably excellent care for those patients and families with whom it has direct contact. However, it has been criticised over the years for focusing on a significant yet small population of terminally ill cancer patients. It has also been accused of collecting patients together in what some have seen as ‘collective dying’. The answer to these charges is, of course, the integration of palliative care philosophy into core clinical practice.
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Assessment of neuropathic pain in palliative medicine
Jan Gaertner, Christoph Ostgathe and Raymond Voltz
pp 137-140
Neuropathic pain is a common element of cancer pain syndromes. It has been reported that 20–40% of all cancer patients suffer from it. As treatment requires specific classes of drugs and is often difficult, the identification of neuropathic pain is essential for the initiation of adequate analgesic therapy. Neuropathic or neurogenic pain is defined by the International Association for the Study of Pain as ‘pain caused by a primary lesion or dysfunction of the nervous system’, but there is ongoing debate about the term ‘dysfunction’. While some authors criticise this definition as being too vague, it is generally agreed that neuropathic pain is characterised by the association of pain with a variety of further positive and negative sensory symptoms.
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A tailor-made psychological approach to palliative care
Dominic Bray and Karen Groves
pp 141-143
As a doctor, nurse or allied healthcare professional working in a palliative care service, your raison d’être is helping people to live well until they die. How do you know when you are achieving your aim? How do you plan treatment in its various forms, and decide on a place of care, diet and all the everyday elements of life that take on a new significance in this situation, as well as affording patients and carers the dignity that comes from having every opportunity to use their strengths and abilities? Solution-focused practice can meet this challenge.
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Case study masterclass 33: Managing an elderly, independent patient with motor neurone disease
Laura Booth and Bernadette Lee
pp 144-145
Lillian, an independent 78-year-old, presented to her GP with gradual weakness in her hands. She had noticed mild weakness in her left leg, with foot drop in the past year. She had recently had a fall and fractured her wrist and neck of femur. On examination, the GP noted widespread fasciculation in her arms, thighs and back. She had wasting in the intrinsic muscles of the hands and bilateral foot drop. Her power was grade 4/5 proximally and grade 3/5 distally in her upper and lower limbs, with normal sensation. She had brisk reflexes and upgoing plantars. Her peak expiratory flow rate was 260 l/min (normal range is 290–390). She was admitted to the regional neurology centre for nerve conduction studies, electromyography and other investigations.
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Case study masterclass 32 answers: Complex end-of-life care: cultural issues
Carol Davis
pp 145-145
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Prognosis in patients with advanced incurable cancer
Sushma Bhatnagar, Madhurima Srikanti, Roopesh Jain and Seema Mishra
pp 146-147
Doctors face two challenges in dealing with patients with advanced incurable cancer – formulating an accurate prognosis and communicating it. An accurate prognosis enables patients to make plans, put their affairs in order and decide how they want to spend the time they have left. It also helps the doctor to decide about a further treatment plan and to prevent or avoid invasive and ineffective medical therapy. It also enables the doctor to decide on appropriate supportive therapy in time.
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Does favouritism play a part in bed allocation at hospices?
Bridget Taylor
pp 148-151
Audit is increasingly used as a means of evaluating nursing practice. This is endorsed by the Department of Health, which states that all aspects of care that use resources or affect patient care should be audited. The purpose of audit is to extend practitioners’ knowledge about their own practice and improve the quality of care. The audit cycle involves three stages: identifying the current situation, comparing this with the ideal situation and taking action to close the gap. The audit cycle includes monitoring the achievement of standards,1 although it is unclear whether it should be the practitioners or the patients who set these standards. This paper presents the results from the first of these steps, an exploratory bed-
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Palliative care for older people
Dylan Harris
pp 152-154
As a group, older people have many unmet needs, experience multiple problems and disabilities and require more complex packages of treatment and social support. The principles of geriatric medicine, which are to foster independence and preserve quality of life, and those of palliative care, which aim to provide active total treatment of patients whose disease is not responsive to curative treatment, share many common themes, such as a holistic ‘whole person’ approach and multidisciplinary teamworking.
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Are patients’ psychological needs being met?
Sally J Westwood and Gregory Wood
pp 157-160
The principle underlying palliative care is a holistic approach, which addresses the needs of the patient and the family across physical, psychological, social and spiritual domains. This approach has not traditionally been taken within UK oncology services, which have tended to focus on the medical needs of patients. However, the concept of ‘supportive care’ – which, over the past few years, has been pushed by the UK government’s cancer agenda – refers to care throughout the cancer pathway and has a holistic ethos and focus on quality of life, similar to that in palliative care.
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Israel breaks new ground with law for the terminally ill
Michaela Bercovitch
pp 161-163
In Israel, the Terminally Ill Patient Law was passed following the second and third hearing in the Knesset, the legislative branch of the Israeli government, in December 2006. It is, undoubtedly, an important breakthrough in Israeli medical ethics and social relations.
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Death, dying and burial rites in Islam
Mohammad Zafir Al-Shahri, Nada Fadul and Ahmed Elsayem
pp 164-167
Improving cultural awareness among healthcare professionals is fundamental to providing culturally competent healthcare. Religious beliefs and rites are among the major factors that interact to shape the culture of a particular community, family or individual. Minority groups may be at increased risk of receiving suboptimal healthcare. Muslims form the largest religious minority in western Europe, with Islam being recognised globally as the fastest growing religion, with estimates of the world’s Muslim population ranging from 1.3 billion to almost 1.8 billion. In this article, we provide an overview of Islamic rites pertinent to death, dying and burial with the aim of assisting palliative healthcare providers in enhancing their cultural competence when caring for dying Muslim patients and their families.
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Teaching palliative care: a blended approach
Isabel Dosser, Karen Lockhart and Patricia Black
pp 168-171
The provision of palliative care has become more common in general clinical areas in addition to specialist areas such as hospices. The demand for it has increased in line with an aging population and to encompass the care of patients with nonmalignant as well as malignant conditions. Such changes in clinical practice require practitioners to develop their knowledge and skills to meet the needs of this changing clinical picture. This presents challenges to educationalists when developing approaches to the delivery of palliative care education.
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