Comment: Teamworking in palliative care
Andrew Hoy
pp 227-227
It has been said that multiprofessional teamworking is awell-developed characteristic of the activity we know as palliative care. There are few other disciplines where the core team includes members from such a diversity of backgrounds, although many include professions in addition to doctors and nurses.
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Oropharyngeal dysphagia in advanced non-head and neck malignancy
Justin Roe
pp 229-232
Dysphagia (difficulty with eating and drinking) occurs frequently in the context of advanced cancer and this may be due to primary and/or secondary effects of the disease. Ekberg et al cite epidemiological data that estimates that as many as 22% of people over the age of 50 suffer with dysphagia. Palliation of symptoms and maintenance of quality of life are important goals in the care of dysphagic patients.
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The use of midazolam infusions in palliative care
Rachel Thorp
pp 233-236
Benzodiazepines are widely used in palliative medicine to treat a variety of symptoms. Of this group, midazolam has the advantage of being short-acting and water-soluble, making it suitable for parenteral use in the terminally ill.
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Case study masterclass 23: Difficult pain in a patient with mesothelioma
Sabrina Bajwah and Bernadette Lee
pp 237-238
Mr Jack Peters is 50 years old and lives with his partner. His past medical history includes angina and myocardial infarction and he is a smoker. He previously worked as a lift engineer and was exposed to asbestos.
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Case study masterclass 22 answers: A patient with acute myeloid leukaemia (AML)
Beverley Lee and Sue Haig
pp 238-238
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Adapting the Liverpool Care Pathway for the dying patient
Eric Somerville, Mazen Mahyoub, Karen Hales and Janet Squire
pp 239-242
When the decision was made to introduce an integrated care pathway for dying patients at Thorpe Hall Hospice in Peterborough, we naturally referred to the Liverpool Care Pathway for the dying patient (LCP). John Ellershaw and others had already published widely on this topic and some of these articles were reviewed. Dr Somerville attended a presentation by a team member from the Royal Liverpool Hospitals NHS Trust on the implementation of the pathway in an acute setting. We felt it was necessary to adapt the criteria for entry to the pathway and the paperwork for use in our hospice.
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The use of hypodermoclysis in palliative care
Laurette Claisse, Claire Grosshans and Yves Passadori
pp 243-246
Hypodermoclysis is defined as the infusion of fluids into subcutaneous tissue. The technique is simple to perform and the equipment needed is similar to that used to administer an intravenous infusion.
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Supporting bereaved people with intellectual disabilities
Noelle Blackman
pp 247-248
Historically, people with intellectual disabilities have not had their grief recognised. It is only recently that any consideration has been given to the emotional wellbeing of this group of people. For decades, people with intellectual disabilities have been denied the ‘talking cures’, such as counselling and psychotherapy, because of a misguided idea that they would not be able to make use of these interventions.
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Caring for people with learning difficulties
Dominique Jacquemin
pp 249-250
The care of residents with multiple intellectual disabilities at the end of life was the subject of a joint investigation carried out by the ethics committee and teams of carers at the Enfant Jésus home in Ciney, Belgium, a residential care establishment that looks after people from the age of 12 with mild-to-severe mental deficiency who may also have associated disabilities. The aim of the investigation was to consider the significance of the care given to residents towards the end of their lives.
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Working with the patient who is in denial
Simon Dein
pp 251-253
A diagnosis of life-threatening illness can provoke a number of extreme emotional reactions, including anger, depression, hopelessness and anxiety. How the person reacts is dependent on their appraisal of the situation, which itself depends on their view of the diagnosis, and their perceived control over the illness and its prognosis. As with any stressor, patients resort to various coping mechanisms to deal with the threat of illness.
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Family information and communication – what works?
Frances Sheldon and David Oliviere
pp 254-256
In palliative care, we recognise the unit of care as encompassing the person who is dying and those who care about that person. This principle has been contested and in practice it is often a challenge to balance the sometimes conflicting needs and wants of both parties; yet it still remains a distinguishing feature of palliative care. But what are the best ways to achieve this goal? What evidence do we have to help us decide which interventions are likely to be effective?
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The view from Lebanon
Huda Huijer Abu-Saad and Michel Daher
pp 257-260
The expansion and diversification of palliative care into a wide variety of settings can be seen in many countries. This process mirrors developments in clinical practice and healthcare policy. Many areas of clinical practice have seen an increased emphasis not only on patient-centred care, multidisciplinary collaboration, adequate coordination of care and the provision of continuity of care, but also on expanding the boundaries of healthcare professionals.
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Why palliative care cannot exist without spiritual care
Irma Biechele and Traugott Roser
pp 263-264
In 1999, Munich’s university hospital centre, Klinikum Großhadern, added palliative medicine and care to its programme. Since then, palliative care has been practised as part of a counselling service in all parts of the hospital. Members of the pastoral care unit worked with the team from the start, and, in March 2004, the Roman Catholic and Lutheran churches agreed to send a chaplain each to provide a deeper theological understanding of spiritual care. In this article, two chaplains reflect on the meaning of spiritual care through a case study.
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