Comment: A movement full of promise
Lucie Hacpille
pp 47-47
With the death of Cicely Saunders, the pioneer of the global palliative care movement, on 14 July 2005, we are reminded that her work was a thoughtful, visionary question of the circumstances under which we live. Little work has up until now responded to the ‘crisis of the modern world’ by getting so deeply involved with it professionally, humanely and radically.
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Opioids and the control of breathing: what do we know?
Bassam Estfan and Declan Walsh
pp 50-53
Opioids and their respiratory depressant effect have been studied, with varied enthusiasm, for over half a century. Opioids have long been considered the principal drugs for cancer pain, and the WHO recommends opioids for moderate-to-severe pain. In spite of these recommendations, cancer pain remains a problem and is often poorly controlled, and adversely affects quality of life. Many barriers affect prescribing or dispensing by healthcare professionals. Fear of opioid-induced respiratory depression is a well recognised, but probably overemphasised, barrier.
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Managing phantom limb pain
Seema Mishra and Sushma Bhatnagar
pp 54-56
Phantom limb pain was first reported in the 16th century by the French military surgeon, Ambroise Paré, who noticed that patients complained of agonising pain in the region of a removed limb, often months or even years after their amputation. The term ‘phantom limb’ was coined by Weir Mitchell who described this phenomenon and provided the first detailed study of painful and non-painful phantom limb. It is a form of nerve pain that appears to arise from an area of the body that has been removed, either surgically or traumatically.
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Case study masterclass 25: Palliative care of a paediatric patient with relapsed neuroblastoma
Torsten Hildebrandt, Jo Venables and Richard Hain
pp 57-58
A young girl with obstructive jaundice secondary to relapsed neuroblastoma presents to your paediatric palliative care service after the family moved into your area.
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Case study masterclass 24 answers: Managing a young woman with cystic fibrosis
Jane Grant, Carol Davis and Clare Forsyth
pp 58-58
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The use of implantable pumps in palliative care
Barry Laird, Lindsay McNeil and Catriona Ross
pp 59-62
Most cases of malignant pain can be controlled by conventional methods of analgesia and fewer than 2% of patients require spinal analgesia. In such cases implantable intrathecal pumps providing analgesic and anaesthetic agents are of proven value. However, the cost of the pumps, lack of practical experience, limited provision of anaesthetic services and access to surgical facilities are barriers to the use of such methods, even in a specialist inpatient unit.
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Access to specialist palliative care for cancer patients
Conrad Lee, Rico Liu and Chun-Chung Yau
pp 63-66
A new oncology department is planned for the Princess Margaret Hospital (PMH) in Hong Kong and the building is due for completion in February 2006. In the run-in period, an interim oncology service was started with a small team of two doctors and two nurses providing consultation services for the hospital, outpatient follow-up clinics and an outpatient-only chemotherapy service.
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The EAPC Ethics Task Force on Palliative Care and Euthanasia
Lars Johan Materstvedt
pp 69-71
In the first issue of the European Journal of Palliative Care (EJPC) in 1994, the European Association for Palliative Care (EAPC) published a paper stating its position on euthanasia. In February 2001, the EAPC Board asked an expert group to form an Ethics Task Force to review the subject and advise the organisation accordingly. In the March 2003 issues of Palliative Medicine and the EJPC, the task force published a new paper on the subject. In the same issue of Palliative Medicine, there are no fewer than 55 commentaries from 32 countries across the world, covering many varied and diverging views – both from within and from outside the palliative care community. That in itself serves to testify just how complex the topic is. The task force’s reply to critics appeared in the July 2003 issue of Palliative Medicine. Although the EAPC Board did not want to originally endorse the paper, since June 2003 the paper has been the Association’s official position on the question of euthanasia and physician-assisted suicide (PAS).
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Learning palliative care
Max Watson and Caroline Lucas
pp 72-75
Improving the quality of education in palliative care has been highlighted by medical and nurse educators and also by other healthcare professionals (HCPs) working with patients with palliative care needs. There have been calls to increase the time given to palliative medicine in undergraduate curricula and also to provide better in-service training in palliative care skills and knowledge. Despite the increasing recognition of the value of improved palliative care training, doctors and nurses repeatedly mention palliative care as an area in which they need further training and expertise.
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Palliative care in the developing world: a social experiment in India
Chenganakkattil Shabeer and Suresh Kumar
pp 76-79
The emergence of palliative care was probably a response of the medical profession to the marginalisation of patients who are terminally ill or incurable. Rapid advances in healthcare resulting from improved public healthcare services and advances in medical technology have raised expectations. Palliative care operates in the background of unrealistic expectations about medical technology and longevity. Meanwhile, changes in relationships in society have affected traditional ways of dealing with illness and death in communities.
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The construction of palliative care: experience and challenges
Virginie Tournay and David Roy
pp 80-81
On 2 June 2005, Virginie Tournay interviewed Dr David Roy, Editor-in-Chief of the Journal of Palliative Care for his thoughts on the developments in the field of palliative care over the last 25 years.
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Monitoring a hospital palliative care team using the PACA tool
Claud Regnard, Julie Dixon, Susan Besford, Helen Merlane and Michelle Bowman
pp 82-84
Since the early days of palliative care, there are now nearly 300 hospital support teams. However, these teams vary in size from those with five full-time nurses, a full-time consultant, secretary, social worker and psychologist, to teams with only two nurses and part-time medical cover. For smaller teams, it can be a daunting prospect to monitor their effectiveness over a prolonged period.
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