Comment: Improving palliative care
Jo Lansdown
pp 47-47
In March 2004, the National Institute for Clinical Excellence for England and Wales (NICE) published the much-anticipated guidance on Improving Supportive and Palliative Care for Adults with Cancer. The publication of the guidance will provide no surprises for those involved in cancer care. The optimum service configurations and processes underpinning high-quality care will also come as little or no surprise as the recommendations are entirely practical and sensible.
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Management of the adverse effects of corticosteroids
Syed Qamar Abbas
pp 49-52
Glucocorticosteroids are one of the most commonly used medications in the palliative care setting. Their use is common in specific circumstances such as spinal cord compression or raised intracranial pressure and in non-specific circumstances such as poor appetite, lethargy and breathlessness. In one study, it was found that 33% of patients admitted to a hospice were on steroids and more than half of them did not know why.
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Safer anti-emetic prescribing for the palliative population
Lucy Nicholson and Suzanne Kite
pp 54-56
Nausea and vomiting are common in patients with advanced cancer, with 40–70% of patients experiencing these symptoms during their illness. Anti-emetics may be chosen on the basis of their receptor site affinities or by the use of clinical pictures.
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Case study masterclass 14: A complex bereavement after the death of a patient with learning difficulties
Carol Davis
pp 58-59
A 44-year-old woman with metastatic lung cancer has been referred for specialist palliative care assessment and symptom control. Both the GP and staff of the adult mental health unit have telephoned to provide extra information. Jackie* was one of seven children of a single mother. Her birth was premature and complicated by maternal haemorrhage. As an infant, she was diagnosed as suffering moderate-to-severe learning difficulties. Aged eight, she was admitted to residential care due to social neglect. Four of her siblings were also in care. She attended a ‘special school’ and some aspects of her behaviour improved markedly.
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Case study masterclass 13 answers: A man with no evidence of recurrent acute myeloid leukaemia
Carol Davis
pp 59-59
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Is there still any pleasure in eating for palliative care patients?
Benoît Burucoa and Hélène Bely
pp 60-64
Eating and food are synonymous with pleasure, with having a good time and with life itself. Anything that interferes with this pleasure has major psychological and relationship repercussions, both for the person affected and that person’s ‘nearest and dearest’.
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Behavioural problems in palliative care patients
Dean Blackburn, Lisa Williams and Jane Bake
pp 65-68
Patients with severe behavioural problems probably present some of the biggest challenges we face as palliative care professionals. In particular, ineffective or inadequate treatment of these symptoms can result in distress for patients and their families and are a potential source of stress and division among staff.
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The goldfish bowl
Polly Edmonds, Rachel Burman and Claire Sinnott
pp 69-71
In the UK, the General Medical Council (GMC) has identified the core components of the undergraduate medical curriculum in its publication Tomorrow’s Doctors. It states that, ‘Graduates must know about and understand the principles of … palliative care, including care of the terminally ill’. The updated document highlights a change in emphasis away from gaining knowledge and towards a learning process that includes doctors developing skills for interacting with patients and colleagues.
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Developing a paediatric hospice programme in Romania
Kirsteen Cowling and Susan Fowler-Kerry
pp 73-74
The paediatric palliative care movement continues to gain momentum throughout the world. The issue for many healthcare professionals is not whether there is a need for paediatric palliative care programmes, but rather how to initiate and develop these programmes.
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Hospice care and models of spirituality
Michael Wright and David Clark
pp 75-78
Spirituality has come to be regarded as an essential feature of hospice and palliative care. When new services are founded, attention is frequently paid to the spiritual domain, especially in areas where spiritual expression has previously been restricted. Andrei Gnezdilov, co-founder of Russia’s first hospice, Lakhta, considers that the spiritual basis of the hospice is crucial, ‘Everything is united around this,’ he says. ‘It’s the most important part.’ Yet without a generally accepted definition, questions arise about the nature of spirituality and its place in end of-life care.
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Evaluating a palliative care consultation service
Gérard Guesdon
pp 79-81
In the course of their work and after evaluating the patient’s symptoms, hospital palliative care team (HPCT) doctors tend to make treatment recommendations to the referring team rather than telling them how to proceed with the treatment of the patient by giving them direct prescriptions.
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