Comment: Reflections on a ‘good death’ in palliative care
Huda Huijer Abu-Saad
pp 223-223
The notion of a ‘good death’ is closely related to the principles and practices of palliative care. Some historians argue that technological and medical advances, as well as professional domination of death, typify our modern times. Others counter the above by focusing on the notions of expression of feelings and having a sense of meaning and trust. These issues become of paramount importance when new subjectivity within the healthcare system prevails, where patients are assessed not only on the basis of their disease and the ensuing symptoms and needs, but also in relation to their personal, psychosocial, spiritual and cultural concerns.
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The use of antitussive drugs in terminally ill patients
Zbigniew Zylicz and Malgorzata Krajnik
pp 225-229
Transient, acute cough may be a trivial symptom familiar to all people from early childhood. In the context of terminal disease, the same symptom may become a troublesome and tiresome complaint. Chronic cough occurs in 37% of patients with advanced cancer. Prolonged bouts of coughing are exhausting and frightening. They may exacerbate fatigue and induce sleeplessness, vomiting, dyspnoea and haemoptysis.
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Cannabis and pain control
William Notcutt
pp 230-232
Cannabis has been used therapeutically for more than 5,000 years. The modern history of cannabis starts in the mid-1800s with William O'Shaughnessy, who participated in experiments in its use in Calcutta. Towards the end of the 19th century, over 100 papers have been produced on its use as an analgesic, a muscle relaxant, an anticonvulsant and treatment for restlessness and anxiety in terminally ill patients.
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Case study masterclass 18: Aileen’s story: palliative care from a patient’s perspective
Carol Davis
pp 234-235
This case study master class is written in a different style. It is based on a series of conversations with Aileen before her death on 1 October 2004. She specifically asked that her story should be written in the first person, and that her name should not be changed. She saw drafts of the manuscript but it was finalised after her death.
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Case study masterclass 17 answers: A prisoner with a history of drug abuse
Carol Davis
pp 235-235
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Hospice and NHS partnership
Eva Garland and Jan Morrison
pp 236-238
Palliative care continues to have a high political profile in the UK. This is partly as a result of consistent pressure from the predominantly voluntary providers of hospice and specialist palliative care, and partly as a result of the high profile of cancer networks. These were first highlighted in the Calman–Hine report and formalised by The NHS Cancer Plan. Both were largely driven by comparing European cancer survival rates and finding the UK figures worse than most of its neighbours.
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Risk factors predicting the development of delirium
Marjolein Bannink, Hetty van Veluw, Lia van Zuijlen, Roelien Enting and Karin van der Rijt
pp 239-240
Delirium is a frequent neuropsychiatric complication in patients with advanced cancer. It is characterised by acute onset and cognitive impairment, affecting orientation, attention, memory and organisational skills. Delirium is distressing for both patients and families. Most importantly, delirium prevents adequate communication with loved ones and patient participation in treatment decisions. It is associated with poor survival, although, in a substantial number of patients, it may be reversible. Diagnosing delirium early enables prompt delivery of adequate interventions to reduce suffering and improve quality of life.
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The recognition and respect of patient needs at the end of life
Eytan Ellenberg
pp 242-245
In the context of the consensus conference on ‘L’accompagnement des personnes en fin de vie et de leurs proches’ (the support of people at the end of life and their relatives), held in January 2004, I have carried out a systematic review of the literature on the recognition of and respect for the expectations, demands and rights of people at the end of life, from 1985 to 2004. In this article, I will set out the key findings of my review – but there are two important points to make before I analyse the issues in greater detail.
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A lifeline for women with breast cancer?
Liz Reed
pp 246-247
Over the past five years, significant progress has been made in managing metastatic breast cancer, with improved treatments and increased survival time. As a result, the average life expectancy for a person with metastatic breast cancer is two years, with 20% living to five years. With this prolonged disease trajectory, those with metastatic breast cancer can have complex needs. The management of metastatic disease remains a challenge to those living with it and the multidisciplinary team.
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Life review in palliative care
Ian Trueman and Jonathan Parker
pp 249-253
The aspirations of many people are destroyed with the onset of a life threatening illness. Anticipated life trajectories and perceptions that people have of themselves must be altered, as the prospect of growing old becomes unattainable. Such news may often leave people bewildered and yearning for a future that is different to the one they now face. They may harbour feelings of regret, helplessness and hopelessness
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Bringing the arts to the bedside
Cynthia Kennett, Lynn Harmer and Marion Tasker
pp 254-256
Patients are mostly admitted to the inpatient unit of St Christopher’s Hospice for symptom control and for terminal care. While physical symptoms and emotional distress are readily identified and addressed, it can be more difficult to find a way of supporting someone who feels that all meaning in life has been lost. Time is short and precious but can hang heavily when an individual is too ill to initiate any of the things that used to give meaning to life; it is not unusual for patients to say that they are bored or depressed. Attempting to alleviate these symptoms places a great demand on the nursing resources.
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EAPC task force on the development of palliative care in Europe: autumn 2004
The task force
pp 257-259
Information relating to the development and provision of palliative care across Europe remains difficult to obtain and is often of variable quality. In many countries, palliative care is an unknown discipline, or is still at an early stage of its evolution compared with those countries that initially founded the hospice and palliative movement. Europe is fast becoming a community of economic cooperation, policy harmonisation and cultural exchange. The EAPC is also growing each year, representing more and more national and regional associations, with an increasing number of members.
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