Comment: Transforming end-of-life care – a reimagined urgent care workflow
Julia Riley
pp 6-6
Over the past five years there has been a great deal of learning from Electronic Palliative Care Coordination Systems (EPaCCs) for terminally ill patients. It has become apparent that the greatest potential benefit of EPaCCs is to underpin a clinical service that transforms all urgent care for all vulnerable patients. End-of-life care is one clinical pathway that has a high dependency on urgent care services. Others include services for vulnerable adults, the homeless and the mentally ill.
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Tuberculosis at the end of life
Fiona Runacres, Leeroy William, Anna Ingram, Michael Franco, Jaclyn Yoong and Peter Poon
pp 7-10
With rates of TB increasing in some parts of the world, the disease continues to be a major killer in Africa and Asia. Fiona Runacres and colleagues discuss the issues surrounding the management of the condition in palliative care patients in developed countries, where there is a lack of guidelines on this topic.
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Exploring the challenges of implementing palliative care in China
Wei Liu and Ping Guo
pp 12-17
Wei Liu and Ping Guo look at palliative care in China and ask: can a ‘good death’ be achieved for Chinese patients with advanced illness?
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Reflections on ethical issues in palliative care for patients with heart failure
Manuel Martínez-Sélles, Pablo Díez Villanueva, Ruthmarijke Smeding, Bernd Alt-Epping, Daisy JA Janssen, Carlo Leget, Marta Albert, Agustin Losada, Piotr Sobanski and David Oliver
pp 18-22
In a paper produced by a European Association for Palliative Care taskforce, Manuel Martínez-Sélles and colleagues discuss the needs of patients with end-stage heart failure as they receive palliative care, highlighting the importance of medical teams initiating timely discussions of a range of end-of-life issues at various points in the progression of the disease.
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Psychological ideas in palliative care: attachment theory
Jenny Strachan
pp 24-27
There is growing recognition in the palliative care community of the emotional and psychological needs of patients – and their carers – as they reach the end of life. But not every patient needs, wants or has access to formal contact with a psychologist. What’s more, all members of a multidisciplinary team are likely to experience the impact of psychological matters on their daily practice with patients and colleagues, whether or not their role is to explicitly address those. This series of articles aims to summarise some of the ‘big ideas’ in psychology and translate them into practical advice to promote psychologically informed practice for those providing palliative care, whether as doctor, nurse, allied health professional or in any other clinical or nonclinical role. The first article in the series looks at attachment theory.
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Update on symptom control: nausea and vomiting
Edith Ubogagu
pp 28-32
Nausea and vomiting are common in people with life-limiting diseases and those nearing the end of life. Edith Ubogagu examines the mechanisms that lead to these symptoms and reviews the evidence for the efficacy of various classes of drugs in alleviating them.
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A shorter average length of stay in a UK hospice – how is this happening?
Carmen Chan and Michael Tapley
pp 33-35
Carmen Chan and Michael Tapley describe how a hospice transfer programme has reduced the average length of stay in a UK hospice, facilitating a focus on end-of-life care.
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Book review: Through the Valley of Shadows: Living Wills, Intensive Care, and Making Medicine Human
Jacqueline Phillips
pp 35-35
In this book, US ICU physician Samuel M Brown explores the reasons underlying what he considers to be the too-frequent failure of the medical system to help patients die well in hospital. His main target is the advance directive and its perceived inadequacies – although medical paternalism’s eclipsing of personal autonomy caused the advance directive to come into being, Brown considers it now not fit for the task and to be undermining the very autonomy it purported to preserve.
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Breaking new ground in hospital palliative and end-of-life care: Liverpool’s Academic Palliative Care Unit
John Ellershaw, Ben O’Brien and Deborah Murphy
pp 36-41
John Ellershaw, Ben O’Brien and Deborah Murphy describe the thinking behind the design of a state-of-the-art academic palliative care unit in Liverpool, which opened last year, explaining the immense benefits that a custom-designed unit can bring to patients and their families – and consequently to staff as well.
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The needs of patients, and their caregivers, with non-malignant life-limiting illnesses
Mei Ling Look, Siti Amirah Saharudin and Alireza Behzadnia
pp 43-46
In Malaysia, Mei Ling Look, Siti Amirah Saharudin and Alireza Behzadnia conducted an interview-based study to elicit the most important concerns of patients nearing the end of life and receiving palliative care from family members.
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