Comment: The professionalism of palliative care personnel
Philippe Poulain
pp 76-76
Teamwork is part and parcel of the professional approach to palliative care. Staff working in this field have to recognise the fact that every other professional person, regardless of their position and rank in the management structure, provides an essential link in the palliative care chain. The professional approach encourages patients to exercise their right to take initiatives and make decisions. It also inspires patients’ inevitable role in the care process, emphasising at the same time that we fully acknowledge their worth.
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Imaging of skeletal metastases
Roger Chinn
pp 77-80
Although primary cancer of the bone does occur, cancer affecting the bone is usually metastatic in origin. Bone metastases are usually multiple and are present in one-quarter to one-third of all patients who die from malignant disease. However, cancer can be present as a solitary bone lesion in up to 10% of cancer patients. The initial presentation with cancer may be due to symptoms from a bone metastasis.
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Cutaneous paraneoplastic syndromes – PART 1
Louise Fearfield and Chris Bunker
pp 82-86
Avariety of cutaneous eruptions may reflect the presence of systemic malignant disease. The frequency with which these dermatoses are associated with internal malignancy suggests that this occurrence is not a chance event. However, some of these conditions can occur as an isolated finding or in association with a benign systemic disease. In many instances, the pathophysiology remains unknown.
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Spiritual care, need and pain – recognition and response
Henry Dom
pp 87-90
Without a deeper understanding of holistic care, we cannot recognise spiritual pain and the need to respond to it. Holistic care involves an appreciation of the term ‘spirituality’ and the ability to respond effectively to the spiritual needs of the individual.
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Speaking without words
Michèle Echaubard
pp 91-93
Dreams enable us to work through our emotions and can help us come to terms with important life events, such as illness and death. Symbolism is the language of dreams, enabling our subconscious to communicate with our conscious self (and to those with whom we share our dreams) without using words. In this article, I wish to share with you the dreams – or symbolic language – of a person approaching the end of life.
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The effect of treatment choices on the total cost of palliative care
Robert Twycross, Marie Fallon, Kavi Sharma, Carla Hartley, Julian Guest, Warren Hart and Elizabeth Wager
pp 94-97
Ideally, evidence-based decision-making requires information about the efficacy, unwanted effects, costs and outcomes of different treatment strategies. Although randomised controlled trials provide useful evidence of clinical efficacy, they are not appropriate for gathering economic data because they often involve interventions that would not occur in routine clinical practice. In addition, the carefully selected study population may not be representative of palliative care patients as a whole.
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Empathy, creativity and the arts in palliative care
Paulo Moraes
pp 99-102
The palliative care movement has the potential for shaping a system of care where arts, compassion and medical science embrace each other to enhance healing possibilities for the dying person, their carers and ultimately for the community at large:‘Palliative care involves the skills of the mind embodied in competent medical care, but also demands the friendship of the heart with its caring, acceptance, vulnerability and reciprocity. Neither alone is sufficient. Interactions of the heart and mind, and the growth they result in at the deepest levels of human experience, have never been easy to measure’.
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Self-help support groups in secondary breast cancer – a new UK initiative
Eileen McLeod
pp 103-105
Asignificant new resource addressing the psychosocial needs of women with secondary breast cancer has emerged in the UK. This is a network of self-help support groups, developed over the last three years through the C4Ward initiative, an alliance of group members, supportive professionals and volunteers. The founding group in the network originated from the efforts of a woman who herself had secondary breast cancer, Alison McCartney, and her breast care nurse counsellor. They drew, in turn, on the work of Spiegel and his colleagues in the USA who had found evidence that participation in such groups significantly enhanced women’s emotional wellbeing.
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