Comment: Language and speech
Andrew Hoy
pp 224-224
We live in an age of catchphrases and slogans. Before condemning such language out of hand, however, it is worth remembering that these phrases were probably coined originally to draw attention to a specific issue or to campaign for a particular cause. Similarly, incomprehensible jargon often originates from a need to express ideas that are new or difficult to discuss without cumbersome explanation. Jargon is shorthand to the cognoscenti but gobbledegook to the rest of us.
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The changing face of terminal care for AIDS
Sarah Cox and Kathy Pickhaver
pp 225-228
The advent of highly active antiretroviral therapy (HAART) in the mid-1990s changed the outlook for people infected with HIV. Before this, infection resulted in immune damage, leading to an AIDS diagnosis and/or death in about ten years. Where effective combination drugs are now available, immunosuppression has been delayed or reversed. As a consequence, the development of AIDS-defining illnesses has dramatically reduced and with it the death rate from HIV.
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Feeding tubes in palliative care
Paul Keeley
pp 229-231
Percutaneous endoscopic gastrostomy (PEG) tubes have been part of patient care since 1980. This article reviews the use of PEG tubes in patient populations referred to hospices or specialist palliative care teams. The aim of this review is to outline the indications for gastrostomy feeding in a palliative care population, the technicalities of PEG placement and the adverse effects and complications that can be expected. The review will also discuss the ethical problems that are a consequence of the use of PEG feeding in a population with incurable illness.
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Examining the comfort of the unconscious patient
Ann Fullarton
pp 232-233
At the beginning of the last century, Sir William Osler, Professor of Medicine at Oxford University, conducted the first study of the sensations commonly experienced by dying patients. He concluded that, ‘The great majority gave no signs; like birth, death was a sleep and forgetting’. While this may be a comforting thought it does raise the question, what about the minority – those patients who do give signs that all is not well? How often do those of us caring for the dying find ourselves assuring relatives that noisy breathing or twitching are more distressing to them than to the patient? Can we be truly certain of this?
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Case study masterclass 6: Mesothelioma
Carol Davis and Maureen Syed
pp 234-235
Mr Long was diagnosed as suffering from mesothelioma of the left chest two and a half years ago. He was 52 years old, married for 30 years with no children. After appropriate investigation and with his informed consent, he underwent a pleuropneumonectomy followed by radiotherapy and chemotherapy. His postoperative course was complicated by pneumonia, followed by a wound infection, and the planned treatment took ten months to complete. After a few weeks’ convalescence, he returned, part-time, to his job as a garage attendant.
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Case study masterclass 5 answers: Fungating carcinoma of the breast
Carol Davis and Maureen Syed
pp 235-235
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Reflections on the use of sedation in terminal care
Lukas Radbruch
pp 237-239
In medicine in general, as well as in everyday, life, ‘sedation’ is usually used synonymously with ‘feeling tired’. In this context, sedation is one of the most common symptoms in cancer patients and is one of the major side-effects of opioid therapy. In palliative care, sedation is often used in another context, meaning the reduction of the level of consciousness of the patient to alleviate intolerable symptoms and distress. If this is done intentionally, it has been named ‘terminal sedation’ or ‘end-of-life sedation’. Sedation as a side-effect of symptom treatment and sedation as the primary goal of therapy are often confused.
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Care for the dying mother-to-be
Rosemary Mander and Erna Haraldsdóttir
pp 240-242
The childbearing woman who has a life-threatening illness encounters conflicting responses within herself and in others. While pregnancy engenders pleasurable optimism in our pronatalist society, life-threatening conditions can induce pessimistic horror. The significance of this may be judged from the incidence of cancer in pregnancy (one in 1,000–1,500 live births). There are many complex issues arising out of this situation – both for those personally affected and for formal carers. These issues cause the childbearing woman, and those near to her, to face many difficult decisions. The palliative care approach includes non-hierarchical care and suggests that decisions should be taken jointly with the woman and, possibly, those close to her.
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Rituals of the hospital palliative care team
Donatien Mallet, Sylvie Soyer, Arnaud Herbaut, Marie Danel and Karin Parent
pp 244-246
At a time when large numbers of hospital palliative care teams (HPCTs) are emerging in French hospitals, we wish to focus on the ultimate aims of these teams, taking into account their institutional and social context. In comparison with British hospital-based palliative care teams that have a more medical and physical input, French HPCTs provide more spiritual and social care. We begin by describing three methods of intervention used by the HPCTs within hospital structures, before emphasising how often the creation of a HPCT occurs in a sociocultural context of loss of spirituality, rituals and symbolic links.
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The development of terminal care in Budapest, Hungary
Michael Wright and David Clark
pp 247-250
Hungary is a country with over 10 million inhabitants. It has the lowest life expectancy in Western and Central Europe for most adult age–sex groupings. In 1999, there were 34,255 deaths from cancer, 342.5 per 100,000 – the highest cancer death rate found in our review of palliative care in Eastern Europe and Central Asia. Around 70% of all deaths occur in hospitals or nursing homes. The National Health Insurance Fund is the major payer for healthcare services, which are still in a process of transition from the state ownership of communist times.
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Quality of life in terminally ill cancer patients
Kyriaki Mystakidou, Efi Parpa, Eleni Tsilika, Stavroula Georgaki, Athina Mavromati and Lambros Vlahos
pp 252-255
Developments in medicine over the last 30 years are partly responsible for current dilemmas regarding quality-of-life issues. These dilemmas are mainly associated with either life-sustaining treatments offered to terminally ill patients, or invasive methods, which are usually regarded as inappropriate for these patients. Nowadays, healthcare professionals face these issues in everyday practice.
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Teaching children to understand death and grieving
Marie-Ange Abras
pp 256-257
Society generally associates serious illness with death, and the grieving experience with the loss of a loved one. Generally, it views palliative care favourably, as the aim of such care is to allow sick people to die with dignity and without suffering. There are many philosophers and poets who have been inspired by death to see some sense in life. In the same way that sex education forms an integral part of education before a child enters the adult world, education about death should be given as an integral part of life’s education.
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