Comment: Palliative care and its impact on public health policy
Andrew Hoy
pp 179-179
The early enthusiasts for palliative care have been committed clinicians backed by local service users. Policy makers and politicians have usually followed in the wake of these initial innovations to promote, support and expand what has been seen to represent excellence in healthcare. Nearly 40 years after the opening of St Christopher’s Hospice, integration and adaptation of its philosophy into mainstream healthcare is clearly important.
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The role of radiotherapy and chemotherapy in NSCLC
Maire O’Riordan
pp 181-184
Lung cancer is one of the most common malignancies in both men and women, and a leading cause of cancer-related death worldwide. Non-small cell lung cancer (NSCLC) accounts for approximately 80% of all cases and of these, only 15–20% are potentially curable. The remainder are associated with locally advanced or disseminated disease at presentation. For patients with advanced disease (stages IIIb and IV), the majority die within the first year of diagnosis. Therefore, a primary objective for these patients must be palliation of their symptoms and treatment should be focused on improving or maintaining quality of life.
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Palliative care for patients with MND/ALS
David Oliver and Gian Domenico Borasio
pp 185-187
Motor neurone disease (amyotrophic lateral sclerosis) is a relatively rare progressive, degenerative neurological disease with a prevalence of about 7 per 100,000 population. The cause is usually unknown, although in about 5% there is a family history and of these in 20% (that is, 1% of the total MND/ALS population) an abnormal gene can be found – the superoxide dismutase 1 gene on chromosome 21. There is no curative treatment but the glutamate blocker, riluzole, has been shown in trials to reduce the rate of progression and may extend life by a few months. The prognosis is in the order of three to five years.
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Terminal restlessness – is it a fair clinical concept?
Sandy Macleod, Jane Vella-Brincat and Mel Topp
pp 188-189
Terminal restlessness is a term commonly used to refer to unsettled behaviours during the last few days of life. However, consistent clinical descriptions and valid diagnostic criteria are lacking. Many terms have been used to describe this clinical state including terminal anguish, terminal agitation, terminal delirium, agitated delirium and pre death restlessness. To date, there has been only one study determining its prevalence; this suggested a rate of 42% in the last 48 hours.
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Case study masterclass 17: A prisoner with a history of drug abuse
Carol Davis
pp 190-191
Nick*, a 28-year-old, unemployed plasterer with a history of intravenous drug abuse is an inpatient in the regional cancer centre with newly diagnosed metastatic germ cell cancer. Two prison officers are posted in his sideroom, 24 hours a day. He is not handcuffed but the prison officers never leave his side.
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Case study masterclass 16 answers: A patient with rapidly progressive dementia
Carol Davis
pp 191-191
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Occupational therapy in a hospice inpatient unit
Barbara Littlechild
pp 193-196
There is very little published information describing the actual work of an occupational therapist (OT) within a hospice inpatient unit in the UK. Bray describes the range of activities an OT may be involved in and the application of occupational therapy theory to a hospice setting. Tigges mentions briefly the importance of facilitating some degree of independence in patients returning home but talks primarily about the OT’s involvement as part of the multi professional team in maintaining quality of life in terminally ill patients
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Treating pain and caring for children at the end of life
Philippe Poulain
pp 198-201
Caring for children in the palliative phase of a serious illness primarily involves healthcare professionals (HCPs) recognising that there are means of providing relief and improving quality of life, without resorting to treatment specific to the illness, which is likely to cause discomfort.
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A virtual multidisciplinary team for terminal care
Barbara Pitsillides and Andreas Pitsillides
pp 202-203
The Cyprus Association of Cancer Patients and Friends (PASYKAF) was established in 1986 by a group of patients aiming to improve cancer care in Cyprus.
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Setting up a support group for carers in palliative care
Felicity Hearn
pp 204-206
The needs of carers are gaining increasing recognition in the palliative care field, as in health and social care generally. Group work as a way of offering support is also well recognised, with many palliative care settings using support groups for a variety of people, including those with cancer, terminally ill people, women with breast cancer, children whose parents have cancer5 and staff/volunteer support.
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Death, bereavement and stepfamilies
Frances Sheldon and Julie Tribble
pp 208-210
Much has been written on the subject of loss, grief and bereavement, but very little on the particular issues that may arise for separated or reconstituted families when a family member is dying. When a stepfamily, formed following a divorce or parental separation, experiences the death of a family member, the previous loss associated with divorce may never have been acknowledged, or may powerfully recur.
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Perceptions of existential experiences of death and dying
Francie Dulieu
pp 211-213
Aranda proposed that we need to acknowledge how we are affected by what we see and do in our work on a daily basis in palliative care nursing and to share our practice stories. This paper aims to break the silence about the encounters as we interact with those facing life-threatening and terminal illness, revealing the depth of the raw emotion, the pain and the sense of loss experienced.
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