Comment: Interdisciplinarity: is it a trend or a necessity?
Françoise Porchet
pp 179-179
From the beginning of the EAPC, the importance of interdisciplinarity has been highlighted. There is almost no congress, national or local meeting announcement without reference to this concept. But what does it actually mean? Is it a trend? Is it an inevitable element of palliative care? If yes, what is it necessary for and for whom?
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A palliative care approach for patients with heart failure
Miriam J Johnson
pp 182-184
Heart failure patients have problems affecting many areas of their lives. In the last few years, there has been an increasing realisation that a palliative care approach with appropriate access to specialist palliative care services is required. Historically, such services have been accessed by cancer patients, but not by those with non-malignant disease. There are joint ventures developing in the UK between cardiology and palliative care, but barriers remain in many places.
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Opioid analgesia: new insights
Pål Klepstad
pp 185-187
Opioids are the most widely used drugs for treating severe cancer pain. Clinical experience is that individual patients need different opioid doses. Studies have shown that this variability is not fully explained by variations in pharmacokinetics or by patient characteristics, such as cancer diagnosis, duration of opioid treatment, age or gender.
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Case study masterclass 28: Another challenging patient with a primary brain tumour
Lucy Boyland
pp 188-189
A 54-year-old married man presented with a three-month history of headaches, followed by a grand mal convulsion. A CT brain scan showed a large ring enhancing lesion in the right temporal area, with marked peri-tumour oedema. He was commenced on dexamethasone and phenytoin. He underwent a partial excision and histology revealed a high grad glioma (WHO grade IV – glioblastoma multiforme).
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Case study masterclass 27 answers: A patient with refractory hypercalcaemia
Helen Burgess and Craig Gannon
pp 189-189
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The nutritional aspects of palliative care
Lene Thoresen and Ann Kristin de Soysa
pp 190-193
The WHO defines palliative care as ‘an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment, and treatment of pain and other problems, physical, psychosocial and spiritual’. According to the WHO, palliative care, among other factors, enhances quality of life and offers a support system to help patients live as actively as possible. Therefore, it should be offered as the patient’s needs develop, but before these needs become unmanageable. Taking this definition into account, nutritional care is a crucial component of palliative care.
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Artificial nutrition at the end of life: is it justified?
Sami Antoun, Mansouriah Merad and Martine Gabolde
pp 194-197
The appropriateness of artificial nutrition (AN) in patients with advanced cancer is often the subject of controversy, and needs to be approached and considered from an ethical point of view. The results of the European survey on home parenteral nutrition (PN) clearly reflect an absence of consensus, a diversity in practices1 and considerable variation according to country.
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Palliative care for people with mental health problems
Paula McCormack and David MM Sharp
pp 198-201
In the UK, specialist palliative care services are frequently provided by charity-based hospices. Highland Hospice comprises a ten-bed inpatient unit and a range of day care services for patients with complex palliative care needs, including ‘difficult to manage’ pain and symptom control. Staff have identified increasing concerns about providing safe and effective management to the growing numbers of patients being admitted with mental health problems, who may also exhibit violent and aggressive behaviours. This compounds the usual care management issues of patients in the late stages of progressive terminal illness.
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Is corticosteroid prescribing appropriate in palliative care?
Elizabeth Shafford
pp 202-204
Corticosteroids are used for a number of reasons in palliative care. They may be prescribed by a variety of doctors, including oncologists, GPs, palliative medicine consultants or hospice medical staff. This audit was prompted by concern that, as these patients are often seen by several different doctors, steroids might be continued without the effect and appropriateness of the dose being reviewed.
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Lost in translation?
Lars Johan Materstvedt
pp 207-209
In a previous issue of this journal this year, I reported on the work of the European Association for Palliative Care (EAPC) Ethics Task Force on Palliative Care and Euthanasia. That group’s paper was originally published in English. As of today, there are translations in French, Italian, Hungarian, German, Greek and Finnish.
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Developing a cognitive behaviour therapy service
Gill Satterley
pp 210-211
There is a wealth of evidence to suggest the presence of significant psychological morbidity, especially anxiety and depression, in cancer sufferers. Many patients who develop psychological problems may not have these adequately managed and at times they are not even recognised. This must inevitably affect the patient’s quality of life and cause unnecessary suffering. In my opinion, the cognitive therapy approach to emotional distress in cancer patients is one of the most exciting developments in recent years. Cognitive therapy has been shown to reduce anxiety and depression as well as facilitate mental adjustment to cancer by inducing a positive fighting spirit. In palliative care settings for those with more advanced or terminal disease, cognitive behaviour therapy (CBT) may enable patients to cope with the impact of their cancer rather than overcome the disease itself.
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The link between palliative and supportive care
Odette Frova
pp 212-213
The Institut Gustave-Roussy’s (IGR) Centre for Pain and Palliative Care provides inpatient and outpatient care for patients with cancer pain caused by the disease itself and/or by the sequelae of treatment. Its other mission is to look after terminally ill patients and to provide them with medical, psychological, spiritual and social follow-up care for as long as possible at home.
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Development of a care programme for older people
Athina Vadalouca, Ioanna Siafaka and Erifili Argyra
pp 214-215
In Greece, palliative care for cancer and non-cancer patients is not officially recognised as a branch of medicine. However, professional educational activities in palliative care began in 1989, when the first university palliative care centre was established by Assistant Professor Athina Vadalouca.
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