Comment: An international collaboration for family carer research
Peter Hudson and Sheila Payne
pp 135-135
Support for family carers is a core tenet of palliative care philosophy and practice. At the recent EAPC Research Congress in Venice, an open meeting was convened to discuss the inception of a research group to foster international collaboration related to projects associated with family carers.
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Syringe drivers and subcutaneous sites: a review
Fiona Graham
pp 138-141
In palliative care, the subcutaneous (SC) route is generally accepted as the parenteral route of choice when oral medication becomes impossible and the rectal route is unacceptable. The reasons for this include ease of access and relative simplicity for domiciliary care. However, this approach is not unproblematic, since site reactions can cause distress to patients and reduce the effectiveness of drugs. Advice on minimising reactions can be conflicting and practice varies. This article aims to provide a framework for the safe and effective management of SC sites and draws on the literature, observations of practice and contemporary discussions.
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Dyspnoea in cancer patients
Sushma Bhatnagar, S Madhurima and Seema Mishra
pp 142-146
Breathing is an automatic activity that is usually effortless. However, when the respiratory system is compromised by disease, every breath becomes laborious. The American Thoracic Society consensus statement defines dyspnoea as ‘a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. The experience derives from interaction among multiple physiological, psychological, social and environmental factors, and may induce secondary physiological and behavioral responses’. Dyspnoea is common in patients with terminal cancer, occurring in 21% to 78% of patients, mainly in the last weeks of life.
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Case study masterclass 27: A patient with refractory hypercalcaemia
Helen Burgess and Craig Gannon
pp 147-148
Mrs Green is an 86-year-old widow who was diagnosed with squamous cell carcinoma of the left lung eight months ago. She has not received surgical or oncological treatment for her cancer in view of her poor performance status and a lack of suitable symptoms to justify even palliative interventions. She has been referred to your inpatient specialist palliative care unit for ‘symptom control’ by her community clinical nurse specialist, specifying a need for treatment of hypercalcaemia.
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Case study masterclass 26 answers: Managing a patient with complex pain and adenocarcinoma
Caroline Lucas
pp 148-148
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Latest report from the EAPC Task Force on the Development of Palliative Care in Europe
Carlos Centeno
pp 149-151
In April 2002, and following a proposal from those responsible for the Spanish Directory on Palliative Care, the board of directors of the EAPC started considering the possibility of devoting special attention to a project on the development of palliative care in Europe. In June 2003, after examining different possible approaches, Carlos Centeno, a member of the board of directors, was assigned the role of setting up the team.
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What does palliative day care mean to you?
Isabel Dosser and Jacqueline S Nicol
pp 152-155
Palliative day care essentially provides specialist, multidisciplinary care incorporating physical, social and psychological support as well as spiritual care in an holistic manner. It also, given the opportunity, addresses the definition and principles of palliative care as described by the World Health Organization (WHO). This recent definition has now been expanded to include caring for patients with non-malignant disease and the need for carer support. However, palliative day care, like palliative care, means different things to different people.
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Dutch experiences with the Liverpool Care Pathway
Siebe Swart, Hetty van Veluw, Lia van Zuylen, Maureen Gambles and John Ellershaw
pp 156-159
The modern hospice movement developed in the 1960s as a result of the inherent tension between the need for appropriate and effective care for dying patients and the increasingly technologically led ‘cure-focused’ environment of healthcare in the UK. Today, hospices are promoted as best practice in the provision of care at the end of life. However, in the UK, just over two-thirds of patients die in hospital and only a very small proportion (4%, most of whom are cancer patients) die in the hospice environment.
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Evaluation of medical student placements in palliative care
Joy Waldock
pp 160-162
Palliative care is an integral part of the work of most doctors, whatever their specialty. Education in the subject should begin during training so that from their first day, qualified doctors are equipped for the issues around end-of-life care. Most medical schools now include a short educational programme in palliative medicine during undergraduate training. However, there is a lack of published information about the effectiveness of this training in the UK.
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The provision of grief services by primary care physicians
Jesus A García-García and Victor Landa Petralanda
pp 163-166
The death of a loved one is the most stressful life event that a person can face. In fact, bereavement is associated with an increased risk of depression, generalised anxiety and panic disorder, alcohol abuse, use of medications, sudden cardiac events, suicide and an increased demand for healthcare resources. The family physician (FP) or GP is the only specialist who, through his or her position in the healthcare system and in the community, can give emotional support to the bereaved and simultaneously deal with the problems associated with the process.
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The role of the volunteer at the Institut Gustave-Roussy
Arlette Mouniqua
pp 169-171
The Association pour le développement des Soins Palliatifs (ASP, the Association for the Development of Palliative Care) has had a presence at the Institut Gustave-Roussy, and been supporting patients who come for consultations since 1992. The association was formed to provide patients with palliative and end-of-life care support. Volunteers are initially recruited by telephone. Those who express an interest in becoming volunteers are sent an application form.
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