Comment: Returning meaning to palliative care staff
Alun Jones
pp 161-161
The search for meaning and values is a concern for all of us throughout our lives. However, it can become a discomforting preoccupation for palliative care nurses, for whom repeated contact with death and dying can lead to personal crisis. Clinical supervision is invaluable because it provides a structure of formal work discussions, and can help staff to maintain a safe work environment, with good teamwork and balance.
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A proposed alogrithm on when to switch opioid
Kumaraja Wilkinson
pp 162-165
Most patients with moderate-to-severe cancer-related pain require strong opioids, such as morphine. In the past ten years, a number of alternatives have become available; generally, these are not new molecules but novel formulations of existing drugs. However, because of its availability, familiarity, established effectiveness and relative cheapness, rather than proven superiority, morphine remains the ‘Step 3’ opioid of choice, as recommended by the WHO and the European Association for Palliative Care.
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Treating pain associated with head and neck cancer
John E Williams and Jonathan TC Yen
pp 166-169
Arecent systematic review of cancer pain showed that pain associated with head and neck cancer is more prevalent and severe than pain from other types of cancer. This review describes the prevalence of this form of pain and its impact on quality of life, and outlines a classification system that can be used clinically to facilitate analgesic treatment. Different types of acute and chronic pain are illustrated, including some specific pain syndromes. By raising awareness of these types of pain among palliative medicine and pain specialists, it is hoped that recognition and treatment can be improved.
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Case study masterclass 45: Helping a young woman to fight the psychological side-effects of cervical cancer treatment
Jita Das and Carol Davis
pp 170-171
Sara is a 28-year-old woman who lives with her partner. Eighteen months ago, she underwent radical treatment, including chemoradiotherapy, for early-stage carcinoma of the uterine cervix. Six months ago, she started experiencing persistent abdominal and rectal pain and was admitted for an ileostomy to resolve her symptoms. This was performed nine days ago.
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Case study masterclass 44 answers: A recurrrent case of pseudomembranous candidosis
Andrew N Davies
pp 172-172
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Is it appropriate for doctors to take a spiritual history?
Joanne Sinclair
pp 174-177
Koenig has encouraged doctors to take a spiritual history as part of their regular patient care to ensure that the spiritual needs of patients are met. Nelson, however,
comments that a significant minority of patients do not welcome such discussions. Research by Ehman et al supports this: they found that 16% of patients would not welcome sensitive questioning on this issue. The challenge to doctors today is whether the minority should rule the majority.
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Using sedation without the consent of the terminally ill
Anne-Marie Raftery and Carole Willard
pp 178-182
Suffering at the end of life may be caused by unrelenting physical symptoms
and/or existential distress, which can often be effectively relieved. However, there are still a number of patients whose suffering will remain intractable. For them, the use of terminal sedation (TS) may offer some relief. In this article, TS is defined as the continuous use of sedative medications to relieve intolerable distress by achieving almost or complete unconsciousness until death.
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Palliative care and Parkinson's disease: a literature review
Dorry McLaughlin and Barbara Cochrane
pp 183-187
It is recognised that the physical and psychosocial needs of people with advanced
non-malignant disease are similar to those of people with a cancer diagnosis and, therefore, an ethical argument exists that people with nonmalignant disease should receive equitable palliative care services and advice. This adds to the increasingly widespread agreement that palliative and end-of-life care should be accessible to people dying from conditions other than cancer, regardless of setting or need.
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Working with emotion in palliative day care
Jacqueline H Watts
pp 188-190
Emotionality and feelings are supposed to be kept outside the arena of professional practice, according to discourses on professionalism, and this applies as much to medicine and healthcare as it does to other professions.
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A new course to improve the communication skills of oncology specialists
Pauline Leonard
pp 192-195
Good communication between doctors and patients is vital in providing high-quality patient care, and is a core clinical skill for any healthcare professional. This is especially pertinent for doctors who are dealing with patients suffering from cancer or terminal illnesses, and with those at the end of life.
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Improving governance, knowledge management and teamwork in palliative care
Michael Lucey
pp 196-198
In the current economic climate, companies are having to re-evaluate their priorities and focus on their core competencies to survive. In healthcare too, we are being made more accountable for the resources we use and the efficiency of the care we give. More than ever, the structures and processes of the organisations we work in need to be revitalised. Teams need to reset goals, review their processes and dynamics, and focus on energetic leadership.
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Principles of management in palliative care
Rhidian Hughes and Robert Marshall
pp 199-201
Within any palliative care service or organisation, special projects will inevitably be set up. These projects, which are outside daily operational work, are best served by project management (PM). PM is the application of an established methodology to meet agreed objectives within available resources, including time and money.
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European insight: FCP: why Italy is a special case when it comes to palliative care
Francesca Crippa Floriani
pp 204-206
Italy was a late starter in developing palliative care, but things are now changing rapidly. Nevertheless, the country seems to be unique among its European counterparts in still suffering from ‘opiumphobia’. Francesca Crippa Floriani, President of the Federazione Cure Palliative (FCP), explains what is being done for terminally ill patients and their families.
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