Comment: Palliative care is no longer the Cinderella specialty
Julia Riley
pp 3-3
For as long as I can remember, palliative care has been the Cinderella specialty. This is not a surprise, as death is taboo in Western cultures. Recently, however, things have begun to change – at local, national and international levels. This is a hugely exciting time to be involved in palliative care, as it gains widespread recognition and acceptance.
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Are abdominal X-rays useful in palliative medicine?
Ruth L Lagman and Declan Walsh
pp 6-10
The clinical usefulness of abdominal X-rays (AXRs) in palliative medicine is largely unknown. The current information is derived mostly from the general medical and surgical literature, and there is controversy about the indications for AXRs and whether or not they alter diagnosis and management. Following the strict guidelines set by the UK’s Royal College of Radiologists (RCR), AXRs should be ordered only in specific clinical situations. Nevertheless, several questions arise concerning their use in specialist palliative medicine practice.
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Use of microsurgery in lymphoedema management
Alisa Mitford and Stephen Mason
pp 12-15
Lymphoedema is an accumulation of lymph, producing swelling due to obstruction of lymphatic flow and inadequate lymphatic drainage. It is a distressing condition affecting a range of patients and, in particular, those receiving palliative care. Although conservative treatment is available, it is not always effective and may need to be continued over many years. Microsurgery deals with the specific cause of the condition, and may be a more efficient and effective intervention than current strategies. This review explores whether microsurgery is feasible for lymphoedema patients receiving palliative care.
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The national end-of-life care strategy: a summary
Maureen McGinn
pp 16-18
Once through the trauma of birth, the only guaranteed healthcare experience we are all likely to have is end-of-life care. Since 1948, in the UK, there have been seven, clear governmental policy documents relating to maternity services but, until now, there has been no comprehensive strategy relating to end-of-life care.
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Case study masterclass 42: An elderly patient with opioid-induced constipation
Anna Hume and Carol Davis
pp 19-20
Jean Tremlett* was admitted to the palliative care unit as an emergency. She is 79 years old and, 18 months ago, was diagnosed with lung cancer, which was treated with palliative radiotherapy. She has mild-to-moderate dementia and lives in an elderly mentally infirm (EMI) registered home. She has been getting a lot of back pain and is known to have bone metastases in her ribs and thoracic spine. These were diagnosed on a radioisotopic bone scan. She refused any further anticancer treatment and is not being followed up by the oncologists.
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Case study masterclass 41 answers: A patient with advanced oesophageal malignancy who requires tracheal stenting
Dwipaj Datta and Andrew Hoy
pp 21-21
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An update on the Budapest Commitments
Carl Johan Fürst, Liliana de Lima, David Praill and Lukas Radbruch
pp 22-25
‘Describe your commitments, your goals and the level of your success.’ This is the challenging call to palliative care organisations, encouraging them to be partners in the Budapest Commitments. The concept was initiated by the European Association for Palliative Care (EAPC), with the International Association for Hospice and Palliative Care (IAHPC) and the Worldwide Palliative Care Alliance (WPCA), as an inspirational tool to support the development of palliative care in Europe and beyond.
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The value of art therapy – case studies from France
Wadih Rhondali, Mario Barmaki and Marilène Filbet
pp 26-30
Modern medicine, led by the biomedical model, often neglects the individual by reducing him/her to an illness or an organ. In the palliative care approach – which focuses on the patient as a person as well as on their loved ones – art can play an important role, helping to re-establish dignity, personal identity, good humour and the ability to relax. Art offers patients a vehicle to communicate through means other than speech. It can also help carers to interpret their own reactions to the clinical situations with which they are faced.
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Borderline personality disorder: challenges in the palliative care setting
Tonia M Mezzini and Gregory B Crawford
pp 31-35
Physicians have long been interested in the psychological distress experienced by oncology patients. The diagnosis of psychiatric illness, and personality disorders in particular, can be problematic in oncology patients because the symptoms are less overt than in non-cancer patients. The side-effects of treatment, or the symptoms related to the underlying malignancy, may mimic or mask psychiatric symptomatology. If psychiatric conditions remain unrecognised and untreated, the patient’s quality of life may be reduced and the course of the illness may become more difficult to manage, necessitating earlier or more frequent inpatient care.
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Decision-making and the law for patients who lack capacity
Fiona Randall
pp 36-39
Deciding whether or not patients lack capacity to consent to, or refuse, treatment is sometimes difficult. Making decisions for those who lack the capacity to do so themselves is arguably the most ethically difficult aspect of patient care. In recent years, decisions about life-prolonging treatments in the context of incurable and terminal illness have become more complex, largely because of the increase in life-prolonging measures that are technically possible but almost always associated with harm and risks.
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Palliative care at home in cancer patients in Milan
Antonio Bonaldi, Fabio Parazzini, Oscar Corli and Laura Lodetti
pp 40-42
From May 2005 to May 2006, a multicentre, prospective, observational study was conducted in Milan, Italy, on terminally ill cancer patients receiving publicly funded palliative care at home in the last weeks of life. Our aim was to analyse resource consumption, which would allow us to estimate the cost of palliative care at home and then ensure consistent levels of care throughout the Milan area. As part of the study, we collected data on three symptoms: pain, pressure ulcers and dyspnoea. We chose these because, apart from asthenia, they are the most frequently treated in palliative care patients. This paper presents the results of this specific part of the study.
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Homage to Vittorio Ventafridda
Andrew Hoy
pp 44-45
Vittorio Ventafridda was the father of European palliative care. However, his influence was very much greater even than that. He was one of the select group of people whose vision has had a profound influence in reducing suffering worldwide. He died in Milan, his adopted home city, in October, less than a week before his 81st birthday. He is deeply mourned by all his many friends and colleagues worldwide.
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European insight: APM: still much to be done to improve the delivery of care in the UK
Bill Noble
pp 47-49
What began as the vision of a few passionate individuals, with ideas that had origins in France and Ireland, is now firmly established at the heart of our health services. Over the years, we have debated definitions, referral criteria and outcomes, while steadily deepening and broadening the reach of palliative care. We have brought the benefits of rational therapeutics and modern pharmacology to many patients in great distress. This was achieved with the collaboration of our colleagues in nursing and other disciplines, the support of local communities and resources of many voluntary sector organisations. Latterly, the tenets of palliative care have entered undergraduate medical curricula, postgraduate training programmes and mainstream health service policy relating to end-of-life care.
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