Comment: Patient-centred, quality care is at the top of the agenda
Julia Riley
pp 5-5
The recently published interim report of the Palliative Care Funding Review – which encourages healthcare professionals to provide flexible services that give patients greater choice, thereby allowing individualisation of care – marks the advent of a new approach towards the funding of palliative care services.
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High-grade brain tumours: managing symptoms from diagnosis to terminal phase
Jane Fleming and Aisling O’Gorman
pp 6-9
The diagnosis of a brain tumour brings with it many challenges for patients, family and carers, and healthcare professionals. Until recently, the prognosis for high-grade tumours has been particularly bleak. Median survival has been generally less than one year from the time of diagnosis. Even in the most favourable situations, most patients die within two years.
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Palliative medications: understanding the analgesic role of ketobemidone
Eric Prommer
pp 10-13
Ketobemidone is an opioid analgesic that is used to treat moderate-to-severe pain in patients with cancer or non-malignant disease. It is also used postoperatively. It has been widely used in Scandinavian countries since 1952, but its use has been confined to that part of the world due to concerns about its potential for addiction. Ketobemidone is a potent µ-receptor agonist and a non-competitive N-methyl-D- aspartic acid (NMDA)-receptor antagonist. This review aims to provide clinicians and researchers with information on its use as an analgesic.
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Case study masterclass 54: Complicated home discharge of an elderly patient with hypercalcaemia
Catherine Thomas
pp 14-15
Graham, an 85-year-old widower, was admitted to hospital following an episode of syncope. A preliminary diagnosis of acute renal failure was made and subsequent blood tests revealed hypercalcaemia with a corrected calcium level of 3.12 mmol/l. Primary hyperparathyroidism was excluded biochemically, and a bone scan was performed that was suggestive of degenerative changes in Graham’s cervical spine, L2 vertebra and right knee.
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Case study masterclass 53 answers: Management of malignant bowel obstruction
Ehab Ibrahim and Carole Willard
pp 16-16
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Marie Curie’s multi-visit service for palliative care patients in Northern Ireland
Audrey Agnew, David Bickerstaff, Tommy Haynes, Paula Heneghan and Patricia McDowell
pp 18-21
The vision for end-of-life care is that it
should help any patient in the advanced stages of a progressive and incurable disease, whether cancerous or non-malignant, to live as well as possible in their preferred place of care. This requires a person-centred, integrated and holistic approach to service planning and delivery.
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Creating a therapeutic space by using commissioned art
Susan Salt and Penny Warden
pp 22-25
Hospices and other places involved in end-of-life care deal with patients, families and carers who are facing the most challenging of events: imminent death – their own or the death of a loved one. In such places, creating spaces where patients, families and carers feel safe enough to share their thoughts and fears is essential.
Within hospices, these spaces tend to be virtual ones, created via good communication and high quality, patient-centred care. For many people, this virtual space for exploring difficult issues is highly effective, enabling them to share their stories.
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Palliative Care in Long-Term Care Settings for Older People: introducing an EAPC Task Force
Katherine Froggatt and Elisabeth Reitinger
pp 26-28
There is growing interest across Europe, and in other developed countries, in the provision of palliative care for older people in nursing homes and other similar long-term institutional care settings. In many countries, a significant proportion of older people live and die in such settings. These people often have complex end-of-life trajectories, and there is a high prevalence of non-malignant co-morbidities and dementia in this population. This presents challenges for the medical and nursing practitioners, the other health- and social care professionals and the volunteers involved in their care.
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How to apply for research ethics approval in the UK
Syed Qamar Abbas
pp 30-33
Evidence-based practice is the gold standard of healthcare. In palliative care, the importance of conducting research is even greater, as many treatments are based on relatively weak evidence. Palliative care providers have begun to engage more and more with research, although there have been concerns about the rigour and credibility of palliative care research, especially qualitative. This could be due to a number of factors, including practical difficulties, financial limitations, lack of experience, too many regulatory committees, and the particulars of the palliative environment, where care is given priority over science.
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How to tackle impaired sexuality in oncology and palliative care patients
Tom Levett
pp 34-38
Palliative care strives to address all factors that may have an impact on the patient’s quality of life, spanning physical, social and psychological issues. Sexuality is implicit in one’s sense of self and relationships with others, and an altered sexuality may negatively affect well-being. This is an area that is impinged upon by a terminal diagnosis or high symptom burden. However, in spite of its importance, the sexuality of palliative care patients is neglected both in the literature and in clinical care, and healthcare professionals find it a difficult topic to discuss.
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Establishing a paediatric palliative care team in an Argentinian hospital
Rut Kiman, María Constanza Varela and María Laura Requena
pp 40-45
Palliative medicine emerged as a specialty 40 years ago. As is the case for all paediatric specialties, palliative medicine for children cannot be simply replicated from the adult model, but must be developed taking into account the practice and experience of paediatricians. Palliative care for children and young people with life-threatening or life-limiting conditions embraces physical, cognitive, emotional, social and spiritual aspects. Its goal is to enhance the patient’s quality of life and to help the family, by managing symptoms and providing psychosocial care, respite care and bereavement support.
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European insight: Developing palliative care in Moldova: a top-down approach
Daniela Mosoiu
pp 46-49
Palliative care often develops as a grassroots movement: initiatives in the community serve as models for the healthcare system, before gradually being integrated into it. In Moldova, it is the opposite. Palliative care was first introduced in 2007 in the country’s national long-term healthcare strategy for 2008–17 under pressure from the local branch of the Soros Foundation, and the Moldovan Ministry of Health (MoH) took the initiative to draft a legislative framework with the aim of developing co-ordinated palliative care services.
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