Comment: A vision for integrated palliative care pathways
Julia Riley
pp 57-57
Historically, palliative care has been driven by the goodwill of champions and communities and funded by charities. Healthcare services around the world are beginning to recognise that a significant percentage of an individual’s healthcare budget is consumed in their last year of life. Good will and charitable donations are no longer a sustainable resource for end-of-life care.
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The importance of awareness of cognitive impairment in palliative care patients
Mike Tapley, Charlotte Talbot and David Jolley
pp 58-61
The mature human being is able to comprehend their current circumstances – to place themselves in time and space and in relation to other people. Through language, they can receive communications from other people by speech and the written or recorded word (whether current or historical), and can respond using these same channels. They can remember events, information and instructions, and set these in context. They can make decisions, based on their interpretation of this information matrix, which may be modulated by their cultural beliefs, current mood and personality.
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Suffering – difficult to define, difficult to identify and difficult to relieve
Heather M Davies
pp 62-65
Palliative care ‘integrates the psychological and spiritual aspects of patients’ care’ and ‘offers a support system to help patients to live as actively as possible until death’. Emotional, physical and psychosocial suffering are common as people confront the end-stages of an illness and their lives, and the consequent severing of earthly ties. The literature encompasses a number of definitions and ideas about suffering, but there is a comparative paucity of research in the area.
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Case study masterclass 61: A colon cancer patient requiring artificial nutrition
Nicholas Herodotou
pp 66-67
Kajal, a 38-year-old Bengali Muslim, is admitted to hospital with constipation, fever and abdominal pain. A CT scan reveals a large (5 cm) tumour in the sigmoid colon, with perforation. Kajal undergoes an emergency laparotomy and Hartmann’s procedure, and histology confirms a diagnosis of a poorly differentiated adenocarcinoma of the sigmoid colon. He receives five cycles of oxaliplatin/capecitabine chemotherapy and a repeat CT scan six months later shows that the tumour mass has not enlarged.
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Case study masterclass 60 answers: A patient struggling with motor neurone disease
Anna Hume
pp 68-68
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OPCARE9 work package 3 – complementary comfort care at the end of life
Olav Lindqvist, Carina Lundh Hagelin, Gunilla Lundquist, Sylvia Sauter, Urska Lunder, Birgit Rasmussen, Carol Tishelman and Carl Johan Fürst
pp 69-72
Work package (WP) 3 of the OPCARE9 project was conducted in collaboration between Sweden and Slovenia, with representatives from all OPCARE9 countries.
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OPCARE9 work package 4 – psychological and psychosocial support
Vanessa Romotzky, Maren Galushko, Ovidiu Popa-Velea, Christoph Ostgathe and Raymond Voltz
pp 73-76
Psychological and psychosocial support (PPS) for patients and relatives is considered to be an essential part of palliative care, contributing to addressing the patient as a whole and enhancing their quality of life.
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The ESAS in patients with advanced cancer: a review of studies of the Spanish version
Ana Carvajal, Marina Martínez and Carlos Centeno
pp 77-81
The Edmonton Symptom Assessment System (ESAS) is one of the most widely used instruments in the assessment of palliative care and advanced cancer patients. It has been used internationally in clinical practice and research.
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Collaborating with users: involving hard-to-reach groups in research – part one
Susi Lund and Pam Denicolo
pp 82-87
Groups that are hard to reach in research studies include minority communities and women, and in a project in east Berkshire, the aim to give a subgroup a research voice produced a design strategy to engage their involvement throughout the whole research process. Asian women are an example of ‘silent users’ of palliative support, so their collaboration and engagement was central to this research.
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The path to developing unified palliative care services in India
Max Watson, Libby Sallnow and Suresh Kumar
pp 88-90
To describe the current state of palliative care in India is an almost impossible task, raising existential questions as to the true nature of palliative care in a country with such extremes of wealth and poverty, wisdom and ignorance, compassion and indifference, and both high regard for, and frank distrust of, Western models of healthcare. This article attempts that task, through an snapshot view of palliative care in India, and its challenges and opportunities, highlighting two educational initiatives that offer much encouragement for the future.
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A day in the life of … Christina Oyebode, Research Nurse
Christina Oyebode
pp 91-92
I am a research nurse for the Department of Palliative Medicine at The Royal Marsden Hospital NHS Foundation Trust. The department hosts and sponsors many trials, and I am particularly involved with the recruitment of patients to four of these trials.
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Providing evidence of intention when giving palliative sedation
Vinnie Nambisan
pp 93-97
The continuous, deep sedation for symptom control of patients who are at, or near to, the end of life (to which I shall hereafter refer as ‘palliative sedation’) has long been a challenging area for end-of-life healthcare practitioners.
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European insight: Help the Hospices: the charity for hospice care in the UK
Heather Richardson and Steve Dewar
pp 98-100
The UK hospice sector faces uncertain and challenging times. In response, Help the Hospices, the charity for hospice care in the UK, has established the Commission into the Future of Hospice Care. Its aim: to help hospices adapt and innovate so they can meet the ever-changing needs of the communities they serve. In 2010, Help the Hospices commissioned a report by the thinktank Demos. The report, Dying for Change, called for a radical transformation in the way that people who are dying are cared for the UK. This is the commission’s starting point.
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