Comment: Loss and palliative care
Andrew Hoy
pp 3-3
Everyone who is connected with palliative care, either as professionals or as patients or families, is familiar with the concept of loss. We all learn sooner or later to adapt and to try to accept both the big losses, such as bereavement, and the little losses such as decreased mobility, loss of independence or just the abandonment of a cherished dream.
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An overview of opioids in palliative care: part 2
Julia Riley, Anna-Marie Stevens, Sophy Gretton, Joanne Droney and Joy Ross
pp 6-10
Following on from the review published in the last issue of European Journal of Palliative Care, we look at the remaining opioids and their side-effect profiles.
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Convulsive seizures in patients with brain tumours
Carlos Centeno and Sebastián Cervantes
pp 11-14
Epileptic seizures are episodes of uncontrolled motor, sensory or psychic activity, caused by sudden and excessive discharge of neurons in the brain cortex.
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Case study masterclass 30: And baby came too: Lucy’s story
Carol Davis
pp 15-16
When Lucy was 25 years old and in the early stages of an unplanned pregnancy, she developed hyperemesis. An abdominal ultrasound revealed an ovarian mass. Repeat scanning a fortnight later showed that the mass had doubled in size. At laparotomy, the mass was removed: histology revealed a poorly differentiated adenocarcinoma probably of ovarian origin. A further tumour deposit was removed from the anterior abdominal wall. At this stage, Lucy was well. Limited staging investigations were performed and were normal. After much deliberation, Lucy and her oncologist decided to withhold chemotherapy and follow an expectant ‘watch and wait’ policy. She had a staging MRI.
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Case study masterclass 29 answers: Psychological care in palliative day care
Isabel Dosser and Jacqueline S Nicol
pp 16-16
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Acute care palliative medicine – the Cleveland model
Ruth L Lagman and Declan Walsh
pp 17-20
Physicians are usually trained to cure diseases, not to palliate them. Individuals with advanced cancer typically undergo aggressive antitumour treatment until current options are exhausted. When this occurs, they may be referred to a hospice. In the USA, hospice care has mostly been provided by nurses with little day-to-day physician involvement. Modern palliative medicine, which is used in patients still undergoing chemotherapy or radiation, provides expert medical management and psychosocial support to patients at an earlier stage of illness than conventional hospice care.
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Subjective symptom assessment in terminal care
Marianne J Hjermstad, Jon H Loge and Stein Kaasa
pp 21-25
Despite developments in symptom assessment over the last two decades, there is little consensus regarding measurement of quality of life (QoL) and subjective symptoms. This hampers the interpretation and comparisons of studies, and makes meta-analyses difficult, as demonstrated in two Cochrane reviews. Inadequate measurement of symptoms has direct adverse effects on symptom management. In a survey of physicians, 76% reported poor pain assessment as the single most important barrier to adequate pain management. Thus, the European Association for Palliative Care (EAPC) working group recommended the use of standardised pain assessment methods.
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Is integrated specialist palliative care a myth?
Laura Chapman and Karen Groves
pp 26-28
The integration of healthcare has become a priority on the political agenda, particularly for patients with long-term conditions. The need to move from fragmented to integrated service provision, with an emphasis on continuing relationships that are flexible enough to respond to the changing needs of patients and carers, was highlighted by both the Department of Health and the National Institute for Health and Clinical Excellence (NICE).
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Realising unmet needs in breakthrough pain
Marie Fallon, Giovambattista Zeppetella, Philippe Poulain and Christoph Stein
pp 29-31
This is an overview of presentations delivered at a satellite workshop, held as part of the 4th Research Forum of the European Association for Palliative Care (EAPC) in Venice, Italy, in May 2006.
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What does ‘spiritual care’ now mean to palliative care?
Victoria Slater
pp 32-34
This was the question that I was invited to address at a debate on the current place of spiritual care within palliative care held at St Christopher’s Hospice, London. But why ask the question? What is the context that prompted it to be asked?
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Establishing an education programme in terminal care
Philippe Chastonay, Emmanuel Kabengele Mpinga, François Pellissier, Annie-Moria Venetz and Charles-Henri Rapin
pp 37-40
The World Health Organization considers training in palliative care for healthcare professionals a priority. Indeed, increased life expectancy and a high prevalence of chronic and incurable diseases further emphasise the need for well-trained healthcare professionals in palliative care. The European Association for Palliative Care (EAPC) shares the concern of the WHO. Some countries, such as France and Canada, have developed national action plans to implement basic training and continued education in palliative care. In Switzerland, the ‘Manifeste de Fribourg’ called for a similar action plan in palliative care training and set it as a top priority.
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