Comment: Who’s afraid of palliative care?
Marilène Filbet
pp 109-109
The palliative care movement is still in its infancy. Although the idea is now widely publicised, many people who need such care experience difficulties accessing it, even in countries where it is well developed. Lack of opioids, lack of education and training, and lack of care institutions are among the obvious problems that have been identified by the World Health Organization.
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Morphine metabolites: a review of their clinical effects
Sophy Gretton and Julia Riley
pp 110-114
Morphine remains the firstline strong opioid for moderate-to-severe cancer pain. It is a prototypical opioid and its clinical effects are characterised by analgesia and morphine-induced side-effects. The main metabolites of morphine are morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G). These metabolites have been the focus of intense research for more than 30 years.
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How effective are parenteral antibiotics in hospice patients?
Elinor Brabin and Leslie Allsopp
pp 115-117
The role of parenteral antibiotics in terminally ill patients is uncertain. Evidence of their effectiveness at the end of life is limited, as randomised controlled trials raise ethical concerns. Observational studies suggest that antibiotics may bring symptomatic benefits in some patients, but do not prolong survival. There is a need to establish guidelines for their use, based on the collective experience of their effectiveness in hospice patients.
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The case for training to deal with end-of-life experiences
Sue Brayne and Peter Fenwick
pp 118-120
This article argues for the recognition of two categories of end-of-life experiences (ELEs) – transpersonal ELEs, which are related to the process of dying, and final-meaning ELEs, which prompt the dying to come to terms with unfinished issues. Both categories have existential or substantive qualities that appear to relieve the spiritual discomfort of the dying.
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Case study masterclass 38: Severe tenesmus and anal pain as a result of radiotherapy
Zivai Nangati and Bernadette Lee
pp 122-123
Mrs Smith is an 81-year-old widow who lives on her own. She has led a fit and active life. She enjoys line dancing and is a member of a local walking club. Eight months previously, she suffered a stroke from which she recovered well and had an Eastern Co-operative Oncology Group (ECOG) performance status of 1. Her medical history included atrial fibrillation and hypertension. She developed symptoms of rectal bleeding and a change in bowel habit over a two-month period. Following investigation, she was diagnosed with anal squamous cell carcinoma. No metastases were found. She attended the oncology clinic accompanied by her brother.
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Case study masterclass 37 answers: A patient with severe opioid-induced pain
Joanne Droney, Sophy Gretton, Wolfgang Koppert and Julia Riley
pp 124-0
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Syringe driver site reactions: a review of the literature
Jennie Pickard, Kath Mitchell and Dai Roberts
pp 125-131
Syringe drivers are routinely used in palliative care for the subcutaneous administration of drugs for pain and symptom control. Local reactions occurring at the site of the infusion can lead to discomfort for the patient and the possibility of suboptimal symptom control. Hence, good management of syringe driver sites is important. Effective prevention of site reactions is likely to have a positive impact on a patient’s quality of life.
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A skills course for volunteer bereavement counsellors
Ann French and Hilary Minter
pp 132-135
In 2006, following local consultation and research, Hartlepool and District Hospice included the development of a comprehensive bereavement service for adults, children and young people in its five-year strategy. It was deemed important for this service to be available to the community as a whole and to be developed in line with the National Institute for Health and Clinical Excellence guidance and the British Association for Counselling and Psychotherapy ethical guidelines.
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The EAPC Research Network meets in Trondheim
Augusto Caraceni and Stein Kaasa
pp 136-137
When modern palliative care research was first established, an academic affiliation was promoted by many pioneers. Despite this, from the mid-1960s until the end of the last century, most of the focus of palliative care was directed towards service development. In 1996, the gap that developed between service development and research was narrowed through the establishment, by Franco De Conno, of the European Association for Palliative Care Research Network (EAPC RN). During the initial phase, the EAPC RN focused primarily on the development of clinical guidelines. These guidelines were instrumental as a first step towards evidence-based medicine.
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Why dying at home indicates unmet needs in Colombia
Jairo Moyano and Sofia Carolina Zambrano
pp 138-141
The provision of good palliative care is still a challenge for public health services throughout the world, but this is particularly the case in developing countries. In Colombia, for example, serious limitations in the delivery of palliative care, both in hospital and at home, have been reported.
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How to ensure good quality palliative care: a Spanish model
Xavier Gómez-Batiste, Frank Ferris, Josep Maria Picaza, Silvia Paz, Jose Espinosa, Josep Porta-Sales and Joaquim Esperalba
pp 142-147
Acornerstone of progress in any healthcare service – in addition to education, training and research – is the evaluation and improvement of its quality. It is essential, therefore, that this is set out in a strategic plan that defines the values, vision, objectives and actions for the short, medium and long term.
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