ABC of Palliative Care E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: ABC Series
• Sprache: Englisch

Seitenzahl: 281

Veröffentlichungsjahr: 2013

Beschreibung

This brand new edition pulls together the most up-to-date information on this complex, multidisciplinary area in a practical, user-friendly manner. It deals with the important social and psychological aspects for palliative care of people with incurable diseases including quality of life, communication and bereavement issues.

Leseprobe

Contents

Contributors

Foreword

1 The principles of palliative care

Components of palliative care

Application

Care delivery

Specialist role

Multidisciplinary teams

Future challenges

2 The principles of control of cancer pain

The WHO analgesic ladder

Adjuvant analgesics

Opioid analgesics for severe pain

ABC of palliative care

Alternative routes of administration

Which opioid for cancer pain?

Tolerance, addiction, and physical dependence

Opioid responsiveness

3 Difficult pain

Opioid irrelevant pain

Pain that responds poorly to opioids

Neuropathic pain

Episodic pain

Interventional techniques

Invasive analgesic techniques

The future

4 Breathlessness, cough, and other respiratory problems

Breathlessness

Cough

Haemoptysis

Stridor

Pleural and chest wall pain

5 Oral health in patients with advanced disease

Oral hygiene

Denture hygiene

Oral symptoms

Oral infections

Dental and denture problems

Oral problems in patients with advanced non-malignant disease

6 Anorexia, cachexia, nutrition, and fatigue

What is cachexia?

Why is cachexia important?

Does this patient have cachexia?

Why do patients become cachectic?

Management

What can be expected from treatment of cachexia?

The future

7 Nausea and vomiting

Managing nausea and vomiting

Antiemetics and other useful drugs

Management of specific nausea and vomiting syndromes

Drug induced nausea and vomiting

8 Constipation, diarrhoea, and intestinal obstruction

Constipation

Intestinal obstruction

9 Depression, anxiety, and confusion

Causes

Clinical features

Recognition

Prevention and management

Psychotropic drugs

Outcome

10 Emergencies

Hypercalcemia

Obstruction of superior vena cava

Spinal cord compression

Bone fracture

11 The last 48 hours

Principles

Symptom control

Emergency situations

Support

12 Palliative care for children

Which children need care?

Aspects of care in children

Specific problems

Support for the family

Bereavement

13 Communication

Why is good communication necessary?

Why is communication difficult?

Challenges in communication

Barriers to good communication

Distancing tactics

Interprofessional communication

Improving communication

Terminal care and bereavement support

14 The carers

Support from family and friends

Healthcare professionals

15 Chronic non-malignant disease

Introduction

Advanced cardiac disease

End stage renal disease

Respiratory disease

Amyotrophic lateral sclerosis/motor neurone disease

HIV/AIDS

16 Community palliative care

Home care

The needs of dying patients

Other settings and patients without cancer

Multiprofessional teamwork

Optimising home care—some models of good practice

Conclusion

17 Bereavement

Grief

Vulnerable groups

What helps?

18 Complementary therapies

Definition of terms

Patterns of use

Why do patients seek complementary therapies?

Referral and assessment

The therapies

Sources of information

Index

© 1998 BMJ Books

© 2006 by Blackwell Publishing Ltd

BMJ Books is an imprint of the BMJ Publishing Group Limited, used under licence

Blackwell Publishing, Inc., 350 Main Street, Malden, Massachusetts 02148-5020, USA

Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK

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The right of the Authors to be identified as the Authors of this Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.

First published 1998

Second edition 2006

5 2010

Library of Congress Cataloging-in-Publication Data

ABC of palliative care/edited by Marie Fallon and Geoffrey Hanks. — 2nd ed. p.; cm.

“BMJ Books.”

Includes bibliographical references and index.

ISBN: 978-1-4051-3079-0 (alk.paper)

1. Palliative treatment. 2. Terminal care. I. Fallon, Marie. II. Hanks, Geoffrey W. C. [DNLM: 1. Palliative Care—methods. 2. Palliative Care—psychology. 3. Terminal Care. WB 310 A134 2006]

R726.8.A23 2006

616’.029—dc22

2006009883

A catalogue record for this title is available from the British Library

Cover image is courtesy of John Cole/Science Photo Library

Commissioning Editor: Eleanor LinesDevelopment Editors: Sally Carter, Nick MorganSenior Technical Editor: Barbara SquireEditorial Assistants: Francesca Naish, Victoria PittmanProduction Controller: Debbie Wyer

For further information on Blackwell Publishing, visit our website: http://www.blackwellpublishing.com

Blackwell Publishing makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check that any product mentioned in this publication is used in accordance with the prescribing information prepared by the manufacturers. The author and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this book.

Contributors

James Adam

Consultant in Palliative Medicine, Hunter’s Hill Marie Curie Centre, Glasgow

Julia Addington-Hall

Professor of End-of-Life Care, University of Southampton

Jeremy Bagg

Professor of Clinical Microbiology, Glasgow Dental Hospital and School, Glasgow

Matthew Barber

Consultant Surgeon, Edinburgh Cancer Centre, Edinburgh

Gian Borasio

Interdisciplinary Palliative Care Unit, Department of Neurology, Munich, Germany

Eduardo Bruera

Professor of Oncology, UT MD Anderson Cancer Center, Houston, Texas, USA

Joanna Chambers

Consultant in Oncology and Palliative Medicine, Southmead Hospital, Bristol

Nathan Cherny

Director of Cancer Pain and Palliative Medicine, Share Zedek Medical Center, Jerusalem, Israel

Lesley Colvin

Consultant Anaesthetist, Department of Clinical Neurosciences, Western General Hospital, Edinburgh

Andrew Davies

Consultant in Palliative Medicine, Royal Marsden Hospital, London

Carol Davis

Consultant in Palliative Medicine, Moorgreen Hospital, Southampton

Francis Dunn

Consultant Cardiologist, Stobhill Hospital, Glasgow

Stephen Falk

Consultant in Clinical Oncology, Bristol Haematology and Oncology Centre, Bristol

Marie Fallon

St Columba’s Hospice Chair of Palliative Medicine, University of Edinburgh, Edinburgh

Kenneth Fearon

Professor of Surgical Oncology, University of Edinburgh, Edinburgh

Kenneth Fearon

Professor of Surgical Oncology, University of Edinburgh, Edinburgh

Karen Forbes

Macmillan Professorial Teaching Fellow in Palliative Medicine, Department of Palliative Medicine, Bristol Haematology and Oncology Centre, Bristol

Rob George

Consultant in Palliative Medicine, Meadow House Hospice, Middlesex

Ann Goldman

CLIC Consultant in Palliative Care, Great Ormond Street Hospital for Children, London

Debra Gordon

Clinical Nurse Specialist in Palliative Medicine, Western General Hospital, Edinburgh

Geoffrey Hanks

Professor of Palliative Medicine, University of Bristol, Bristol

David Jeffrey

Consultant in Palliative Medicine, Borders General Hospital, Scotland

Michelle Kohn

Complementary Therapy Adviser, London

Mari Lloyd-Williams

Professor, Academic Palliative and Supportive Care Studies Group, Division of Primary Care, University of Liverpool, Liverpool

Lorna McGoldrick

Clinical Nurse Specialist, Palliative Care, Western General Hospital, Edinburgh

Jane Maher

Consultant Oncologist, Mount Vernon Cancer Centre, Middlesex

Kathryn Mannix

Consultant in Palliative Medicine, Marie Curie Centre, Newcastle-upon-Tyne

Balfour Mount

Professor of Palliative Medicine, Department of Oncology, McGill University, Montreal, Quebec, Canada

Gillian Percy

Clinical Specialist Physiotherapist, Moorgreen Hospital, Southampton

Amanda Ramirez

Professor of Liaison Psychiatry, Institute of Psychiatry, King’s College, London

Colette Reid

Research Fellow in Palliative Medicine, Bristol Haematology and Oncology Centre, Bristol

Marilyn Relf

Head of Education, Churchill Hospital, Oxford

Carla Ripamonti

Palliative Care Physician, National Cancer Institute of Milan, Milan, Italy

Nigel Sykes

Medical Director, St Christopher’s Hospice, Sydenham, London

Keri Thomas

Macmillan GP facilitator, Shrewsbury

Raymond Voltz

Consultant Neurologist, Institute for Clinical Neuroimmunology, Munich, Germany

Roger Woodruff

Director of Palliative Care, Austin and Repatriation Centre, Heidelberg, Victoria, Australia

Foreword

It is almost impossible for a health care professional to avoid being called upon to care for people getting frailer as life ebbs away, to care for them at their dying and to have to help and support their loved ones afterwards. Who can be insensitive to their pain, their breathlessness, their weakness and their fears? Who can forget how helpless they have felt at these times, how lost for words, how unskilled and unprepared. Doctors and nurses, whether generalist or specialist, can no more avoid these professional and personal challenges than they can deny or avoid death itself.

Palliative care – “the care of patients with active, progressive, advanced disease where the prognosis is short and the focus of care is the quality of life” – is a basic human right, not a luxury for the few. Its principles are not peculiar to the care of the dying but are the integral features of all good clinical care – freedom from pain and the alleviation so far as is possible, of all physical, psychosocial and spiritual suffering; the preservation of dignity; the utmost respect for honesty in all our dealings with these patients and their relatives.

The emergence in 1987 of palliative care as a medical sub-specialty (mentioned in the Preface to the first edition of this book) has brought about improvements in care, research, professional education and training, and in the understanding by the public and the politicians of what needs to be done and what can be done for those at the loneliest time on their life journey. It has also had a downside. Many have come to suspect that providing palliative care requires unique people to do justice to this demanding work, unique skills to do it well, and more time than today’s doctors and nurses ever have. So easy is it to phone a palliative care specialist whether working in a hospital, a specialist unit or in the community, and get advice or an admission that some are leaving the palliative care of their patients to them. In fact only about 10% of terminally ill patients have problems so rare or so complex that specialist expertise is needed. All the others can be cared for by non-specialists if they learn the principles of palliative care, if they develop the right attitude to it, if they are willing to share themselves as well as their therapeutic skills… and if they study this book. One thing is undeniable – no-one is born with a built-in ability to provide excellent care. It has to be learnt from a book such as this, and hopefully from watching others with more experience, but that is a luxury some never have.

In situations where too often the knee-jerk response can be “there is no more we can do”, the reader will find that there is always a means of helping and of caring. It may be pharmacological or psychological, nursing or physiotherapy, occupational therapy, music or art therapy, or complementary medicine. Often it may be no more, no less than enabling patients to open their hearts in that atmosphere of safety created by the doctor or nurse who has learned to be honest, and is humble enough to listen and to learn.

The reader will be surprised at how richly rewarding palliative care can be; how surprisingly often terminally ill patients speak of the sense of safety they feel when suffering has been relieved and they know everyone is being honest with them and the loved ones they will leave behind. This can happen anywhere – in a hospital, in a hospice, in a nursing home or in someone’s home.

This excellent book produced by editors and contributors with international reputations deserves to be read by every doctor and nurse who will ever offer palliative care – and that means most of us!

Derek Doyle

Retired consultant in palliative medicine

Vice President, National Council for Palliative Care

Founding Member and Adviser,

International Association for Hospice and Palliative Care

1

The principles of palliative care

Balfour Mount, Geoffrey Hanks, Lorna McGoldrick

Components of palliative care

Palliative care is recognised by individualised, holistic models of care, delivered carefully, sensitively, ethically, and therapeutically by using skilled communication with attention to detail, meticulous assessment, and advancing knowledge.

Wherever palliative care is used, its core ingredient is the quality of presence that the caregiver brings to the patient, a way of caring that enables discernment of the ongoing needs of the patient and family as they evolve and emphasises being alongside them. The focus is on all that is still possible in this time of multiple losses, the patient’s and family’s quest for meaning, and sustaining their experience of connectedness as they adapt to the challenges of the moment.

The term “palliative care” implies a personalised form of health care. It extends the healthcare professional’s mandate beyond the biomedical model to the wider horizon necessary if one is to attend to suffering as well as the biology of disease, caring as well as curing, quality of life as well as quantity of life. The patient and family or significant others are taken together as the unit of care in assessment of needs related to illness. The aim of palliative care is to support optimal quality of life and to foster healing—that is, a shift in response towards an experience of and wholeness on the continuum of the quality of life.