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Advance Care Planning is an essential part of the new NHS National Programme on End-of-Life Care, aiming to improve the chances of ‘a good death’ by discussing and planning how this might be managed. This book helps readers explore a wide range of issues and practicalities in providing Advance Care Planning (ACP) for their patients nearing the end of life. This book takes a comprehensive look at the subject of ACP; frames the purpose, process, and outcomes; and includes contributions from experts from around the world.

Even for the most experienced healthcare professional, managing the last few days of life can be difficult. This book provides guidelines for the care of the dying based on the Liverpool Integrated Care Pathway for the Dying Patient (LCP). Developed at a hospice, the information can be disseminated and adapted to fit different settings such as hospitals and nursing homes. The LCP is a multiprofessional document that incorporates evidence-based practice and appropriate guidelines related to care of the dying. It provides a template that describes the process of care, which is generally delivered in a clinical situation and incorporates the expected outcome of care delivery. The LCP replaces all other documentation in this phase of care. Care pathways can provide a potentially powerful aid to professionals involved in palliative care. Basic principles of treatment are translated into daily practice, including bedside documentation systems, policies and procedures, standards of practice, continuing education, and quality improvement programmes. The book also includes chapters on symptom control, ethical issues, communication skills, and spiritual care.

Even for the most experienced healthcare professional, managing the last few days of life can be difficult. This book provides guidelines for the care of the dying based on the Liverpool Care Pathway for the Dying Patient (LCP). Developed at a hospice, the information can be disseminated and adapted to fit different settings such as hospitals and nursing homes. The LCP is a multiprofessional document that incorporates evidence-based practice and appropriate guidelines related to care of the dying. It provides a template that describes the process of care which is generally delivered in a clinical situation and incorporates the expected outcome of care delivery. The LCP replaces all other documentation in this phase of care. Care pathways can provide a potentially powerful aid to professionals involved in palliative care. Basic principles of treatment are translated into daily practice, including bedside documentation systems, policies and procedures, standards of practice, continuing education, and quality-improvement programmes. This book includes chapters on symptom control, ethical issues, communication skills, and spiritual care, which underpin the use of the LCP.

Most chronically and terminally ill patients are cared for in their own homes by family and friends, rather than in hospitals or hospices. These carers are an invaluable free resource and there is an increasing amount of research into their role and the experiences of caring for the terminally ill, patients with cancer, and patients with other chronic diseases. This book provides a critique of the theoretical concept of caring, carers, and caregivers. The material is based on empirical evidence from recent studies of adults with acquired chronic illnesses, including terminal illness. The empirical data within the book has been gathered from the perspective of those providing personal, domestic, or emotional care to others already known to them by virtue of kinship, co-habitation, or friendship, rather than carers organised on a professional or voluntary basis. This new evidence is used to make suggestions about possible ways forward within health and social care practice.

Cicely Saunders founded St Christopher’s Hospice in London in 1967 as a centre for teaching, research, and care. Its influence quickly spread around the world. Cicely Saunders — A Life and Legacy shows how she played a crucial role in shaping a new discourse of care at the end of life. From the nihilism of ‘there is nothing more we can do’, medicine and healthcare gradually adopted a more purposeful approach to care in the face of advanced disease and at the end of life. This came to be known as palliative care. This biography links for the first time the ideas and practice of Cicely Saunders to the spreading global interest in hospice and palliative care. It explores her deep reflection on the nature of suffering at the end of life, the possibilities of a more informed approach to the medical management of pain and other symptoms, and above all the importance of remaining focussed on the personal and spiritual concerns of the individual patient as death approaches. It is a story of a remarkable personal and professional life and of a seismic shift in twentieth-century medical history.

This book shows how much better fitted advanced concepts of primary care medicine are to America's health-care needs. It offers insights into how primary care physicians can be better trained to meet the needs of their patients, both well and sick, and to keep these patients as the focus of their practice. Modern medical training, the book notes, arose at a time when medical science was in ascendancy. Thus the ideals of science — objectivity, rationality — became the ideals of medicine, and disease — the target of most medical research — became the logical focus of medical practice. When clinicians treat a patient with pneumonia, they are apt to be thinking about pneumonia in general — which is how they learn about the disease — rather than this person's pneumonia. This objective, rational approach has its value, but when it dominates a physician's approach to medicine, it can create problems. Most important, this book argues that primary care medicine should become a central focus of America's health care system, not merely a cost-saving measure as envisioned by managed care organizations. Indeed, the book shows that the primary care physician can fulfill a unique role in the medical community, and a vital role in society in general. It shows that primary care medicine is not a retreat from scientific medicine, but the natural next step for medicine to take in the coming century.

Dyspnoea (breathlessness) is an uncomfortable awareness of breathing that occurs in approximately 30–75% of terminal cancer patients. It is one of the most distressing symptoms for both patients and family members and can seriously impact on quality of life. Typically, dyspnoea is associated with congestive heart failure, end-stage chronic obstructive pulmonary disease, or lung cancer. This book provides palliative care doctors and specialist nurses with practical guidelines to help manage and treat patients with breathlessness. It includes the science behind the symptom in an attempt to explain the pathology and physiology of this complex condition. The book has been organized to address generalized aspects of breathlessness in advanced illness and more specific aetiologies and managements relevant to particular underlying diseases. It summarizes the epidemiology and the pathophysiology of breathlessness, measurement, research approaches, rehabilitation and exercise, clinical approaches that can be taken at the bedside, pharmacological and non-pharmacological approaches, and surgical interventions. The care of patients with dyspnoea requires input from a variety of disciplines such as palliative care, physiotherapy, respiratory medicine, and nursing, and this is reflected in the multidisciplinary list of contributors.

This book is a guide to complementary cancer therapies, also described as natural or holistic therapies. More and more patients are turning to these therapies as there is now considerable evidence that they can help with symptom control and quality of life, and that some may also extend survival. Complementary therapies can also provide the patient with a greater sense of control regarding the management of their illness. The book provides commentary on a broad range of complementary therapies and features practical advice on how to implement therapies to enhance current practice. The first part of the book deals with the general principles behind complementary therapies and the factors driving their growing popularity, the challenges of evaluating their benefits and unwanted effects, and experience of using them in oncology units, hospices, the private sector and primary care. The second part includes chapters on specific interventions, including complementary therapies such as acupuncture and aromatherapy massage; lifestyle modifications through diet and exercise; creative therapies using art and music; and psychological and spiritual support for individuals and groups. These chapters provide descriptions of the therapies, a summary of the evidence for their benefits in cancer care, and illustrative case histories. The emphasis throughout this book is on enhancing practice; that is, using the therapies alongside conventional medicine, rather than as alternatives to it.

Children with life-threatening and terminal illnesses—and their families—require a unique kind of care to meet a wide variety of needs. This book, now in its third edition, provides an authoritative source for the many people involved in the care of dying children. Written by leading authorities in pediatrics and palliative medicine, it emphasizes practical topics and covers the entire range of issues related to hospice care, from psychological stress to pain and symptom management. The text has been fully updated and includes an international perspective chapter and a chapter written by Children's Hospice International with detailed all-inclusive care plans.

When the first edition of this book was written in 1990, there were only a few advisory palliative care teams working in hospitals. Since then, the number of teams has grown rapidly. The concept of these teams is now widely accepted but there is an increased need for information about setting up a team, how they work, and how effective they are. This book looks at the need for hospital-based palliative care teams and the challenges of bringing palliative care into the acute hospital setting. It reviews the needs of patients, their families, and their professional carers, and also looks at the theoretical and practical problems that may be encountered. The book contains practical advice on setting up hospital-based palliative care teams, the selection of team members, team dynamics, and the role of the pain clinic and palliation oncology.

The new edition of this book has been updated to incorporate recent advances in both the approach to, and treatment of, the terminally ill. Based on many years of monitoring clinical practice and research at St Christopher's Hospice, the author presents practical, balanced advice on the general ethical and medical principles of caring for dying patients. This will continue to be an invaluable handbook for all hospice physicians and nurses as a compassionate source of factual information.

The essence of nursing care continually exposes nurses to suffering. Although they bear witness to the suffering of others, their own suffering is less frequently exposed. This book attempts to give voice to the suffering that nurses witness in patients, families, colleagues, and themselves. By making this suffering visible, the book aims both to honor and help solve the problem. The book offers nurses' colleagues in other professions — social workers, psychologists, chaplains, ethicists, and physicians — a window onto what it means to practice nursing.

In most patients, pain medication, along with physical therapy and supportive counselling, adequately controls the pain of terminal disease, but in some cases pain medication fails or produces unacceptable side effects, and other more invasive interventions may be used. This book provides guidelines on nerve blocking and neuromodulation techniques to help patients and professionals make choices in pain management. Patient selection and appropriate referral are discussed as well as ethical issues and consent. The book outlines the full range of techniques considered to provide excellent care for patients with pain that is difficult to manage and will be a source of information for a variety of professionals working with patients with advanced disease, including palliative care doctors and specialist nurses.

Consultants and nurses in palliative medicine who do not have a background in oncology need to know about the different types of cancer to be able to deal with palliation in these patients. The new edition of this book continues to provide comprehensive coverage of cancer management aimed at palliative care professionals. To aid understanding in the specialty, the format of the book has been thoroughly revised to include numerous tables, figures, algorithms, case histories, and key points to ensure that it will prove an invaluable, practical guide to oncology for all health care professionals involved in the care of patients with malignant disease. It provides a comprehensive overview of the management of malignant disease from the perspective of palliative medicine. The pathology, diagnosis, and management of individual tumour sites are described, with an emphasis on the symptoms produced in advanced disease and the place of oncological treatment in their management. Introductory chapters present the principles of oncological management, and later chapters address specific symptoms from the viewpoint of their pathophysiology and management. Each chapter is enhanced by typical case histories and patient journeys.

Lesions of the oral cavity have an enormous impact on the quality of life of patients with advanced disease. They cause considerable morbidity and diminish a patient's physical and psychological well being. Oral complications impair oral nutrition and can cause a variety of problems including malnutrition, anorexia, and cachexia. Psychological problems relate to the role that the oral cavity plays in communication and social life. This book provides comprehensive, clinically relevant, evidence-based guidelines on oral problems to ensure first-rate care. The scientific foundations and research base for their management underpin the discussion throughout. A multi-disciplinary group of contributors provide authoritative guidelines on clinical features, investigations, and pharmacological and non-pharmacological treatment, as well as complementary therapies. Chapters cover oral assessment, hygiene, domiciliary dental care, infections, taste disturbance, pain, HIV infection and AIDS, neurological diseases, and paediatric problems.

Amyotrophic lateral sclerosis (or motor neuron disease) is a rare disease but one that can cause profound suffering for both the patient and their family. Whilst new treatments for ALS are being developed, these are not curative and offer only the potential to slow its progression. Palliative care must therefore be integral to the clinical approach to the disease. This book reflects the wide scope of this care; it must cover not just the terminal phase, but support the patient and their family from the onset of the disease. Both the multidisciplinary palliative care team and the neurology team are essential in providing a high standard of care and allowing quality of life (of both patient and carer) to be maintained. Clear guidelines are provided to address care throughout the disease process. Control of symptoms is covered alongside the psychosocial care of patients and their families, culminating in a discussion of bereavement. The experience of patients and families is considered, and case studies are provided to show the practical application of the theoretical knowledge. Different models of care are explored, and this third edition of the text utilizes the increase in both the evidence base and available literature on the subject. Additional chapters on complementary medicine and the family experience are included in this edition.

Hospital palliative care teams have been established in rapidly increasing numbers over the last twenty, as it has been recognised that hospices can never transfer the philosophy and practice of palliative care into the acute sector by simply existing; they often work as ‘stand alone units’ and remain outside mainstream medicine. However it has become apparent that improving access to palliative care for patients in acute hospitals is not as easy as employing external palliative care specialists as consultants. Even setting up a team of professionals who work solely in a hospital will often not improve the care of the great majority of patients being treated there. Based on the experience and knowledge of three clinicians in the area who have developed palliative care services in acute settings, this book provides those facing the same challenges with guidance and advice on a range of problems they might encounter. Using a problem focused and practical approach, this guide is filled with case-based problems to help with the identification of realistic, usable, everyday solutions. It also covers the skills and knowledge needed to help teams make progress in the hospital as well as outlining the best training to help professionals continue to flourish.

Most people with far-advanced illness wish to be cared for at home for as long as possible. The challenge of providing good palliative care at home is therefore of major importance for family doctors, nurses, and all those committed to maintaining the highest possible quality of life for the dying person. As modern specialist palliative care has raised both standards of care and also public expectations of family doctors and community nurses, this book helps to place specialist care in context. As palliative care is a major responsibility for teams providing care at home, the book provides a definitive guide on how to provide effective care for people with far-advanced disease. It has been written by two palliative specialists, both of whom have been family doctors. The book deals with all the physical, emotional, spiritual, and social problems that will be encountered by family doctors and community nurses caring for patients and relatives in a home setting. It deals in detail with emergencies, communications, and ethical issues, and emphasises throughout the importance of team work.

Drawing from his extensive clinical experience and many years of teaching, the author of this book has written a guide to palliative care for clinicians. The topics addressed range from an overview of death and dying to specific approaches to symptom management. As an introduction to both the art and science of palliative care, the book reflects the perspectives of one physician who has dedicated his career to this rapidly evolving field. It links real stories of illness with practical advice, thereby delineating clinical practice in a way that reflects the daily concerns of clinicians.

Day care for people with advanced diseases is one of the most rapidly expanding components of palliative care in the UK, and is increasingly a focus of new-service development throughout the world. Many benefits, in terms of quality of life, holistic care for the patient and family and increased time at home are claimed by day care. This book provides a comprehensive overview of the current philosophy, patterns, and policies of palliative day care. It places emphasis on the need to evaluate performance in palliative day care and describes in detail aspects such as audit, health economics, and research, and their associated problems and pitfalls. For readers new to the field it aims to survey the broad concepts and components of palliative day care and the philosophies and practical issues that relate to them. For those more experienced in the field, it seeks to highlight some of the questions, challenges, and dilemmas that palliative day care services face and which will need to be addressed in the years ahead.