In recent years, palliative care has emerged as the leading model of person-centered care focused on preserving quality of life and alleviating distress for people and families experiencing serious and life-limiting medical illness. Alongside this development has come a growing recognition of the need for expertise in psychiatric diagnosis, psychopharmacology, and psychotherapy within the interdisciplinary team of specialists tasked with identifying and addressing the varied sources of suffering in patients with advanced medical illnesses. The Clinical Manual of Palliative Care Psychiatry was written to motivate and guide readers-whether mental health clinicians or palliative care providers-to deepen their understanding of the psychosocial dimensions of suffering for the benefit of seriously ill patients and the support of their families. Great care has been exercised in the choice of topics and features: * Chapter content emphasizes practical aspects of assessment and management that are unique to the palliative care setting, ensuring that clinicians are equipped to address the most common challenges they are likely to face.* Each chapter ends with a list of supplemental materials-including key publications (e.g., "Fast Facts" from the Center to Advance Palliative Care) and links to relevant modules from the Education in Palliative and End-of-Life Care curriculum (e.g., EPEC for Oncology)-aimed at extending and enhancing reader knowledge of the topics covered.* The authors provide thorough coverage of medication use, including off-label applications, which are common in palliative care.* A wealth of tables and figures present clinically relevant information in a concise and easy-to-grasp manner. Practical and brimming with essential information and useful techniques, the Clinical Manual of Palliative Care Psychiatry empowers both mental health clinicians and palliative care practitioners to more skillfully respond to psychosocial suffering in seriously ill and dying patients.

The importance of spiritual well-being and the role of "meaning" in moderating depression, hopelessness and desire for death in terminally-ill cancer and AIDS patients has been well-supported by research, and has led many palliative clinicians to look beyond the role of antidepressant treatment in this population. Clinicians are focusing on the development of non-pharmacologic interventions that can address issues such as hopelessness, loss of meaning, and spiritual well-being in patients with advanced cancer at the end of life. This effort led to an exploration and analysis of the work of Viktor Frankl and his concepts of logotherapy, or meaning-based psychotherapy. While Frankl's logotherapy was not designed for the treatment of patients with life-threatening illnesses, his concepts of meaning and spirituality have inspired applications in psychotherapeutic work with advanced cancer patients, many of whom seek guidance and help in dealing with issues of sustaining meaning, hope, and understanding cancer and impending death in the context of their lives. Individual Meaning-Centered Group Psychotherapy (IMCP), an intervention developed and rigorously tested by the Department of Psychiatry & Behavioral Sciences at Memorial Sloan-Kettering Cancer Center, is a seven-week program that utilizes a mixture of didactics, discussion and experiential exercises that focus around particular themes related to meaning and advanced cancer. Patients are assigned readings and homework that are specific to each session's theme and which are utilized in each session. While the focus of each session is on issues of meaning and purpose in life in the face of advanced cancer and a limited prognosis, elements of support and expression of emotion are inevitable in the context of each group session. The structured intervention presented in this manual can be provided by a wide array of clinical disciplines, ranging from chaplains, nurses, palliative care physicians, to counselors, psychotherapists, social workers, graduate psychology students, psychologists and psychiatrists.

The study and practice of end-of-life care has seen an increasing understanding of the need for care that integrates clinical, psychosocial, spiritual, cultural, and ethical expertise. Yet, no one existing volume pulls together perspectives from a diverse array of religions with ethical dilemmas and clinical problems in view. Safe Passage coaches clinicians and others on the front lines of care on understanding how to incorporate different traditions of thinking into the most difficult of moments around the end of life. The book is structured around five major moments of realization - when disease progresses, when emergencies happen, when dying will be a long process, the time of death, and when grieving begins. Each decision point is introduced with a research summary and an extensive case example that describes disease processes, health care delivery possibilities, and the end-of-life dilemmas involved so as to apply across the varying cultural, socio-economic, and spiritual contexts. The case example is followed by a clinical commentary written by a palliative care specialist, an ethical commentary written by an ethicist, and three short essays written by religious thinkers of different traditions. Each situation is concluded by remarks on potential approaches that respect religious and spiritual beliefs, values, and practices at the end of life across all contexts, and a bibliography. The five decision points are bookended by an introductory section that explores broad historical and cultural perspectives and a conclusion section that summarizes the book and provides guidance for further reading and study.

The relationship between spirituality and healthcare is historical, intellectual and practical, and it has now emerged as a significant field in health research, healthcare policy and clinical practice and training. Understanding health and wellbeing requires addressing spiritual and existential issues, and healthcare is therefore challenged to respond to the ways spirituality is experienced and expressed in illness, suffering, healing and loss. If healthcare has compassionate regard for the humanity of those it serves, it is faced with questions about how it understands and interprets spirituality, what resources it should make available and how these are organised, and the ways in which spirituality shapes and informs the purpose and practice of healthcare? These questions are the basis for this resource, which presents a coherent field of enquiry, discussion and debate that is interdisciplinary, international and vibrant. There is a growing corpus of articles in medical and healthcare journals on spirituality in addition to a wide range of literature, but there has been no attempt so far to publish a standard text on this subject. Spirituality in Healthcare is an authoritative reference on the subject providing unequalled coverage, critical depth and an integrated source of key topics. Divided into six sections including practice, research, policy and training, the project brings together international contributions from scholars in the field to provide a unique and stimulating resource.

Maintaining dignity for patients approaching death is a core principle of palliative care. Translating that principle into methods of guiding care at the end of life, however, can be a complicated and daunting task. Dignity therapy, a psychological intervention developed by Dr. Harvey Max Chochinov and his internationally lauded research group, has been designed specifically to address many of the psychological, existential, and spiritual challenges that patients and their families face as they grapple with the reality of life drawing to a close. Tested with patients with advanced illnesses in Canada, the United States, Australia, China, Scotland, England, and Denmark, dignity therapy has been shown to not only benefit patients, but their families as well. In the first book to lay out the blueprint for this unique and meaningful intervention, Chochinov addresses one of the most important dimensions of being human. Being alive means being vulnerable and mortal; he argues that dignity therapy offers a way to preserve meaning and hope for patients approaching death. Dignity Therapy: Final Words for Final Days is a beautiful introduction to this pioneering and innovative work. With history and foundations of dignity in care, and step by step guidance for readers interested in implementing the program, this volume illuminates how dignity therapy can change end-of-life experience for those about to die - and for those who will grieve their passing.

Oxford Case Histories in Oncology contains 30 well-structured cases from clinical practice, giving a comprehensive coverage of the diagnostic and management dilemmas in oncology. The cases cover a wide spectrum of oncology including rare presentations and clinical problems of common cancers. Each case comprises a brief clinical history with relevant clinical examination findings. Questions are based on clinical investigations and aspects of management. Detailed answers are based on the best available evidence from the latest research, systematic reviews, meta-analysis and guidelines from national and international academic bodies. The text is complimented by over 50 illustrations, including radiographic images and radiotherapy treatment plans. The format of this book is thought provoking, and it helps to improve critical thinking and interpretative skills. It is a perfect self-assessment tool for oncology and palliative medicine trainees and consultants, and will be useful for those preparing for exit examinations in oncology. It will also be of interest to non-specialist readers who wish to improve their skills in the diagnosis and management of a broad range of cancers.

Acute and chronic pain places a huge burden on our society. Approximately 10% of the population in Western countries report suffering from chronic pain, and both chronic and acute pain are responsible for high absenteeism in the workplace. It is therefore crucial that we have effective ways of treating pain. Unfortunately though, we have no objective measures of pain - no blood tests, no urine dipsticks. We have to rely on what the patient tells us. So how then do we know what are and what are not effective pain treatments? It is here that the principles of evidence-based medicine have been of great value - helping us to understand the most effective forms of pain treatment. Bandolier's Little Book of Pain is a unique portable guide to evidence-based pain treatments. For each possible treatment, the book provides the evidence supporting the efficacy of the treatment, along with a clinical bottom line, for those requiring immediate information. Written by world leaders in the field of evidence-based pain treatments, the book will be indispensable for the multi-disciplinary professionals managing acute and chronic pain in primary and secondary care.

How do people face life-limiting illness and death? This challenging question is discussed in-depth in Life to be Lived by looking at the feelings, hopes, fears and stresses associated with life-threatening illnesses, often experienced by patients and their carers. Drawn from research, clinical, and pastoral experiences, the authors examine the process of adjustment that patients and their families go through in major illnesses and when approaching the end of life. Life to be Lived is written in an accessible style using many stories shared by counsellors, chaplains, patients and relatives. Describing the messiness, uncertainties, and paradoxes that are part and parcel of living through an advanced illness, dying, and bereavement, but also what helps and heals, it reviews a range of responses to the challenges to patients and carers and the support, both personal and organisational. Life to be Lived is essential reading for professionals and trained volunteers who work as a part of multidisciplinary teams in palliative and end-of-life care to improve their understanding of the attitudes and behaviour of patients and carers. Families and friends will also benefit from this book as they try to come to terms with their own situations and how they can cope better with them.

Excellent end of life care for people with heart failure is challenging but possible. Failure to address this aspect of care has serious consequences for patients, their families, clinicians and the use of health resources. Heart Failure: From Advanced Disease to Bereavement illustrates the complexity and importance of end of life care for patients with advanced heart failure. This book is a pocket reference for everyday use in the clinic, ward or home visit for all doctors, nurses and AHPs caring for people with advanced heart failure. It outlines the underlying pathophysiology of heart failure, summarises standard pharmacological and device therapy, and sets the context of the challenges resulting from an unpredictable course of disease. In easily digestible summaries, this book presents practical advice about how and when to integrate a palliative care approach alongside standard heart failure management, how to communicate honestly in the face of uncertainty, the rationalisation of medication and device therapies at the end of life, symptom control, care for the dying, and care after death.

The case of Terri Schiavo, a young woman who spent 15 years in a persistent vegetative state, has emerged as a watershed in debates over end-of-life care. While many observers had thought the right to refuse medical treatment was well established, this case split a family, divided a nation, and counfounded physicians, legislators, and many of the people they treated or represented. In renewing debates over the importance of advance directives, the appropriate role of artificial hydration and nutrition, and the responsibilities of family members, the case also became one of history's most extensively litigated health care disputes. The Case of Terri Schiavo assembles a team of first-hand participants and content experts to provide thoughtful and nuanced analyses. In addition to a comprehensive overview, the book includes contributions by Ms. Schiavo's guardian ad litem, a neurologist and lawyer who participated in the case, and scholars who examine issues related to litigation, faith, gender, and disability. The volume also includes a powerful dissent from the views of many scholars in the bioethics community. The book is intended for students, health care professionals, policy makers, and other in search of carefully reasoned analyses of the case that will shape our view of death and end-of-life medical care for decades.

Worldwide, more than 50 million people die each year and it is estimated on the basis of the conditions leading to death that up to 60% of them could benefit from some form of palliative care. It is a public health challenge to ensure that these people can access good palliative or end-of-life care. Pursuing good population health essentially also implies striving for a 'good enough death' and a good quality of care at the end of life. Safeguarding a good quality of the end of life for patient populations for whom it is appropriate requires a public health approach. In most developed countries ageing populations that increasingly die from chronic diseases after a prolonged -often degenerative- dying trajectory make up the public health challenges for palliative care. The very large baby boom generation will soon reach old age and can be expected to pose strong demands regarding the circumstances and care at their end of life. Only by applying a public health approach to palliative care (instead of individual patient perspectives), can societies successfully help to organize and plan end-of-life care in accordance with these aspirations. A Public Health Perspective on End of Life Care presents a synthesis and overview of relevant research and empirical data on the end of life that can bear a basis for a more systematic 'public health of the end of life'. The book focuses on population health, rather than clinical interventions or other aspects of individual health, and discusses studies using different methodologies (not only epidemiological research). The focus is on the quality of the end-of-life of populations, in particular from social sciences, environmental sciences, and humanities perspectives.

The Oxford Specialist Handbooks series provides readers with clear, concise information on all that is needed to successfully train in the medical sub-specialties. Each book gives an overview of clearly defined procedures, skills, guidelines, and technologies and provides practical tips and case studies to supplement hands-on experience. Where appropriate, each book complements the revised curriculum as developed by the Specialist Advisory Committees.
Dementia is a growing issue, exacerbated by improvements in health care which have led to an ageing population; currently three quarters of a million people suffer from dementia in the UK, and this is expected to rise to 1.8 million by 2050. This book concentrates on advanced disease and addresses issues such as pain management, decision-making, spiritual needs, communication, the Mental Health Capacity Act, dementia in the younger patient, and the carer's perspective.
Written by specialists, this book will be invaluable for doctors and nurses involved in palliative medicine, geriatrics, and old-age psychiatry, and the generalist who treats the patient with dementia.

The care home sector is large, with over 400 000 residents in the UK and a similar number employed within the homes. It is therefore an area of considerable economic importance. Care home residents are often very old, and many have multiple physical and mental health needs, meaning that their care poses particular challenges. They are also a distinctly and profoundly marginalised group who are often invisible in the wider debates on quality of care including those about care homes.
Mental Health and Care Homes is a coherent and evidence-based text exploring these issues. Bringing together both clinical and research perspectives it will help those working in the care home sector to deliver high quality care and support to both residents and staff. This important, yet neglected, area is thoroughly reviewed by a range of experts including residents, family carers, staff, researchers, and clinicians.
The book has four sections: 'the inside view' which includes several first-hand accounts of care home life; 'the outside view' which discusses the regulatory, funding, and legislative context in which care homes operate; 'mental health and care', a detailed review of the major mental and other health issues that arise in care homes, as well as interventions and services to offer support; and a section exploring the 'promotion of health and wellbeing' including examples of good practice. It concludes by synthesising key themes and setting an agenda for further enquiry.
The book is written in a style that encourages engagement, with the inclusion of contemporary case studies and examples, making it topical and readable. It will be valuable for a broad professional and vocational audience across both health and social care, as well as students and researchers.

With a rapidly expanding elderly population, there has been a marked increase in the incidence of dementia, and this dreadful, debilitating illness now affects - directly or indirectly - millions of people across the world. Dementia throws up a number of particular clinical, ethical, and conceptual problems, which mostly reflect complicated evaluative decisions, for instance about diagnosis and the distinction between normal and abnormal ageing.
Different disciplines approach dementia in different ways - thus there are disease, cognitive neuropsychology, and social constructivist models of dementia, Underlying these models and approaches, each of which is clinically useful, are various and differing conceptual committments. These models carry ethical implications concerning how we ought to treat people suffereing from dementia.
Thinking through Dementia offers a critique of the main models used to understand dementia-the biomedical, neuropsychological, and social constructionist. It discusses both clinical issues and cases, together with philosophical work that might help us better understand and treat this illness. Drawing on philosophical critique of models of dementia, as well as empirical data and clinical experience, the book unifies the biological, psychological, and social accounts of illness and disease.
Highly original and thought provoking, this book will interest psychiatrists, philosophers, psychologists, and anyone involved in the care and management of those with dementia.

A widely adopted practitioner resource and course text, this book shows how to apply knowledge about behavior change in general -- and the stages-of-change model in particular -- to make substance abuse treatment more effective. The authors are leaders in the field who describe ways to tailor interventions for clients with varying levels of motivation or readiness to change. They draw on cutting-edge theory and research on the transtheoretical model to explain what works (and what doesn't work) at different stages of change. Rich clinical examples illustrate the "whats," "whys," and "how-tos" of using the stages-of-change model to inform treatment planning and intervention for individuals, groups, couples, and families. New to This Edition *Reflects the ongoing development of the stages-of-change model and research advances over the past decade. *Chapter on stage-based brief interventions in health care, social service, and community settings. *Group treatment chapter has been significantly revised. *Expanded coverage of the change processes relevant to each stage. See also Group Treatment for Substance Abuse, Second Edition, by Mary Marden Velasquez et al., a manual for a group-based approach grounded in the transtheoretical model.

Since the turn of the century, there has been worldwide growth in the effort to improve the quality of end of life care. Alongside these initiatives, growing interest in the international development of hospice and palliative care has created the need for an informed, in depth overview of the state of development in different world regions.
A follow-up to the successful Hospice and Palliative Care in Africa: a review of developments and challenges (Wright and Clark, OUP 2006), this book provides a detailed evidence-base of the palliative care provision in Malaysia, Thailand, and the Philippines, identifies barriers to development and how these may be overcome. The book aims to stimulate a more informed debate around these issues, to improve policy-making among intergovernmental and governmental organisations on end of life care in these regions, and to encourage further research and improved practice.
Hospice and Palliative Care in Southeast Asia: a review of developments and challenges in Malaysia, Thailand, and the Philippines includes in-depth country reports that analyse the current state of hospice and palliative care. The book is written using a template that allows effective comparison between countries and regions. Data has been gathered from multiple sources, field visits, and interviews with key activists made possible by close working relations with hospice-palliative care colleagues across the region and in particular through links with the Asia Pacific Hospice Palliative Care Network (APHN) and the national associations of each country. This book will be of relevance to anyone interested in international palliative care, including practitioners, researchers, policy-makers, social scientist, and medical historians.

Hospital palliative care teams have been established in rapidly increasing numbers over the last 20 years, as it has been recognized that hospices can never transfer the philosophy and practice of palliative care into the acute sector by simply existing; the 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 extensive experiences 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 practical guidance and down to earth advice on a range of problems they might encounter. Using a problem focused and practical approach, Palliative Care in the Acute Hospital Setting: A Practical Guide is filled with case-based problems to help readers identify 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 them continue to flourish.
Written in an accessible style with short and focused chapters, this clearly laid out book helps readers find the information they need to tackle particular problems easily and with confidence. With a supportive outlook and covering the non-clinical management aspects of palliative care, this book is the ideal guide for palliative care specialists making the transfer from hospice to hospital, and for those setting up palliative care teams in the acute hospital setting.

Support for the family is a key component of palliative care practice and philosophy, with both patient and family construed as the 'unit of care'. However, there is not always formal acknowledgement of the importance of the family carer role, or that of friends, neighbours and other non-professional, informal carers. Consequently, health and social care professionals find carer support work particularly challenging. Symptom management, personal care, and administering of medications are just some of the tasks taken on by this group of non-professionals, and the impact of this role can have negative emotional, physical, financial and social implications on the care-giver. Furthermore, family carers consistently report unmet needs, and there has been a lack of intervention studies aimed at improving carer support.
This book therefore provides an evidence-based, practical guide to enable health and social care professionals to assess and respond to family carer needs. It also explores the wider sociological, policy, and research issues related to family carers and palliative care.

Effective palliative care that rests on a sound ethical foundation requires ongoing discussions about patient and family values and preferences. This is especially important when addressing care at end-of-life including artificial nutrition and hydration, withdrawal of life-sustaining therapies and palliative sedation as well as requests for assistance in hastening death. The eighth volume in the HPNA Palliative Nursing Manuals series, Legal and Ethical Aspects of Palliative Care, provides an overview of critical communication skills and formal organizational mechanisms, such as ethics committees and interdisciplinary rounds, required for decisions in ethical dilemmas which respect diversity in the views of colleagues, as well as patients. The content of the concise, clinically focused volumes in the HPNA Palliative Nursing Manuals series is one resource for nurses preparing for specialty certification exams and provides a quick-reference in daily practice.

The first book of its kind, Resilience and Palliative Care - Achievement in adversity takes the increasing international literature on resilience and applies it to palliative and end-of-life care. The book offers an overview of all key aspects of palliative care, presented through a resilience perspective. Why do some patients and families break down while others surmounts the challenges facing them? What interventions strengthen individual, family and community coping? This book aims to facilitate change with people facing the crisis of death, dying and bereavement. Much of the existing literature has focused on risk, problems and vulnerability; the emerging concept of resilience focuses on strengths and possibilities. The 'total pain'/'total care' approach pioneered by Dame Cicely Saunders and St Christopher's Hospice now needs reinterpreting in the light of changing contexts and challenges. The realities of demographic change and resource-constrained health and social care environments have generated an increasingly risk focused approach to service delivery. A narrowly medicalised approach has inevitable limitations; professional care alone will be unable to meet need and demand in the face of ageing populations, changing patterns of illness and the need for equity. The resilience approach offers a counterbalance that harnesses the strengths of individuals and the communities in which they live and in which most of their dying will take place. Resilience thinking emphasises the importance of public health and creates a partnership between patients, professionals and community structures, seeking to build community capacity and to deliver a preventive health care that will leave future generations less afraid of the dying and bereavement that will confront all of us. This book offers insights into how, at all levels of planning and delivering palliative care, there is the opportunity to maximise coping, build an infrastructure for self-help, and increase the capacity of strengthened teams and organisations.

Despite the fact that most palliative care educators are involved in teaching, there is little literature devoted to education specifically within palliative care. This book bridges that gap, giving a wide-ranging, global view of palliative care education. It offers theoretical and practical insights, along with specific suggestions for developing knowledge and skills for teaching. It also contains extensive accounts of important contextual matters which influence the range and quality of palliative care education, including: interprofessional learning; continuing professional development; evaluation; and educational leadership. The development of palliative care as a clinical speciality is increasingly conducted at an international level, and a special feature of this book is the inclusion of chapters reviewing palliative care education in each continent. This enables practitioners and teachers to share knowledge across diverse healthcare systems and cultures. There is also an acknowledgement of the multi-professional team involved in palliative care, as education and training are looked at from the perspectives of doctors, nurses, and allied health professionals. The book is split into three distinct parts: Part 1 - sets the scene for existing palliative care education, both in the UK and internationally. Part 2 - focuses on the theory underpinning each aspect of teaching, learning and assessment, and then examines the practicalities of delivering these in the clinical setting. Part 3 - explores ways of building and nurturing a culture of learning in palliative care, whether as an individual or as an organization.

A practical, empowering guide to navigating your partner's diagnosis of a terminal or life-limiting illness, or death. Receiving the news that your partner has a terminal or life-limiting illness, or has died unexpectedly, is among the worst experiences in life. At a time when you are least able to cope, you are faced with a multitude of difficult decisions, some of which must be made quickly. What you need is a friend who has experienced everything you are about to face, who can support you as you navigate some tough, important choices. This book is that friend. There is plenty of information out there but where to start looking? What information is needed and how can it be accessed? What decisions are essential in the immediate term and what can be left until later? Throughout the book, the emphasis is on protecting and supporting those left behind by presenting almost every choice you may need to make and the possible implications of each decision. You will learn: - The importance of creating a will, arranging power of attorney, organising advanced decisions of treatment, and even getting married or entering a civil partnership - What you are entitled to from the state, the NHS and your employer - How to stabilise your finances and prepare to run a household alone - Where your partner ought to be during treatment and/or palliative care, and how to go about achieving this - Which decisions need to be made after death, from planning the funeral to accessing your partner's estate - How to navigate the grieving process and take control of a happy future No matter where you are in the process, How to Survive Losing a Loved One is a comprehensive, practical and empowering guide to coping with your partner's terminal illness and death, and building the next chapter in your life.

The idea of a philosophy of palliative care emerged with Cicely Saunders' vision for 'a good death', and was developed further with the WHO definition of palliative care. It is now being applied not only to cancer patients, but to all patients in end of life situations. As this 'palliative care approach' advances, it is important to pause and comment on its effectiveness. It is a philosophy of patient care, and is therefore open to critique and evaluation. Using the Oxford Textbook of Palliative Medicine, 3rd edition as their basic reference, Randall and Downie present their argument that the palliative care approach has become too busy and over-professionalised, and that it therefore has significant weaknesses. They examine the framework of the specialty - quality of life, autonomy, dignity, patient-centredness, and the priority assigned to relatives in the remit of care - and the moral problems associated with implementing such a philosophy. The resource implications of various health care policies are also discussed in relation to the WHO definition. Whilst the authors defend the achievements of palliative care and those who work in the profession, they present suggestions for an alternative philosophy. Their philosophy prompts many ethical and philosophical questions about the future of palliative care.

All long-term illnesses, whatever their diagnosis, have much in common. The difficulties and challenges that come with illness, and the strategies to overcome them, are shared by most patients. Managing an illness effectively and tackling the difficulties it causes can greatly improve how you feel and your quality of life. This book identifies the challenges posed by illness and suggests a wide variety of ways in which you might meet them. Key to this is the idea of becoming expert in managing your own illness and learning how best to deal with it. The authors accept that you know more than them about how you experience it, so that rather than telling you what to do, they offer a tool box from which you may pick the strategies that best suit you. The two authors, one a person with a long-term illness and one a doctor, combine their expertise and experience to offer a practical and comprehensive guide along your own unique journey. If you have a long-term illness, or if you care for someone who does, then this is a book for you.

This is the fourth volume in a new international, multi-contributed series aimed at providing practical, clinical guidance on how to deal with difficult symptoms related to specific cancer sites. In this volume the Editors bring together first-rate palliative care with oncological treatment for patients with advanced breast cancer. The book is presented in a user-friendly handbook format, with use of tables and algorithms to ensure that it is portable, accessible and can be read and referred to on, or before going to, the ward, or before a domiciliary visit. Specialists in palliative care and oncology settings, working in the acute sector and in hospices, will find the book invaluable. It will also appeal to consultants as well as specialist registrars, clinical nurse specialists and nurse practitioners in palliative care and oncology. The Palliative Care Consultations series is primarily aimed at those individuals working in an acute hospital cancer centre and/or tertiary referral centre. Books are designed to give the busy clinician advice on clinical problems, both those rarely encountered and those that are very common, but difficult. The volumes are site specific and each volume encompasses a review of the current oncological or haemato-oncological management of advanced disease with symptom control advice. These volumes will give clinicians excellent advice on symptom control in the context of palliative care. The books will also be of use and interest to other professions working in acute hospitals.