Palliative care is a rapidly growing area within health care and one in which there are many ethical dilemmas. Chronically and terminally ill patients increasingly wish to take control of their own lives and deaths, resources are scarce and technology has created controversial life-prolonging treatment. This book has been written by a clinician and a teacher and writer of health care ethics to provide all those who care for the terminally ill - doctors, nurses, social workers, physiotherapists, clergy and other carers - with the concepts and principles to assist them in difficult decisions. A central theme, that technical expertise must be controlled by humane, non-technical judgements, runs through the challenging and thoughtful text. Palliative Care Ethics, in this second edition, is now more user- friendly and includes genuine case histories to illustrate ethical issues in the real world. The authors have expanded the section on rationing in respnse to the changing health care environment and confront the issues of patient rights to a far greater extent..There is also a new chapter covering terminally ill children. As the philosophy of palliation is increasingly recognised to be important from diagnosis, the coverage of more general cancer care ethics has been much increased. 'An excellent book' Palliative Medicine 'A thorough reference for practitioners of palliative care' Toronto Medical Journal 'The authors tackle many delicate concerns with professional and human integrity' Journal of Medical Ethic

When the first edition of this book (Terminal Care Support Teams: the hospital-hospice interface, 1990) was written, 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 in 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 which may be encountered. For example there is practical advice on setting up hospital-based palliative care teams, the selection of team members as well as coverage of team dynamics, and the role of the pain clinic and palliation oncology.

This new edition of the Practical Management of Complex Cancer Pain has been fully updated and expanded, with five new chapters on novel interventional techniques in cancer pain amelioration. The book provides advice on advanced pain management, emphasising the suitability and selection of patients for different invasive and complex procedures based on patient history. Case histories are included throughout the text to give the reader insight into the complexities of holistic management, with pain being only one component in the distress that cancer causes for both patients and families. The book also covers cancer pain management for patients in a community setting, and the collaboration between pain and palliative medicine. Concise, practical, and evidence-based, this guide is essential reading for all pain and palliative care specialists in the community, hospital, and hospice settings.

Pain is something that everyone feels but has always been difficult to understand and investigate due to its subjective nature. Practical Pain Management is written for all those involved in the care of people suffering from pain. The authors explain why pain is so often disregarded and poorly managed by clinicians. With an emphasis on the practical management of both chronic and acute pain, the book explores the mechanisms involved in pain percepetion, the use of analgesic drugs, local anesthetics, nerve blocks and stimulation techniques. The rehabilitation and care of patients whose pain cannot be adequately relieved is also considered and some ways in which specialist pain services can help with chronic pain syndromes are described. This comprehensive guide will help all those caring for patients in pain to have a better understanding of pain and to work more effectively towards its management.

This volume considers the specific medical, psycho-social and practical issues involved in caring for children dying from chronic diseases. The author, a consultant paediatrician in palliative care at the Hospital for Sick Children, London, recognizes the special needs of terminally ill children and their families. She confronts the problems and issues surrounding this emotive subject in order to help paediatricians and other professionals provide the very best possible care for such patients. A range of contributors experienced in palliative care for children provide comprehensive coverage of the subject including: consideration of the magnitude of the problem and the provision of services pain control symptom management family support and communication with children spiritual issues bereavement and stress.

Palliative medicine is the medical care provided for people who have a life limiting illness or condition. It encompasses both the physical symptoms a person may experience but also the psychosocial, emotional, and ethical issues that may arise. Now in its fourth edition, Palliative Medicine: A Case-Based Manual walks clinicians through the management of the most common situations found in palliative medicine, from diagnosis and managing symptoms through to grief and bereavement. Using real patient case scenarios and an easy-to-read question and answer format, it gives students and medical professionals an accessible, evidence-based entryway to gain the skills and knowledge needed to provide high quality palliative and end of life care to patients and their families. This new edition has been fully updated to cover the latest guidance, including new chapters dedicated to medical cannabis, opioids, grief and bereavement, and wider issues including palliative care in the community, structurally vulnerable populations, and public health. Written by over 50 experienced palliative care clinicians and educators, this book will be a welcome guide for palliative care workers, medical and nursing students, and medical professionals of any specialty where palliative needs might arise.

One in 70 children are admitted to paediatric intensive care (PIC) at some time during childhood. Most paediatric junior doctors will rotate through PIC, and will be involved in organising acute intensive care for critically ill children. The range of children and their illnesses going through PIC is vast, making it a hugely diverse specialty. A critically ill child will end up there regardless of their underlying disease, and as a result consultants in PIC must be true generalists and need to acquire knowledge and skills in all areas of paediatrics, as well as acquiring significant knowledge of anaesthesia and surgery. From setting up the ventilator, to managing low cardiac output, Paediatric Intensive Care gives practical and realistic advice for children's doctors and nurses in intensive care. Information is presented in easily-accessible '5 minute chunks' to enable you to quickly get the answers you need, with extensive cross-referencing ensuring that different aspects of a particular clinical problem are fully covered. With detailed answers to specific problems and expert guidance on how to manage the complex issues faced in PIC, this handbook is an indispensible guide for all those who provide care to sick children.

Palliative Care Perspectives is a guide to the art and science of palliative care that links real stories of illness with practical advice to delineate clinical practice in a way that reflects the daily concerns of clinicians. Clearly and compassionately written, this book emphasizes important topics often neglected in formal clinical training, including the history and evolution of palliative care in the United States, as well as how clinicians can better understand aging and dying from both a physiological and human perspective. Written by a recognized pioneer in the field of palliative care, each chapter highlights this human approach to illness with narratives and anecdotes drawn from decades of practice experience. This new edition features thoroughly updated research and citations, a new chapter on burnout and compassion fatigue, and a significant expansion of the topic of intercultural communication. Well-grounded in the academic literature, Palliative Care Perspectives is an ideal introduction to the emerging field of palliative care for care providers new to practice, as well as lay readers seeking to learn more about chronic and terminal illness, presented in a personal and accessible format.

This insightful study examines the deeply personal and heart-wrenching tensions among financial considerations, emotional attachments, and moral arguments that motivate end-of-life decisions. America's health care system was built on the principle that life should be prolonged whenever possible, regardless of the costs. This commitment has often meant that patients spend their last days suffering from heroic interventions that extend their life by only weeks or months. Increasingly, this approach to end-of-life care is coming under scrutiny, from a moral as well as a financial perspective. Sociologist Roi Livne documents the rise and effectiveness of hospice and palliative care, and growing acceptance of the idea that a life consumed by suffering may not be worth living. Values at the End of Life combines an in-depth historical analysis with an extensive study conducted in three hospitals, where Livne observed terminally ill patients, their families, and caregivers negotiating treatment. Livne describes the ambivalent, conflicted moments when people articulate and act on their moral intuitions about dying. Interviews with medical staff allowed him to isolate the strategies clinicians use to help families understand their options. As Livne discovered, clinicians are advancing the idea that invasive, expensive hospital procedures often compound a patient's suffering. Affluent, educated families were more readily persuaded by this moral calculus than those of less means. Once defiant of death-or even in denial-many American families and professionals in the health care system are beginning to embrace the notion that less treatment in the end may be better treatment.

Palliative care has become increasingly important across the spectrum of healthcare, and with it, the need for education and training of a broad range of medical practitioners not previously associated with this field of care. As part of the Integrating Palliative Care series, this volume on palliative care in nephrology guides readers through the core palliative knowledge and skills needed to deliver high value, high quality care for seriously ill patients with chronic and end-stage kidney disease. Chapters are written by a team of international leaders in kidney palliative care and are organized into sections exploring unmet supportive care needs, palliative care capacity, patient-centered care, enhanced support at the end of life, and more. Chapter topics are based on the Coalition for Supportive Care of Kidney Patients Pathways Project change package of 14 evidence-based best practices to improve the delivery of palliative care to patients with kidney disease. An overview of the future of palliative care nephrology with attention to needed policy changes rounds out the text. Palliative Care in Nephrology is an ideal resource for nephrologists, nurses, nurse practitioners, physician assistants, social workers, primary care clinicians, and other practitioners who wish to learn more about integrating individualized, patient-centered palliative care into treatment of their patients with kidney disease.

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.

Textbook of Palliative Care is a comprehensive, clinically relevant and state-of-the art book, aimed at advancing palliative care as a science, a clinical practice and as an art. Palliative care has been part of healthcare for over fifty years but we still find ourselves having to explain its nature and practice to colleagues and to the public in general. Healthcare education and training has been slow to recognize the vital importance of ensuring that all practitioners have a good understanding of what is involved in the care of people with serious or advanced illnesses and their families. However, the science of palliative care is advancing and our understanding concerning many aspects of palliative care is developing rapidly. The book is divided into separate sections for ease of use. Over 100 chapters written by experts in their given fields provide up-to-date information on a wide range of topics of relevance to those providing care towards the end of life no matter what the disease may be. We present a global perspective on contemporary and classic issues in palliative care with authors from a wide range of disciplines involved in this essential aspect of care. The Textbook includes sections addressing aspects such as symptom management and care provision, organization of care in different settings, care in specific disease groups, palliative care emergencies, ethics, public health approaches and research in palliative care. This Textbook will be of value to practitioners in all disciplines and professions where the care of people approaching death is important, specialists as well as non-specialists, in any setting where people with serious advanced illnesses are residing. It is also an important resource for researchers, policy-and decision-makers at national or regional levels. Neither the science nor the art of palliative care will stand still so we aim to keep this Textbook updated as the authors find new evidence and approaches to care.

The first resource on end-of-life care for healthcare practitioners who work with the terminally ill and their families, "Living with Dying" begins with the narratives of five healthcare professionals, who, when faced with overwhelming personal losses altered their clinical practices and philosophies. The book provides ways to ensure a respectful death for individuals, families, groups, and communities and is organized around theoretical issues in loss, grief, and bereavement and around clinical practice with individuals, families, and groups.

"Living with Dying" addresses practice with people who have specific illnesses such as AIDS, bone marrow disease, and cancer and pays special attention to patients who have been stigmatized by culture, ability, sexual orientation, age, race, or homelessness. The book includes content on trauma and developmental issues for children, adults, and the aging who are dying, and it addresses legal, ethical, spiritual, cultural, and social class issues as core factors in the assessment of and work with the dying. It explores interdisciplinary teamwork, supervision, and the organizational and financing contexts in which dying occurs.

Current research in end-of-life care, ways to provide leadership in the field, and a call for compassion, insight, and respect for the dying makes this an indispensable resource for social workers, healthcare educators, administrators, consultants, advocates, and practitioners who work with the dying and their families.

A handbook for acupuncturists and healthcare practitioners on the use of acupuncture for end-of-life care. The book covers the major hospice and palliative care diagnoses from a Chinese medicine perspective, as well as grief and loss, and includes the roots of Chinese historical perspectives on death and dying. The acupuncturist is introduced to the working medical model of hospice care and the interdisciplinary team approach and provided with evidence-based strategies for the use the acupuncture in symptom management.

This is the only handbook for hospice and palliative care professionals looking to enhance their care delivery or their programs with LGBTQ-inclusive care. Anchored in the evidence, extensively referenced, and written in clear, easy-to-understand language, LGBTQ-Inclusive Hospice and Palliative Care provides clear, actionable strategies for hospice and palliative physicians, nurses, social workers, counselors, and chaplains.

Nurses are positioned on healthcare's front line, intimately connected to individuals, families, and communities. How can they leverage this position to work for the common good? In Toward a Better World, Mark Lazenby, a philosopher and a nurse, presents a plan of action. He argues that nurses advance the good society when they fulfill fundamental obligations. Promoting equality, peace and respect, providing assistance and safety, and safeguarding the health of our planet are among these obligations. By acting upon them, nurses become a force for social change in their communities. But through the collective power of more than 20 million nurses worldwide, nurses become a global force for making the world a better place-in the present and for the future. A companion to Caring Matters Most, Lazenby's ethics book, Toward a Better World challenges readers to lead good lives of service to others. This book will invigorate all, nurses and non-nurses alike, who wish to spend their lives making the world a better place.

Nearly half of people at the end of life will receive hospice care, but few psychologists, nurses, physicians, chaplains, and hospice workers have been trained specifically to recognize and address the psychological, social, and emotional issues that may arise in patients who are dying. Patients in the midst of advanced terminal illness may experience a variety of distressing emotions, and may feel anxious, frightened, regretful, or desperate. This guide was created specifically to guide helping professionals of all kinds through the process of working through patients' psychological issues to allow them peace and comfort in their final moments.

The Helping Professional's Guide to End-of-Life Care clarifies the spiritual and emotional care that patients need and presents an evidence-based approach integrating cognitive behavioral therapy (CBT), transpersonal psychotherapy, hypnosis, mindfulness, and guided imagery to help patients manage emotional distress at the end of life. Through case conceptualizations and detailed treatment planning guidance, readers learn to formulate comprehensive assessment and treatment plans for patients and gain skills that will help them manage the emotional intensity of this work. This secular, professional treatment model can be applied to patients of any religious or spiritual background. The book also addresses integrating the patient's therapeutic team with the medical team, addressing the emotional needs of friends and family of the dying, crisis intervention for suicidal patients, working with clients on psychotropic medications, and how helping professionals can manage their own emotions to become more effective clinicians.

The syringe driver is a simple and cost-effective method of delivering a continuous subcutaneous infusion (CSCI). A CSCI provides a safe and effective way of drug administration and can be used to maintain symptom control in patients who are no longer able to take oral medication. There have been several developments in this field since the third edition of this highly successful book. The text in this edition has been completely revised, incorporating new treatment options and an extensive list of new compatibility data. This book serves as a valuable reference source, providing comprehensive review of syringe driver use and administration of drugs by CSCI. The first chapter provides an overview of syringe drivers and CSCIs, including a useful array of frequently asked questions. The second chapter provides information about the chemistry of drug incompatibility and degradation. The third chapter comprises revised and referenced information relating to most drugs likely to be administered by CSCI using a syringe driver. The fourth chapter discusses the control of specific symptoms that are often encountered when CSCIs are required. The fifth and final chapter contains an extensive, referenced list of compatibility and stability data relating to drug combinations administered by CSCI.

Palliative care is an essential element of our health care system and becoming increasingly significant amidst an aging society and organizations struggling to provide both compassionate and cost effective care. Palliative care is also characterized by a strong interdisciplinary approach. Nurses are at the center of the palliative care team across settings and populations. The third volume in the HPNA Palliative Nursing Manuals series, Physical Aspects of Care: Nutritional, Dermatologic, Neurologic and Other Symptoms, provides an overview of the principles of symptom assessment and management for symptoms including: fatigue, anorexia and cachexia, artificial nutrition and hydration, urinary tract disorders, lymphedema, skin disorders such as pressure ulcers, wounds, fistulas, and stomas, pruritus, fever, sweats, neurological disorders, anxiety and depression, and insomnia. The content of the concise, clinically-focused volumes in the HPNA series prepares nurses for certification exams as well as quick-reference in daily practice. Plentiful tables, figures, and practical tools such as assessment instruments, pharmacology tables, and patient teaching points make these volumes useful resources for nurses.

The first volume in the HPNA Palliative Nursing Series, Structure and Processes of Care provides an overview of palliative nursing care, reviews National Consensus Project guidelines, and offers tools for initiating and maintaining palliative care programs. The content of the concise, clinically-focused volumes in the HPNA series prepares nurses for certification exams as well as quick-reference in daily practice. Plentiful tables, figures, and practical tools such as assessment instruments, pharmacology tables, and patient teaching points make these volumes useful resources for nurses.

50 Studies Every Internist Should Know presents key studies that have shaped the practice of internal medicine. Selected using a rigorous methodology, the studies cover topics including: preventative medicine, endocrinology, hematology and oncology, musculoskeletal diseases, nephrology, gastroenterology, infectious diseases, cardiology, pulmonology, geriatrics and palliative care, and mental health. For each study, a concise summary is presented with an emphasis on the results and limitations of the study, and its implications for practice. An illustrative clinical case concludes each review, followed by brief information on other relevant studies. This book is a must-read for health care professionals and anyone who wants to learn more about the data behind clinical practice.

Meeting the Needs of Older Adults with Serious Illness: Challenges and Opportunities in the Age of Health Care Reform provides an introduction to the principles of palliative care; describes current models of delivering palliative care across care settings and examines opportunities in the setting of healthcare policy reform for palliative care to improve outcomes for patients, families and healthcare institutions. The United States is currently facing a crisis in health care marked by unsustainable spending and quality that is poor relative to international benchmarks. Yet this is also a critical time of opportunity. Because of its focus on quality of care, the Affordable Care Act is poised to expand access to palliative care services for the sickest, most vulnerable, and therefore most costly, 5% of patients- a small group who nonetheless drive about 50% of all healthcare spending. Palliative care is specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness-whatever the diagnosis or stage of illness. The goal is to improve quality of life for both the patient and the family.Research has demonstrated palliative care's positive impact on health care value. Patients (and family caregivers) receiving palliative care experience improved quality of life, better symptom management, lower rates of depression and anxiety, and improved survival. Because patient and family needs are met, crises are prevented, thereby directly reducing need for emergency department and hospital use and their associated costs. An epiphenomenon of better quality of care, the lower costs associated with palliative care have been observed in multiple studies. Meeting the Needs of Older Adults with Serious Illness: Challenges and Opportunities in the Age of Health Care Reform, a roadmap for effective policy and program design, brings together expert clinicians, researchers and policy leaders, who tackle 16 key areas where real-world policy options to improve access to quality palliative care could have a substantial role in improving value.

Amytrophic Lateral Sclerosis (ALS or motor neurone disease) is a progressive neurodegenerative disease 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. Palliative Care in Amyotrophic Lateral Sclerosis: From diagnosis to bereavement 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 (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. Case studies are used to emphasise the complexity of the care needs and involvement of the patient and family, culminating in discussion of bereavement. Different models of care are explored, and this new edition utilizes the increase in both the evidence-base and available literature on the subject. New topics discussed include complementary therapies, personal and family experiences of ALS, new genetics research, and updated guidelines for patient care, to ensure this new edition remains the essential guide to palliative care in ALS.

For patients and family caregivers the journey through illness and transitions of care is characterized by a series of progressive physical and emotional losses. Grief reactions represent the natural response to those losses. Grief is defined by a constellation of physical, cognitive, emotional and spiritual manifestations, varying in length and severity. While grief reactions are common and expected responses to loss, they have the potential to cause significant suffering. And, while grief is not a disease, it can develop into a pathological process warranting specialized treatment. Additionally, some aspects of grief overlap with the symptoms of clinical depression and anxiety, making diagnosis difficult. Grief and Bereavement in the Adult Palliative Care Setting provides practical, evidence-based, and clinically effective approaches to understanding the multifaceted nature of grief and bereavement in patients with advanced illness and their caregivers. This handbook is an ideal tool for palliative care providers of various disciplines who provide direct clinical services to patients and family members. It assists clinicians in recognizing and identifying grief reactions as unique expressions of patients and caregivers' history and psychological functioning. Primary care physicians who provide care to patients and families will also find this practical assessment and treatment guide helpful. They will learn how to best support bereaved patients and caregivers when grief is uncomplicated, and when to choose more active interventions that may include appropriate referrals to mental health professionals.

The family are intimately involved in the care of the dying and themselves require support through their experience of both palliative care and bereavement. This volume describes a comprehensive model of family care and how to go about it - an approach which is new, preventive, cost effective and with proven benefits to the bereaved.;The book has been designed rather like a therapy manual, providing a step-by-step approach to assessment and intervention. Its rich illustration through many clinical examples brings the process of therapy alive for the reader, anticipating the common challenges that arise and describing how the therapist might respond. Families are recognised throughout as a central social unit, pivotal to the success of palliative care. This title should be of use to doctors, nurses, psychologists, social workers, pastoral care workers, psychiatrists and other allied health professionals who work in caring for the dying and for their bereaved relatives. Based soundly on a decade of internationally regarded research, this book will alter the direction of future medical practice and is destined to become a classic in its field.