Since the publication of the first edition of "The Medical Care of Terminally Ill Patients," the field of palliative care has progressed significantly, both socially and scientifically. In this new edition, Dr. Robert Enck reviews the results of clinical studies devoted to the care of dying patients. Special attention is given to pain management, management of symptoms, care of advanced cancer patients, and care of patients with nonmalignant diseases. More than 100 new references, a new list of abbreviations, and tables with new drugs and dosages provides valuable information.

Dr. Enck places great emphasis on enhancing the quality of life while addressing the most common symptoms of terminal illness.

This is the third book 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. There are few more distressing problems for patients and families than the development of a primary or secondary brain tumor. Treatment is often palliative, though intensive, from the start. Little firm evidence exists to guide the physician in caring for patients with seizures refractory to standard treatment. Most of the work is based on case reports or personal experience. This book draws the information together in an easily accessible form so that the book can be read and referred to on the ward, or before a domiciliary visit.
Specialists in palliative care and oncology settings, working in the acute sector and in hospices, will find this book invaluable. It will also appeal to consultants as well as specialist registrars, clinical nurse specialists and nurse practitioners in palliative care, oncology and neurology.

In all branches of medicine, effective communication between health care professionals and patients, families and carers is essential to ensure first-class treatment. Increasing public awareness of health issues and the ready availability of health information have lead the public to be more widely informed about common conditions and the treatments available. Patients therefore attend a medical consultation better informed so the need for improved communication skills is even greater. This book aims to demystify the 'doctor-patient' relationship in order that patients and potential patients can more easily understand the information which doctors are seeking to convey as well as gaining some insight into the difficulties of communication from a doctor's perspective. Some conversations require specialised skills. Talking to people with difficult personalities and poor social skills can be challenging. Strong emotions of anger, frustration or distress need sensitive handling and particular age groups call on styles of address appropriate to their particular needs. Using the expertise of experienced doctors from many specialties this book covers not only the theory behind good communication skills but also gives a wealth of practical advice. The book covers ethical and legal issues, planning difficult conversations, the patient's and doctor's perspectives, issues surrounding special groups such as children and the elderly, and conversations with patients from different cultural backgrounds. Outlines of possible clinical cases posing specific problems are included with guidance on how to handle them.

This is the second book 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 gynaecology there are a number of symptoms which cause great distress to the individual and their families, and perplexity to the physicians and nurses caring for them. This volume covers the management of incurable disease for each of the most common cancers followed by a review of the most difficult symptoms that are encountered in this tumor group. Contributors provide scientific background to symptom-control chapters, with an indication of the sources and evidence for their advice.
Specialists in palliative care and oncology setings, working in the acute sector and in hospices, will find this book invaluable. It will also appeal to consultants as well as specialist registrars, clinical nurse specialists and nurse practitioners in palliative care, oncology and gynaecology.

This book offers healthcare professionals, academics and anyone affected by cancer a fresh and original approach to the supportive care of people with cancer. It looks at the underlying reasons why cancer so often leads to high levels of distress and, more importantly, it suggests many practical ways distress can be minimised and prevented. The actual experiences of cancer patients, as recorded in their personal diaries, are combined with theory, research and practical clinical advice. In each of its seven chapters Cancer in Context takes a different perspective towards supportive care in cancer. It begins by considering how people in general manage and adjust to massive changes in their lives and, in particular, how they react to the threat of cancer. It goes on to examine the "lived experience" of people with cancer as they negotiate the many changes and challenges that follow their diagnosis. Of course cancer doesn't only affect the person who has the disease, it also impacts on families, partners and carers. One chapter explores these and other issues, such as sexual difficulties, the needs of older people, single people, and gay and lesbian couples. Chapter 4 shows that the social and cultural context of a person's life is critical to understanding their resources, the way the are treated, and the responses the make to serious illness. However, it is in the clinical context that professionals have an opportunity to minimise disruption to their patients' quality of life as they endure the notorious demands of oncology treatments. The book offers practical clinical advice on psychosocial aspects of conventional cancer treatments, common treatment difficulties, cancer rehabilitation and palliative care. Chapter 6 provides a summary of the burgeoning area of information and communication skills within healthcare and, finally, the book ends by considering how doctors, nurses, radiographers and other healthcare professionals can maintain their supportive care in light of such high levels of stress and burnout among these staff groups.

Patients with degenerative neurological disorders are among the most handicapped patients in medicine. Many of these diseases are incurable. Expert palliative care is the duty of every neurologist: however, to date, this has not been a standard feature of neurological practice or training. This book helps define a new field, namely palliative care in neurology. It brings together all necessary information for neurologists caring for a patient with advance disease. Palliative care is an approach to the management of patients with life-threatening illness that attempts to enhance comfort, relieve psychosocial and spiritual distress, assure respect for decision making, provide support for the family, and prepare the patient and family for the end of life. This unique book covers each of the many dimensions of palliative care as they relate to patients with advanced neurological disorders. Basic principles of palliative care and specific ethical issues (such as euthanasia, food and hydration and advance directives) are covered. The needs of populations with specific neurological disorders are described and the management of symptoms that are common to all is explored in detail. Each chapter introduces its topic using a case report which may be used directly for teaching purposes. The authors have put together an invaluable resource, which lays the foundation for further research in the field.

Fatigue in Cancer provides a comprehensive review of the key issues involved in the research and practical application of current evidence and best practice guidelines for addressing cancer-related fatigue. An international group of contributors draw together core topics relating to this complex area of cancer management, focusing on issues of definition, patho-physiology, treatment related variables and the psychological, social and emotional impact on patients, families and carers. Critical reviews of practical management strategies for both adults and children are included, as are the current approaches to the measurement of cancer-related fatigue in clinical and research contexts. The book contributes a multi-disciplinary overview of a problem increasingly overlooked by cancer scientists, researchers, and clinicians.
This book demonstrates the considerable capacity of cancer-related fatigue to impact on quality of life. Its multi-disciplinary focus and consideration of prioritised areas of future research will ensure that it will prove invaluable for all health professionals and researchers in oncology and palliative care.

Patient participation and user involvement are central to current thinking about the effective delivery of desired healthcare outcomes. Working with the person who lies behind every patient is core to palliative care. A voice can only become significant when it is listened to and acted upon. With palliative care increasingly addressing the needs of people with a variety of conditions in a range of settings, as well as with advances in research, technology, and information, the challenge to be 'a voice for the voiceless' is greater than ever.

This book addresses key aspects in the provision of patient-centred palliative care and tracks significant developments in user involvement. It sets the philosophy within the cultural, social and political context of modern healthcare, particularly addressing issues of quality, standards, education and bereavement. A key component in the delivery of high quality palliative care is the multi-professional team. Following a discussion of teamwork, five core professions present a critical analysis of their working practices. The book concludes with a commentary from a palliative care user and a bereaved carer.

It is often somewhat glibly asserted that the patient is, or should be, at the centre of care. There have been few attempts to examine how to keep him or her there without professional needs and protocols crowding him or her out. This book asks how we listen and why we listen. The book focuses on the challenges of how professionals can keep the needs of the patient central in clinical care and how the patient can influence the direction of that care.

In our society, the overwhelming majority of people die in later life. They typically die slowly of chronic diseases, with multiple co-existing problems over long periods of time. They spend the majority of their final years at home, but many will die in hospitals or care homes. This book explores the possibilities for improving the care of older people dying in residential care and nursing homes. It argues that there are aspects of palliative care that, given the right circumstances, are transferable to dying people in settings that are not domestic or hospice based.

End of Life in Care Homes describes what happens in nursing and residential care homes when a resident is dying, how carers cope, and the practical, health and emotional challenges that carers face on top of their day-to-day work. Based on detailed research from both the UK and US, the book shows how the situation can be improved.

Geriatric Palliative Care covers a broad spectrum of issues characterizing care near the end of life for older adults. Beginning with the social and cultural context of old age and frailty, this volume details with specific aspects of palliative care relevant to particular disorders (e.g. cancer, strokes, dementia) as well as individual symptoms (e.g. pain, fatigue, anxiety.). Communication between care-givers and patients, in a variety of settings, is also discussed.

The theme of this book is that palliative care is the best approach to the care of chronically ill and frail elderly because of its focus on quality of life, support for functional independence, and the centrality of the patient's values and experiences in determining the goals of medical care. Geriatric Palliative Care provides a comprehensive medical reference for all clinicians who care for older adults.

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.

Palliative Day Care in Practice 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, hea;th economics, 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. It will prove valuable to specialist palliative care practitioners, researchers and purchasers interested in establishing or evaluating palliative day care.

Also published by Oxford University Press

Palliative Care in the Home Derek Doyle & David Jeffrey

Chronic and terminal illness - new perspectives on caring and carers Sheila Payne & Caroline Ellis-Hill

Anyone suffering from a terminal illness faces huge challenges, not only emotionally and physically, but also in the range of practical decisions they need to make. In your own time guides the patient through the choices that exist in the current system of medical care, helping them decide on the kind of care they want, and where they receive it - in the hospice or the home. It includes chapters on coming to terms with their situation, the help available to them at home, how to choose between a hospice and home, and advice on coping with the inevitable feelings and emotions of both patient and carer. Written by a GP with extensive experience in this area, the book is unique in presenting both a compassionate and practical guide for anyone affected by serious illness, one that will empower them with the information they need to maintain the highest possible quality of life in their final days.

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 palliative care at home, this book provides a definitive guide on how to provide effective care for people with far-advanced disease. Written by two palliative medicine specialists, both of whom have been family doctors, this book deals with all the physical, emotional, spiritual and social problems likely to be encountered by family doctors and community nurses caring for a patient and relatives at home. It deals in detail with emergencies, communications, ethical issues and emphasises throughout the importance of team work. 'It provides a wealth of information and advice on all aspects of palliative care at home'. Elaine Coleridge Smith Information Exchange, No. 13, 1995

Caring for patients with acute pain problems can present a considerable challenge to junior doctors and nursing staff. Too often, the problems are inappropriately managed, resulting in the patient suffering unnecessary pain. The Management of Acute Pain provides simple, practical guidelines for those who prescribe and administer drugs for acute pain relief, particularly junior medical and nursing staff. The new edition has been extensively revised to take account of drug developments in recent years. Featuring easy to follow flowcharts, and clear concise descriptions, the book will be a valuable reference for House officers, SHO's, physiotherapists, and palliative care nurses.

From reviews of 1st edition: 'This book possesses the qualities of being practical, easy to read and relevant to virtually all medical nursing staff. It should be made widely available on wards and in departments.' Postgraduate Medicine Journal

Cancer related pain can be successfully managed in the majority of patients by the use of medication. Some patients, however, have pain that does not respond to opioids, and require more specialised pain management techniques. Examples of such treatments are nerve blocks, radiotherapy, acupuncture and physiotherapy. This is the first book to provide detailed information on these and other methods of pain management. The Editors are experienced clinicians who have brought together an international, multi-professional team of pain specialists, palliative medicine practitioners and oncologists to provide a practical, comprehensive guide to the overall management of cancer pain. By effectively covering many different aspects of care, this book will appeal to all health care professionals involved with the frontline of cancer related pain.

As someone approaches the end of their life, it is vitally important that they receive quality care and support, that their wishes are met, and that they are treated with dignity and respect. Pathways through Care at the End of Life is a comprehensive guide to providing excellent, person-centred end of life care. Following a pathway from initial conversations about end of life to care in the last days of life and after death, it covers assessing need and planning care, co-ordinating care between different agencies, and ensuring quality in different settings, such as at home, in a hospice, or in hospital. Good practice guidance on communication, ensuring the person's needs are met, support for their family and how to facilitate a good death is given. Case studies illustrate real life practice, and questions throughout each chapter encourage reflective practice. This book will be essential reading for all those working with people at the end of life, such as nurses, social workers, GPs and home carers, as well as students in these fields.

When the first edition of A House Called Helen was published in 1993, there were only a handful of children's hospices in existence, all of them within the UK. There are now more than twenty in operation, and a significant number at the project stage, in the UK alone, and children's hospices have been set up in Canada, the USA, Australia and continental Europe. The concept of a children's hospice, seen as innovative when the first, Helen House, opened in Oxford in 1982, is now well established and the growth in the number of children's hospices has seen corresponding important developments in the field of paediatric palliative care. This book provides an authoritative account of how Helen House came into being. It records the events surrounding the foundation of the hospice and how it stemmed directly from what was learnt from the events following the sudden illness of the author's eldest daughter Helen, after whom it was named. The book sets out the philosophy which underpinned the hospice, which was taken up as the guiding philosophy of children's hospice care. It describes the hospice's operational framework and details the service provided by Helen House, which is widely cited as a model for children's hospice care worldwide. It provides valuable insight into the needs of the families who use hospice services and touches both on the difficulties they face caring, often over a long period of time, for a child with a life-limiting illness, and on the role and attitudes of professionals and indeed of the public at large. In this new edition an additional chapter reviews the growth of children's hospices and reflects on the challenges they face in their maturity. It considers the development of children's hospice care in relation to wider service provision and examines current and future issues surrounding the care of children with life-limiting illness.

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

Bladder cancer represents a significant cause of morbidity and mortality worldwide and presents major problems in detection and management. This book will review comprehensively the current understanding of the biology, pathophysiology and urological oncology of the disease, looking at the
problems and potential solutions. Fully illustrated including a colour plate section, it will include chapters on both the scientific and clinical principles, emphasizing molecular biology, pathogenesis, detection and experimental therapeutics, and focusing on new developments in clinical research.
The contributors are international and well known in the area.

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 book is a comprehensive guide to Targeted Drug Delivery (TDD), also known as Intrathecal Drug Delivery (IDD), and offers an overview to this unique form of treatment. The medication is delivered by intrathecal pumps and is less common than some other techniques for interventional pain management, but is essential in conditions such as refractory pain, cancer pain, multifocal pain, severe spasticity, and in patients who are not candidates for surgical correction of their underlying condition. This book is the first source to describe both the optimal surgical implantation and patient management aspect of this therapy, and thus will be a valuable single reference guide for interventional radiologists, anesthesiologists, physiatrists, oncologists, neurologists, spine surgeons, palliative care physicians, and primary care physicians.

Psychiatric, or psychosocial, palliative care has transformed palliative medicine. Palliation that neglects psychosocial dimensions of patient and family experience fails to meet contemporary standards of comprehensive palliative care. While a focus on somatic issues has sometimes overshadowed attention to psychological, existential, and spiritual end-of-life challenges, the past decade has seen an all encompassing, multi-disciplinary approach to care for the dying take hold. Written by internationally known psychiatry and palliative care experts, the Handbook of Psychiatry in Palliative Medicine is an essential reference for all providers of palliative care, including psychiatrists, psychologists, mental health counselors, oncologists, hospice workers, and social workers.

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.

The third edition of Hospice and Palliative Care is the essential guide to the hospice and palliative care movement both within the United States and around the world. Chapters provide mental-health and medical professionals with a comprehensive overview of the hospice practice as well as discussions of challenges and the future direction of the hospice movement. Updates to the new edition include advances in spiritual assessment and care, treatment of prolonged and complicated grief, provision of interdisciplinary palliative care in limited-resource settings, significant discussion of assisted suicide, primary healthcare including oncology, and more. Staff and volunteers new to the field along with experienced care providers and those using hospice and palliative care services will find this essential reading.

This book presents a timely and multidisciplinary update on the modalities currently available for treating the most feared symptom of patients diagnosed with cancer. The various cancer pain syndromes are explored in detail, covering those related directly to malignancy and those due to the after-effects of cancer therapy. Treatment modalities, including pharmacologic approaches, interventional procedures, and palliative surgical options, are discussed clearly and concisely, with provision of recommendations for the practitioner. Further topics include new and emerging treatments for cancer pain, survivorship considerations, pain management in special populations, and implementation of systems-based pain programs. The book has been written by a multidisciplinary group of experts, reflecting the evolution in pain and symptom management that has occurred in parallel with progress toward more targeted oncologic treatments. Oncologists, palliative care physicians, allied health professionals, and other practitioners involved in caring for cancer patients will find Fundamentals of Cancer Pain Management to be a rich source of evidence-based insights into effective pain management.