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.

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 book provides a practical, evidence-based overview of the supportive care of patients with urological failure, covering issues such as quality of life measurements, the role of the multidisciplinary team, and psychological and social support for patients, families and carers. The book focuses on chronic symptoms such as chronic prostatitis. It begins by looking at quality of life measurements, self-help strategies, the role of the interdisciplinary team, and psychological and social support. It then moves on to clinical chapters which cover issues such as patients who present with hematuria, urinary retention, urinary incontinence, neurological disease affecting the urinary tract, chronic prostatitis, and infertility; ending with a chapter on supportive care for the urology patient and family in the future. The book places a special emphasis on symptomatic interventions, particularly in the setting where the course of the illness cannot be modified.

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

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.

Listening carefully to patients at the end of life is at the heart of good palliative care and this book provides a means of recognizing and talking about spiritual needs even when religious language is not used. The author refers to this as a 'language of spirit'. The book is based on interviews with patients who are dying and the language that they use to describe their experiences. It deals with death, dying, the experiences of patients and the relief of spiritual pain by looking closely at patient stories, drawings and behaviour. The book explains why it is often easier to recognize than to explain spiritual issues. Part One explores the psychological, spiritual and theological interpretations of human experience. A detailed account is given of how the patients' own stories were collected. Drawing on a broad literature which is grounded in patients' words and deeds, Part Two introduces a non-religious 'language of spirit'. Illuminated by patient art, Part Three shows what patients use this language to 'say' about their situation and how it is mediated through various metaphors. Part Four suggests ways of responding positively to patients' spiritual needs. Aimed primarily at palliative care specialists and specialist nurses, this book will also appeal to health care chaplains, pastoral support workers, theologians, social researchers, and psychotherapists. 'The numerous illustrations, given by patients comments as they tell their story, make this book a truly fascinating journey through an important area of end of life care.' Dame Cicely Saunders, OM, DBE, FRCP, Founder/President, St Christopher's Hospice, London 'The emphasis on allowing patients to speak for themselves is striking... the author has presented the topic in a sensitive and refreshing way... I think this book will be well-received and it will be an important contribution to the literature of palliative care.' Dr Odette Spruyt, Head of Pain and Palliative Care Department, Peter MacCallum Cancer Institute, East Melbourne, Australia

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.

This book will be an invaluable resource for GPs, counsellors, managers and others in primary care who seek to understand the debates about counselling and play a part in its future as part of health care. Its authors discuss the nature of counselling in this setting and the contribution it can make in improving the care of patients with a variety of health problems. The authors include practitioners and academics, service providers and counselling clients, supporters and sceptics. Overall they offer a comprehensive and thought provoking guide to those responsible for commissioning, working with and providing counselling services in a health service that seeks to be increasingly primary care led and evidence based.

This book discusses the establishment and evaluation of counselling services in primary care and the need to consider the most appropriate forms of service for different groups. It describes the specialist counselling services that are available to back up what can be provided as part of primary care and the variety of organisations that can be approached for information and advice, and assesses the research evidence on the efficacy and cost effectiveness of counselling.

A GP writes: 'If ever there was a subject guaranteed to generate debate, often heated, it's counselling. Does it work? Who's it for? What does it cost? How can we set up a service? Well, this book has the answers. And not just the positive ones - in the spirit of true balance, it even gives the sceptical view. A bit like turkeys voting for Christmas you might think? Nothing of the kind. The chapters cover just about everything GPs or Primary Care Organisations (PCO) might want to know about counselling in a primary care setting. In amongst the practical pointers on how to deal with thorny clinical counselling problems in specific situations, it even covers cost-effectiveness. Even the most sceptic, hard-hearted PCO clinical director will find the arguments in this book persuasive. The chapters on managed counselling, services for young people, substance misuse, trauma and sexual abuse could easily stand alone. But they don't. They are all in this little gem of a book. If not one for your doctor's bag, it's definitely one for your shelf!'

Gastrointestinal symptoms such as anorexia-cachexia, chronic nausea, vomiting and bowel obstruction are highly distressing for patients with advanced cancer. Approximately one in three adults will be diagnosed with cancer in their lives and approximately fifty per cent of them will die because of malignancy. More than eighty per cent of patients who die of cancer will present severe gastrointestinal symptoms before death.

This book presents detailed, evidence-based information on each of the gastrointestinal symptoms for a multi-disciplinary audience. Comprehensive guidelines have been included on how to assess the patient, in order to ensure effective treatment, in which prescribing is tailored to the cause of the symptoms and to the patient's individual needs. The book recognises that the aim of good cancer management and palliative care is to assess, diagnose, manage and treat these symptoms to ensure best quality of life.

Aimed primarily at hospice and palliative care specialists, medical, radiation and surgical oncologists and selected family physicians and internists who have an interest in cancer care. The book will also appeal to oncology and academic nurses, nutritionists as well as clinical psychologists with an interest in oncology and/or palliative care.

ALSO PUBLISHED BY OXFORD UNIVERSITY PRESS

Cancer Pain Management - a comprehensive approach Edited by Karen H Simpson & Keith Budd

Integrated Cancer Care - holistic, complementary and creative approaches Edited by Jennifer Barraclough

The Syringe Driver: continuous subcutaneous infusions in palliative care Andrew Dickman, Clare Littlewood & Jim Varga

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.

The specialty of palliative care has traditionally grown out of oncology and there has been little research into the needs of patients dying from causes other than cancer. Few non-cancer patients receive hospice in-patient, home care or day care although a good proportion of hospices say that their services are available to non-cancer patients. As a result, the importance of palliative care for non-cancer patients is now being increasingly recognized internationally, and in the UK a committee reporting to the Department of Health recommended that palliative care should be accessible to all patients who need such care. Palliative Care for Non-Cancer Patients considers the needs and experiences of patients dying from, for example, stroke, heart disease or dementia by,drawing on a range of disciplines and specialties in medicine. The provision of palliative care for patients dying from causes other than cancer raises a number of important questions for policy makers and purchasers. This book summarizes what is known about the needs of and appropriate service provision for people dying of causes other than cancer and begins to set a research agenda. Other books of interest from OUP: Palliative care in ALS, David Oliver, Gian Borsio & Declan Walsh

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

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.

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.

By bridging the gap between conventional medical interventions and complementary approaches using aromatherapy, palliative care nurse and clinical aromatherapist, Carol Rose, demonstrates how an integrated and evidence-based approach can have the most significant impact on quality-of-life in patients with life-limiting illness. Aromatherapy is already a fundamental practice in many palliative care settings but its benefits remain under-researched and under-represented. Each chapter of this book incorporates a person-centred focus to consider the integration of various aromatherapy approaches for a range of end-of-life symptoms, alongside conventional medical options. The specificity of this approach and the emphasis of empowering patients to be involved in the process of choosing oils and applications, allows for improved results in the palliation of common symptoms. Integrating Clinical Aromatherapy in Palliative Care has a foundation in research from the patient's point of view. The result is a fresh perspective that prioritises support of patient choices, skilful communication and individualised care, alongside the judicious use of essential oils and other botanical products. Collectively, aromatherapy can completely reframe holistic care to allow for greater emotional, social and spiritual expression.