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.

Cicely Saunders is universally acclaimed as a pioneer of modern hospice care. Trained initially in nursing and social work, she qualified in medicine in 1958 and subsequently dedicated the whole of her professional life to improving the care of the dying and bereaved people. Founding St. Christopher's Hospice in London in 1967, she encouraged a radical new approach to end of life care combining attention to physical, social, emotional and spiritual problems, brilliantly captured in her concept of "total pain." Her ideas about clinical care, education and research have been hugely influential, leading to numerous prizes and awards in recognition of her humanitarian achievements. This book includes a selection of Cicely Saunders' most important writings throughout a period of over forty years.
Full articles, chapters, editiorials, reviews, and commentaries include important clinical themes relating to the care of dying people such as pain and symptom management, issues of communication and truth telling, and the needs of particular patient groups, such as those with cancer and other diseases. The book includes pieces that reflect on the wider development of the palliative care field and on policy and organizational issues. Some of the papers take up the theme of spiritual care at the end of life, as well as the question of euthanasia, raising in turn issues of a wider theological and philosophical nature.
The articles are written for a multi-disciplinary audience and will be of enormous interest to many professionals now working in palliative care. The collection will become a key work of reference for those interested in the evolution of hospice and palliative care and will serveas an important sourcebook of many currently hard to obtain publications by the acknowledged founder of the modern hospice movement. This book will also stand as a remarkable testimony to the personal contribution of Cicely Saunders and the influence she has had upon the modern field of palliative and end of life care.

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.

The Oxford Handbook of Palliative Care returns for a third edition, maintaining the concise yet comprehensive format suited to the busy practitioner for quick access to key information, and fully updated to reflect changes in the palliative care landscape. Featuring an increased emphasis on non-malignant diseases such as dementia, this authoritative text combines evidence-based care with the bedside experience of experienced palliative care professionals to give the reader a complete overview of the physical, emotional, and spiritual aspects of care for the end-of-life patient. Symptom management is covered in detail, with updated formulary tables and syringe driver protocols, and a new chapter on international perspectives to broaden the reader's perception of methods for delivering end-of-life care. The third edition of the Oxford Handbook of Palliative Care is the essential companion for all of those working with adults, children, and families with palliative care needs, in both hospital and community settings. The following correction has been made online and will be included in the first reprint. Readers can get in touch with us directly using the contact details on the back of the book or at our online form via the address below with questions or comments: https://global.oup.com/academic/category/medicine-and-health Chapter 5. Page 109 The dose for Hyoscine butylbromide sc has been amended in line with NICE guidance (https://bnf.nice.org.uk/drug/hyoscine-butylbromide.html): '20-120 mg 4 hourly' has been corrected to '20-80mg 4 hourly'.

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.

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!'

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.