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.

The Textbook of Interdisciplinary Pediatric Palliative Care, by Dr. Joanne Wolfe, et al., aims to inform interdisciplinary teams about palliative care of children with life-threatening illness. It addresses critical domains such as language and communication, symptoms and quality of life, and the spectrum of life-threatening illnesses in great depth. This comprehensive product takes a first-of-its-kind team approach to the unique needs of critically ill children. It shows how a collaborative, interdisciplinary care strategy benefits patients and their families. If you deal with the complex care of critically ill children, this reference provides a uniquely integrated perspective on complete and effective Respect interdisciplinary perspectives, and provide the most comprehensive care. Use an integrated approach to address the physical, psychological, social, and spiritual needs of children and their families. Understand and heed your strengths and vulnerabilities in order to provide the best care for your patients. Recognize the necessity of linking hospital-based palliative care with community resources. Implement consistent terminology for use by the entire palliative care team. Access the full text online with regular updates and supplemental text and image resources. Reflects the collaborative approach necessary to provide optimal care for children and their families

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.

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.

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

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

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'.

Over the past thirty years, the way Americans experience death has been dramatically altered. The advent of medical technology capable of sustaining life without restoring health has changed where, when, and how we die. In this revelatory study, medical anthropologist Sharon R. Kaufman examines the powerful center of those changes: the hospital, where most Americans die today. She deftly links the experiences of patients and families, the work of hospital staff, and the ramifications of institutional bureaucracy to show the invisible power of the hospital system in shaping death and our individual experience of it. In doing so, Kaufman also speaks to the ways we understand what it means to be human and to be alive.
"An act of courage and a public service."--"San Francisco Chronicle
""This beautifully synthesized and disquieting account of how hospital patients die melds disciplined description with acute analysis, incorporating the voices of doctors, nurses, social workers, and patients in a provocative analysis of the modern American quest for a 'good death.'"--"Publishers Weekly
""Kaufman exposes the bureaucratic and ethical quandaries that hover over the modern deathbed."--"Psychology Today
""Kaufman's analysis illuminates the complexity of the care of critically ill and dying patients and] the ambiguity of slogans such as 'death with dignity, ' 'quality of life, ' and 'stopping life support.' . . . Thought-provoking reading for everyone contemplating the fate of us all."--"New England"" Journal of Medicine
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This book examines the ethics of end of life care, focusing on the kinds of decisions that are commonly made in clinical practice. Specific attention is paid to the intensification of treatment for terminal symptoms, particularly pain relief, and the withdrawal and withholding of care, particularly life-saving or life-prolonging medical care. The book is structured into three sections. The first section contains essays examining end of life care from the perspective of moral theory and theology. The second sets out various conceptual terms and distinctions relevant to decision-making at the end of life. The third section contains chapters that focus on substantive ethical issues. This format not only provides for a comprehensive analysis of the ethical issues that arise in the context of end of life care but allows readers to effectively trace the philosophical, theological and conceptual underpinnings that inform their specific interests. This work will be of interest to scholars working in the area as well as clinicians, specialists and healthcare professionals who encounter these issues in the course of their practice.

This book will be the first of its kind to offer intensive conversation analysis on patient-clinician interactions in the context of palliative medicine. The book focuses on a series of individual case studies of conversations that revolve, in each case, around one key critical term that is often evoked or understood differently by clinicians and patients.

This book explores how, in encounters with the terminally ill and dying, there is something existentially at stake for the professional, not only the patient. It connects the professional and personal lives of the interviewees, a range of professionals working in palliative and intensive care. Kjetil Moen discusses how the inner and outer worlds, the psychic and the social, and the existential and the cultural, all inform professionals' experience of work at the boundary between life and death. Death at Work is written for an academic audience, but is accessible to and offers insights for practitioners in a variety of fields.

Cancer and Creativity is a dialogue between accounts by cancer patients and survivors and a more clinical consideration and theoretical discussion from a psychoanalytic point of view of using creativity in coping with serious illness. The contributions featured demonstrate the power of creative expression as a tool for dealing with somatic, chronic and potentially life-threatening illnesses, giving patients a way of expressing and managing their individual cancer journeys and its attendant emotional sequelae. Ten artist-patients and survivors, who were involved in several long-term art therapy groups, give accounts of their experiences with cancer and with their support group, where they create paintings, embroidery, digital photography, comic books, maps and other works to express their experiences of being diagnosed and treated for cancer. The contributors describe their symptoms and their relationships to physicians and family members in words and visual representations. The book also addresses the experience of the public when they are confronted with art by cancer patients. Dreifuss-Kattan's own work as a psychoanalyst and art therapist informs her approach to the art space as what Winnicott calls a "transitional space," influenced by both the personal psychological experience and the physical environment. Dreifuss-Kattan closes her discussion with a reflection on terminal cancer care and the complex transferential and countertransferential relationship between patient and therapist. The book ends with a practical guide for both therapy groups, as well as individuals at home, to creatively address their experiences with cancer and its treatments. Cancer and Creativity will be of great interest to psychoanalysts, psychoanalytic psychotherapists, psychooncologists and art therapists, as well as health professionals working in oncology and in palliative care.

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

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

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

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

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

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

Specifically designed to enhance your knowledge and skills within generalist palliative care, this informative textbook provides a comprehensive overview of the principle areas you may encounter whilst working with adult palliative and end-of-life patients, and their families. The development of the text has been backed by Macmillan Cancer Support and each chapter has been written by a range of specialist and generalist authors. The topics covered include approaches to palliative care and symptom management in a wide range of conditions and populations, with chapters linked to case studies to encourage interactive learning and understanding. Communication skills are also highlighted to help aid confidence when engaging in open and difficult conversations. The text is in line with Scottish Palliative Care Guidelines and the NES Framework for Palliative and End of Life Care. The book may either be used as course reading for relevant training programmes, such as the Enhanced Palliative Care course, as well as by healthcare professionals hoping to develop their skills and practice. It is aimed at anyone involved in management and prescribing within non-specialist palliative care, both in hospitals and in the community, including paramedics, nurses, doctors, pharmacists, and other key health professionals.

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

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

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

Is there a place for palliative care within mental health? This inspirational book offers an excellent foundation for integrating best-practice specialist palliative care into serious and enduring mental health service delivery. The shared practice values and vision between these two disciplines provide an optimistic starting point from which to address the lack of palliative care service delivery in mental health practice. Focusing on the similarity in philosophy between palliative care and mental health practice, it incorporates: . person-centred practice . relationship-based connectedness . a belief in compassionate care . respect for autonomy and choice . quality-of-life issues. The book addresses the practice skills needed in preparation for competent intervention and treatment. Each chapter develops a theoretical framework which is supported by practical application. Both professionals and students of palliative care will find the interactive text and practical case studies especially valuable, as will the professional working in substance use. Its userfriendly approach will appeal to a wide range of readers in various related disciplines. 'While it could be assumed that mental health has a lot to offer palliative care, we both [feel] that palliative care could offer more to mental health practice...It is a neglected area. There is little or no literature related to palliative care within serious mental health practice, and that which does exist relates to care of the dying in terms of cancer.' From the Preface

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