Political, economic, social, cultural and technological changes have led to profound transformations in the ways that death and loss are perceived and managed in contemporary society. Over the last few decades, the long term shift to chronic illness as a major causal factor has significantly increased the time scale of dying. Most people die in institutions and 'care' is typically medical. Many communities and ordinary citizens now relinquish control and involvement to experts in the last stages of life.
At global and local levels, however, new arrangements are emerging to govern the changing face of death, and a reorientation model is being developed to counter claims of the 'creeping medicalisation' of death and dying. With an international authorship and scope, this book illustrates the interlinking nature of society, death and loss, and it gives examples of governance that promotes the empowerment, participation and the increasing need for the involvement of ordinary people and communities in differing social and cultural contexts.
Chapters come from collaborations of academics and practitioners in end of life care - from sociologists, anthropologists or the arts but also from nursing, social work, or medicine. The result is a reflective, academic and practical discussion of the outline of the problem we face in the contemporary governance of death, and an exploration of the critical, theoretical and practice-based ways forward for us all.

Even for the most experienced healthcare professional, managing the last few days of life can be difficult. This unique book provides guidelines for the care of the dying based on the Liverpool Integrated Care Pathway for the Dying Patient (LCP). Developed at a hospice, the information can be disseminated and adapted to fit different settings such as hospitals and nursing homes.
The LCP is a multiprofessional document that incorporates evidence-based practice and appropriate guidelines related to care of the dying. It provides a template which describes the process of care which is generally delivered in a clinical situation and incorporates the expected outcome of care delivery. The LCP replaces all other documentation in this phase of care. Care pathways can provide a potentially powerful aid to professionals involved in palliative care. Basic principles of treatment are translated into daily practice, including bedside documentation systems, policies and procedures, standards of practice, continuing education and quality improvement programmes. This book also includes chapters on symptom control, ethical issues, communication skills, and spiritual care written by experts in the field which underpin the use of the LCP.
Care of the Dying Second Edition will prove invaluable to all healthcare professionals involved in the care of the dying patient, organisations and Trusts who want to develop demonstrable measures and outcomes of care.

Every one of us will die, and the processes we go through will be our own unique to our own experiences and life stories. It is reasonable to reflect on what kinds of dying processes may be better or worse for us as we move toward our end. Such consideration, however, can raise troubling ethical concerns for patients, families, and healthcare providers. Even after forty years of concerted focus on biomedical ethics, these moral concerns persist in the care of lethally impaired, terminally ill, and inured patients. End-of-Life Care and Pragmatic Decision Making provides a pragmatic philosophical framework based on a radically empirical attitude toward life and death. D. Micah Hester takes seriously the complexities of experiences and argues that when making end-of-life decisions healthcare providers ought to pay close attention to the narratives of patients and the communities they inhabit so that their dying processes embody their life stories. He discusses three types of end-of-life patient populations adults with decision-making capacity, adult without capacity, and children (with a strong focus on infants) to show the implications of pragmatic empiricism and the scope of decision making at the end of life for different types of patients.

Drs. Eduardo D. Bruera and Russell K. Portenoy have completely revised and updated the widely respected Cancer Pain: Assessment and Management for the second edition of this unanimously praised book. This is a comprehensive, clinically oriented review of all aspects of the complex and multidimensional problem of cancer pain. The unique characteristics of cancer pain, including pathophysiology, clinical assessment, diagnosis, and pharmacological and nonpharmacological management are all discussed here in detail. Internationally recognized leaders in cancer pain research have contributed to many new chapters, including neuraxial analgesia, hospice and institution-based palliative care programs, bone pain, and cancer pain and palliative care in the developing world. Cancer Pain continues to be a scholarly but accessible text that is an essential resource for physicians, nurses, and medical students who treat suffering from cancer pain. Per the New England Journal of Medicine, This book should be in the library of every physician who comes into contact with patients with pain. It is truly superb.

The Art and Science of Compassion, A Primer offers a succinct, all-in-one introduction to the full gamut of compassion, from the evolutional, biological, behavioural, and psychological, to the social, philosophical, and spiritual. Drawing on her diverse background as a clinician, scientist, educator, and chaplain, Dr. Wong presents a wealth of scientific evidence supporting that compassion is both innate and trainable. By interleaving personal experiences and reflections, she shares her insights on what it takes to cultivate compassion to support the art of medicine and caregiving. The training described in this book draws on both contemplative and scientific disciplines to help clinicians develop cognitive, attentional, affective, and somatic skills that are critical for the cultivation of compassion. With striking illustrations for key concepts and concise summaries for each chapter, this book provides a solid conceptual framework and practical approaches to cultivate compassion. Advance Praise for The Art and Science of Compassion, A Primer "Well-written, deeply personal and scientifically-grounded, this book provides strong physiological, psychological, and ethical reasons why cultivating compassion is essential-and provides a thoughtful roadmap for promoting compassion in healthcare and in all of life." - Ron Epstein, MD, author of Attending: Medicine, Mindfulness, and Humanity "Dr. Agnes Wong, a highly distinguished physician and exceptional researcher at the University of Toronto, has written an absolutely uplifting masterpiece about meaning, compassionate care, and the universal journey that all healers must take to sustain their inner being and nobility of purpose. This book is partly her journey to a deeper state of being that places compassionate care in its rightful place in the healing art; it is also a fabulous scientific presentation of the practice and impact of compassionate care on patients and on one's own flourishing as a physician. This is a book that touches the soul and should be read by every medical student or clinician worldwide as they reflect on what it means to really succeed in their "whole selves" as healers and human beings." - Stephen G. Post, PhD, Director, Center for Medical Humanities, Compassionate Care and Bioethics; Professor of Family, Population and Preventive Medicine, Stony Brook University "Compassion and empathy are traits that make us human, and as Dr. Wong shows, these qualities can be developed, encouraged, and cultivated. In our struggling world, we need this awareness as never before. The future of our species likely depends on it. This book is an example of how science and spirituality can come together in a brilliant synthesis." - Larry Dossey, MD, author of One Mind: How Our Individual Mind Is Part of a Greater Consciousness and Why It Matters

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

Individuals with serious and incurable illnesses often require care that goes beyond the body. As they face the challenges of living with and eventually dying from their conditions, they may need to acquire new skills to cope and increase their quality of life. Even those at the beginning of the end of life can take an active role in their treatment.
This skill-based program emphasizes flexibility and should be tailored to individual clients. The first module introduces stress management techniques, including cognitive restructuring, relaxation, and problem-focused and emotion-focused coping. The second module targets mood management, with sessions on depression, anxiety, and anger. Social support is addressed in the third module where clients learn communication and conflict resolution skills. Special attention is paid to supporting caregivers and working with medical providers. The fourth module focuses on quality of life and covers symptom management, goal setting, positive psychology, and spiritual issues. An adaptation chapter details how to run the program as a group and discusses other possible formats.
Incorporating a wide variety of CBT techniques, this program can benefit patients suffering from a range of chronic and terminal diseases. The corresponding workbook helps clients personalize the content of sessions and practice new skills. The facilitator guide is invaluable to any mental health professional working in a medical or other palliative care setting.

Cancer-related bone pain is experienced by patients with primary bone tumours such as myeloma and osteosarcoma, but is more commonly seen in patients with malignant tumours that have metastasised to bone. Bone pain is one of the most common and severe forms of pain associated with breast, prostate and lung cancer, yet little is known about the underlying mechanisms responsible for the pain. Cancer patients identify bone pain as the most disruptive cancer-related event in terms of their quality of life and daily functioning, and it is also associated with increased incidence of morbidity, depression, and anxiety. Part of the Oxford Pain Management Library, this volume summarises the latest evidence-based and practical information on the management of cancer-related bone pain. Chapters cover the pathophysiology and clinical features of bone pain, general principles of management and the use of opioids and other agents. It will be an invaluable reference for all health care professionals involved in the management of patients with bone pain from various disciplines including palliative care, anaesthetics, oncology and general practice.

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

"I wish I'd had this book when I needed it. Death and dying are not subjects that many people are comfortable talking about, but it's hugely important to be as prepared as you can be - emotionally, physically, practically, financially, and spiritually. This book may be the most important guide you could have." - Elizabeth Gilbert, author of Eat Pray Love ___________ The end of a life can often feel like a traumatic, chaotic and inhuman experience. In this reassuring and inspiring book, palliative care physician Dr BJ Miller and writer Shoshana Berger provide a vision for rethinking and navigating this universal process. There are plenty of self-help books for mourners, but nothing in the way of a modern, approachable and above all useful field guide for the living. And all of us - young, old, sick and well - could use the help. After all, pregnant couples have ample resources available to them as they prepare to bring a new life into the world: Lamaze courses, elaborate birth plans, tons of manuals. Why don't we have a What to Expect When You're Expecting to Die book? An accessible, beautifully designed and illustrated companion, A Beginner's Guide to the End offers a clear-eyed and compassionate survey of the most pressing issues that come up when one is dying, and will bring optimism and practical guidance to empower readers with the knowledge, resources and tools they'll need to die better, maybe even with triumph.

Palliative care is rapidly evolving as a multidimensional therapeutic model devoted to improving the quality of life of all patients with life-threatening illness. Symptom control, management of psychosocial and spiritual concerns, decision making consistent with values and goals, and care of the imminently dying that is appropriate and sensitive to the unique needs of the individual and family - these are among the critical issues addressed through palliative care. As this discipline has evolved, the need for research in all these areas has become widely acknowledged. Issues in Palliative Care Research describes both the progress that already has been made in the investigation of these issues and the methodological elements that must be addressed in future studies. The perspective is broad and the overriding goal is to inform about the state of the art in these rapidly evolving areas of research.

In Caring for Patients at the End of Life: Facing an Uncertain Future Together, Dr. Quill uses his wide range of clinical experience caring for severely ill patients and their families to illustrate the challenges and potential of end-of-life care. Section one utilizes the near death experiences of two patients to explore values underlying medical humanism, and then presents the case of "Diane" to explore the fundamental clinical commitments of partnership and non-abandonment. Section two explores, illustrates, and provides practical guidance for clinicians, patients, and families about critical communication issues including delivering bad news, discussing palliative care, and exploring the wish to die. In section three, difficult ethical and policy challenges inherent in hospice work, including the rule of double effect, terminal sedation, and physician-assisted suicide, are explored using a mix of real cases and an analysis of underlying clinical, ethical, and policy issues. In a final chapter, Dr. Quill discusses the tragic death of his brother which occurred as this book was being completed, and how his family made the most emotionally challenging decisions of their lives.

Dr. Quill exposes readers to an internally consistent and practical way of thinking by simultaneously embracing the potential of palliative care, and also acknowledging that it has limitations. His philosophy of offering forthright discussions with patient and family, mutual decision-making, ensuring medical and palliative care expertise and of committing to see the dying process through to the patient's death is vividly illustrated

The fifth edition of this seminal reference and text in palliative care nursing helps the practitioner and student offer comprehensive, targeted interventions responsive to the needs of palliative and hospice patients and families. Based on the best level of evidence available, reference to clinical practice guidelines, and palliative care order sets to address critical symptoms, the knowledge presented in this edition supports compassionate, timely, appropriate and cost-effective care to achieve quality health outcomes for diverse palliative care populations across the illness trajectory. Noteworthy features of the new edition include broadening population health management by helping the reader to identify patterns and connections within and across population and utilize information to respond to the needs of populations. This strategy allows the reader to apply strategies that are consistent with IHI's Triple Aim that includes Improving the patient experience of care, Improving the health of populations and reducing the per capita cost of health care. Every Chapter in Sections 1, 2, and 3 includes an Evidence Based Box with a current study including a commentary written by someone from a discipline other than nursing or by an interdisciplinary team.

The rapidly evolving field of Palliative Care focuses on the management of phenomena that produce discomfort and that undermine the quality of life of patients with incurable medical disorders. The interdisciplinary clinical purview includes those factors - physical, psychological, social, and spiritual - that contribute to suffering, undermine quality of life, and prevent a death with comfort and dignity. Palliative Care is a fundamental part of clinical practice, the "parallel universe" to therapies directed at cure or prolongation of life. All clinicians who treat patients with chronic life-threatening diseases are ingaged in palliative care, continually attempting to manage complex symptomatology and functional disturbances.
The scientific foundation of palliative care is advancing, and similarly, methods are needed to highlight, for practitioners at the bedside, the findings of empirical research. TOPICS IN PALLIATIVE CARE has been designed to meet the need for enhanced communication in this field.
To highlight the diversity of concerns in palliative care, each volume of the TOPICS IN PALLIATIVE CARE Series is divided into sections that address a range of issues. Addressing aspects of symptom control, psychosocial functioning, spiritual or existential concerns, ethics, and other topics, the chapters in each section review the given area and focus on a small number of salient issues to analysis. The authors present and evaluate existing data, provide a context drawn from both the clinical and research settings, and integrate knowledge in a manner that is both practical and readable. The specific topics covered in Volume 2 are Neuropathic Pain, Cachexia/Anorexia, Asthenia, and Psychological Issues in the Caregiver.

Advance Care Planning (ACP) is an essential part of end of life care in the UK and most developed countries. It enables more people to live well and die as they would choose, and has significant implications for the individual person, their family and carers, and our wider society. In the context of an ageing population and increasing possibilities for medical interventions, ACP is a particularly important aspect of quality care. Expanded and fully updated throughout, this new edition gives a comprehensive overview of ACP and explores a wide range of issues and practicalities in providing end of life care. Written by experts from around the world, the book takes a comprehensive look at the subject by exploring the wide range of issues and practicalities in providing ACP; framing the purpose, process, and outcomes of these plans; and providing an important update on national and international research, policy and practice. Chapters also discuss values, goals and priorities, and include detailed case examples to aid best practice. This book is an invaluable resource for all clinicians involved in the caring for people in their final stages of life. It is of particular value to GPs, palliative care specialists, geriatricians, social care teams, researchers and policy leads interested in improving end of life care.

Palliative care supports patients suffering from life-limiting illnesses by providing relief from physical, emotional and spiritual suffering, improving the quality of life for them and their families. It is an important component of good patient care, an integral part of the continuum of support for patients suffering with advanced cancer and end stage organ diseases. Providing good palliative care requires both sound clinical knowledge and compassion.With new chapters on end stage organ diseases, spiritual care and medical ethics, all healthcare professionals will find wisdom and practical advice in this book by the patient's bedside. The editors and contributors of the 2nd Edition of The Bedside Palliative Medicine Handbook have taken great care to provide readers with an evidence-based, updated guide to the practice of palliative medicine.

Death studies have, over the last twenty years, witnessed a flourishing of research and scholarship particularly in areas such as dying and bereavement, cultural practices and fear of dying. But, despite its importance, a specific focus on the nature of personal mortality has attracted surprisingly little attention. Reflecting on the Inevitable combines evidence from several disciplinary fields to explore the varying ways each of us engages with the prospect of personal mortality. Chapters are organized around the question of how an ongoing relationship might be possible when the threat of consciousness coming to an end points to an unspeakable nothingness. The book then argues that, despite this threat, an ongoing relationship with one's own death is still possible by means of conceptual devices, or 'enabling frames', that help shape personal mortality into a relatable object. In each chapter the subtleties and applicability of key ideas are enhanced through a series of illustrative narratives built up around the lives of four people at different ages living in two adjacent houses. Reflecting on the Inevitable is relevant not only to academics of death studies, but also those training and practicing in people-helping professions, as well as anyone experiencing or attempting to make sense of major life events.

Expert Nursing Care Has The Potential To Greatly Reduce The Burden And Distress Of Those At Life'S End And The Ability To Offer Support For The Many Physical, Psychological, Social, And Spiritual Needs Of Patients And Their Families. This Protocol Sets Forth The Evidence-Based Guidelines For Providing Appropriate End-Of-Life Care; Including Symptom Management; Family Issues And Intervention; Withholding And Withdrawing Life Support; Communication And Conflict Resolution; And Caring For The Caregiver.

This sixth edition of the Oxford Textbook of Palliative Medicine takes us now into the third decade for this definitive award-winning textbook. It has been rigorously updated to offer a truly global perspective, highlighting the best current evidence-based practices, and collective wisdom from more than 200 experts around the world. This leading textbook covers all the new and emerging topics, updated and restructured to reflect major developments in the increasingly widespread acceptance of palliative medicine as a fundamental public health need. The sixth edition includes new sections devoted to family and caregiver issues, cardio-respiratory symptoms and disorders, and genitourinary symptoms and disorders. In addition, the multi-disciplinary nature of palliative care is emphasized throughout the textbook, covering areas from ethical and communication issues, the treatment of symptoms, and the management of pain. The Oxford Textbook of Palliative Medicine is a truly comprehensive text. No hospital, hospice, palliative care service, or medical library should be without this essential source of information. This sixth edition of the Oxford Textbook of Palliative Medicine is dedicated to the memory of Professor Kenneth Fearon husband of Professor Marie Fallon and a surgeon who became a world leader in the research and management of anorexia and cachexia. He modeled a work-life balance that is so critical in our field, with devotion to both his patients and his family.

Crossing Over provides a unique view of patients, families, and their caregivers in the face of incurable illness. Twenty richly-detailed narratives bring vividly to life the experiences of dying and bereavement, weaving together emotions, physical symptoms, spiritual concerns, and the stresses of family life, as well as the professional and personal challenges of providing hospice and palliative care. Drawing on a variety of qualitative research methods, including participant-observation, interviews, and journal keeping, the narratives depict the sights, sounds, tastes, and smells of daily life in patients' homes and in the palliative care unit. Crossing Over moves far beyond conventional case reports in medicine, which typically concentrate narrowly on symptoms and treatments, and beyond cliches about "dying with dignity." It provides intimate views of the anger and fear, tenderness and reconciliation, jealousy and love, unexpected courage and unshakable faith, social support and "falling through the cracks," which are all part of facing death in North American society. It provides an extraordinary portrait of the processes of giving and receiving hospice and palliative care in the real world, as opposed to idealized versions in many textbooks. This edition of Crossing Over has been thoroughly revised and updated to reflect changes in hospice and palliative care and in North American society since the first edition in 2000. Chief among these are the expansion of hospice and palliative care as a field, the ravages of the COVID-19 pandemic, the wider availability of medical aid in dying, and a heightened awareness of how structural racism, classism, and other forms of discrimination shape individuals' and families' experiences right up to the close of life.

Talking openly with sick and dying children about their illness is always difficult and often agonizing. It is honesty, however, that these children deserve and need. Dietrich Niethammer, a prominent pediatric oncologist, explains why it is so important to speak frankly and respectfully to young patients about their disease.

The question at the heart of this book is how children and adolescents feel and think about death and dying. Dr. Niethammer thoroughly examines the literature on the topic, arguing that children and adolescents not only are capable of discussing their illness but benefit from doing so. Puzzled why it took medical practitioners so long to accept truth-telling in their care of dying children, Niethammer traces the development of this notion from the early twentieth-century work of Sigmund Freud to the discomfort surrounding it still today.

Severely sick children and adolescents think about the consequences of their disease, whether adults discuss it with them or not. When adults remain silent, they do a disservice to the children. Dr. Niethammer urges doctors to practice not in silence and denial but in open communication with ill children, giving the children an opportunity to express their fears and anxieties and to cope with their disease on their own terms.

Dr. Niethammer's compelling personal experiences combined with the latest research make this a compassionate and invaluable resource for physicians, nurses, social workers, teachers, parents--for all who care for sick and dying children and adolescents.

Emerging as a new sub-specialization within the hospitalist community, the neurosurgery hospitalist provides preoperative risk stratification, advises on managing pre- and postoperative complications, and helps doctors make decisions about when to involve specialists other than neurosurgeons. This collaborative approach to the neurosurgery patient has been shown to offer effective care since hospitalists can be better attuned than specialists to multiple medical problems that most patients have. Medical Management of Neurosurgical Patients is a first of its kind textbook providing a standardized source of information for neurosurgery hospitalists in order to establish a common ground and improve their knowledge and training. The work will focus on management of CNS infections, management of bleeding in the context of CNS surgery (a potentially catastrophic complication), management of sodium and blood glucose levels including steroid-induced hyperglycemia, perioperative pain control, and management of pressure injuries and rehabilitation in the context of CNS injury.

As humanitarian aid organizations have evolved, there is a growing recognition that incorporating palliative care into aid efforts is an essential part of providing the best care possible. A Field Manual for Palliative Care in Humanitarian Crises represents the first-ever effort at educating and providing guidance for clinicians not formally trained in palliative care in how to incorporate its principles into their work in crisis situations. Written by a team of international experts, this pocket-sized manual identifies the needs of people affected by natural hazards, political or ethnic conflict, epidemics of life-threatening infections, and other humanitarian crises. Later chapters explore topics including pain management, skin conditions, non-communicable diseases, palliative care emergencies, the law and ethics of end of life care, and more. Concise and highly accessible, this manual is an ideal educational tool pre-deployment or during fieldwork for clinicians involved in planning and providing humanitarian aid, local care providers, and medical trainees.

Death, dying, loss, and care giving are not just medical issues, but societal ones. Palliative care has become increasingly professionalised, focused around symptom science. With this emphasis on minimizing the harms of physical, psychological, and spiritual stress, there has been a loss of how cultures and communities look after their dying, with the wider social experience of death often sidelined in the professionalisation and medicalisation of care. However, the people we know and love in the places we know and love make up what matters most for those undergoing the experiences of death, loss, and care giving. Over the last 25 years the theory, practice, research evidence base, and clinical applications have developed, generating widespread adoption of the principles of public health approaches to palliative care. The essential principles of prevention, harm reduction, early intervention, and health and wellbeing promotion can be applied to the universal experience of end of life, irrespective of disease or diagnosis. Compassionate communities have become a routine part of the strategy and service development in palliative care, both within the UK and internationally. The Oxford Textbook of Public Health Palliative Care provides a reframing of palliative care, bringing together the full scope of theory, practice, and evidence into one volume. Written by international leaders in the field, it provides the first truly comprehensive and authoritative textbook on the subject that will help to further inform developments in this growing specialty.

The first resource of its kind, Palliative and Serious Illness Patient Management for Physician Assistants provides a fundamental framework for physician assistants and physician associates to incorporate palliative care medicine, including end-of-life care, into their practice. The book focuses on pharmacologic and integrative medical therapeutic modalities, as well as the evaluation and treatment of special populations, which reflects the reality of a physician assistant's day-to-day job. It uses a patient-centered approach to address the comprehensive management of serious illness patients, as well as their designated families, significant others, caregivers, and health care providers. Chapters are organized into six sections that cover the essential aspects of care, symptom management, and transitioning care at the end-of-life. This book is ideal for physician assistant trainers (didactic or clinical), students, and practicing clinicians who seek to enhance their communication and medical skills in the treatment of all seriously illness patient populations in any specialty, and in the management of their symptoms at any stage of their disease or condition.