M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells
{"title":"Population-based end-of-life care","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0026","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0026","url":null,"abstract":"This chapter describes the changing face of end-of-life care in the face of demographic changes and the need for a population-based approach in providing end-of-life care in a meaningful manner. Building on the major advances in palliative or end of life care across the world over recent decades, there now seems to be radical groundswell of change in this area, as we face the major challenge of meeting the needs the ageing population. This challenge, most noted in the developed nations, now places specific and seemingly overwhelming unprecedented demands on all our health and social care services. Some would argue that a new approach is needed, building on lessons learnt, to care for the rising numbers of people nearing the last stage of life within our population—in other words, a population approach to end-of-life care. Using examples from the Gold Standards Framework in the UK, the chapter explores the importance of enabling generalists to deliver high quality care across a population, citing a variety of examples and programmes promoting person-centred care at the end of life.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126825865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells
{"title":"HIV and palliative care","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0019","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0019","url":null,"abstract":"Since the discovery of HIV in 1983, there have been dramatic advances in the management of people living with the virus due to the availability of effective antiretroviral medication (ARV). Prior to this, acquisition of the virus would lead to the development of AIDS and eventual death within ten years for the majority. By 1996, a regime of triple therapy antiretroviral medication was developed which could sustainably suppress HIV viral replication and viral load in the blood. People living with HIV now have near-normal life expectancies, and opportunistic infection rates have reduced in the UK. Despite these advances, people living with HIV experience a high level of symptoms. Symptoms can be direct effects of the HIV virus, side effects of HIV treatment, or consequences of advanced disease. In the UK, advanced disease is still seen with late presentation of infection and poor adherence to ARV medication. Advanced HIV disease is associated with an impaired immune system, leading to high risk of developing opportunistic infections and HIV-associated malignancies. Painful peripheral neuropathy occurs at all stages of HIV infection and is resistant to many neuropathic pain treatments.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128942846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells
{"title":"Palliative care and haematology","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0007","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0007","url":null,"abstract":"In their advanced stages, progressive disease of any organ finds inroads into the core functions of the body, disrupting it in multifarious ways. Haematological function, the most fundamental of all, is one of the earliest to be affected, irrespective of the organ of origin of the disease. The impairment can reach proportions that endanger survival. This chapter depicts the common concerns affecting the haematological system of patients with advanced systemic diseases It provides an overview of various symptomatic presentations of haematological system dysfunctions and their management, in patients with palliative care needs. We include an overview of the palliative care needs, and opportunities and challenges in incorporating palliative care within the comprehensive care of patients with haematological malignancies","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114359856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells
{"title":"Palliative and end-of-life care for people with learning disabilities","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0028","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0028","url":null,"abstract":"This chapter highlights some of the issues and challenges which exist in the provision of palliative and end-of-life care for people with learning disabilities and how some of these can be addressed. The challenges fall into four key areas: assessment, communication, consent, and bereavement. The reader is also signposted to websites and resources which are helpful in caring for people with learning disability at the end of their life. Concerns exist around choice and the quality of end-of-life care that people with learning disabilities may be offered. A number of different terms have evolved over the years for ‘learning disability’. Currently this term is used in the UK, but in Europe and in other parts of the world, the term ‘intellectual disability’ is used. Internationally there is a consensus that a learning disability can be identified when the following criteria are present: intellectual impairment (known as reduced IQ), social or adaptive dysfunction combined with reduced IQ, and early onset. It is thought that around 2.5% of the population in the UK has a learning disability, but it has also been predicted that this may increase by 1% per year over the next number of years.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"96 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127516426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells
{"title":"Endocrine and metabolic complications of advanced cancer","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0015","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0015","url":null,"abstract":"This chapter covers the common endocrine and metabolic complications associated with malignancies such as hypercalcaemia, SIADH, and changes in glucose metabolism. It also outlines a strategy for managing the patient with iatrogenic hyperglycaemia as well as the patient with diabetes mellitus in the last phase of life. Metabolic and endocrinological disorders have a profound impact on a patient’s physical and psychological well-being. These disorders are at times complex, but it is important to be aware of the associated endocrine and metabolic complications in advanced cancer as they can have a significant impact on morbidity and mortality. In addition, even when the underlying cancer may not be responsive to treatment, such symptoms may be reversible, which can have a significant benefit to the individual patient.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124736792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells
{"title":"Self-care for health professionals","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0032","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0032","url":null,"abstract":"This chapter covers theory of palliative care issues associated with caring for people who are dying and the particular stresses involved. Sources of stress are multiple, may be accumulative, and are linked to all areas of an individual’s life. Working with dying people may be stressful, particularly if staff experience personal bereavement and loss. Such work can put staff in touch with personal anxiety about loss and death. Palliative care staff also find it very stressful to deal with patients who experience intractable pain, those who have young children, and those patients who are afraid to die. Symptoms that leave nurses feeling helpless, useless, and impotent are the most stressful to deal with, as is dealing with distressed relatives. The chapter looks at strategies for supporting a workforce involved in the ongoing delivery of palliative care to avoid burnout and compassion fatigue.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115202625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells
{"title":"Principles of drug use in palliative care","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0005","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0005","url":null,"abstract":"This chapter includes a formulary of the drugs most commonly used in the palliative care setting as well as advice surrounding common pharmacological challenges. These include drug interactions, prescribing in patients with co-morbidities, managing toxicity, the use of syringe drivers, and the impact of medications on driving. It provides a useful overview of current pharmacological practice in the UK in the context of end-of-life care and the need to consider both deprescribing as well as escalation of treatment when appropriate. By law in the UK, a medication must be given a MA (formally, a product license) by the Medicines and Healthcare Products Regulatory Agency (MHRA). The MA specifies the indication, dose, route and patient populations for which the drug can be marketed. Drugs can be used legally in clinical situations that fall outside the remit of the MA, referred to as ‘off-label’ (e.g. a different indication, dose, route, or method of administration than that specified in the MA). Off-label use of drugs in palliative care is routine, with the responsibility for prescribing under such circumstances lying with the prescriber. The prescriber must be fully informed about the actions and uses of the medicinal product and should provide information on the benefits and risks of off-license prescribing to the patient (or their proxy) to facilitate an informed decision regarding treatment options.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125214857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells
{"title":"Access to palliative care: international perspectives","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0033","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0033","url":null,"abstract":"This chapter describes the crucial relevance of palliative care in today’s healthcare environment, as well as the extent and reasons for the inequities in its accessibility globally. It depicts the ongoing efforts by international agencies worldwide to improve the availability of essential palliative care services. The chapter provides examples of activities to develop palliative care and innovative initiatives from a few countries with widely varying socio-economic backgrounds. Resources are provided that could support the initiation of new palliative care services in regions where there is a need. It is hoped that the reader, besides becoming a competent palliative care clinician, is also inspired to initiate activities to enhance access to palliative care services.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114595384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells
{"title":"Ethical issues and the person in the patient","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0001","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0001","url":null,"abstract":"This chapter describes the key ethical issues most commonly encountered in the palliative care setting. The management of the more explicit ethical issues faced by ‘actively dying’ patients is integral to the work of palliative care professionals. Though the underpinning good practice is common across all healthcare, it may only be when facing the reality of impending death that patients, their families, and their clinicians begin to fully consider the most difficult questions around the meaning and quality of their life, provoking a reassessment of the goals from treatment. Differences of opinion and conflicts of interest can emerge, creating increasingly difficult scenarios. Though not easily answered, many ethical issues can be adequately addressed with sensitive, well-informed, honest communication, without even becoming a dilemma.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125719957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells
{"title":"Palliation of head and neck cancer","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0014","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0014","url":null,"abstract":"As a consequence of its location, head and neck cancer can affect breathing, speech, swallowing, and most of the special senses, and can impact massively on quality of life and body image. The head has a particularly complex anatomy in a very restricted space, and tumours have the potential to cause very complex and severe pain, often with a major neuropathic element. Disease in the mouth can lead to fistulae and aspiration pneumonia. Some tumours carry a risk of life-threatening bleeding. Management of all of these and other features of advanced head and neck cancer require skill and knowledge. Head and neck cancer, perhaps more than any other cancer, involves the total person, and requires a multidisciplinary response. This chapter summarizes the clinically important aspects of the main pathologies, and discusses a practical approach to symptom control of this difficult area.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128367996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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