M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells
{"title":"Complementary and alternative medicines","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0025","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0025","url":null,"abstract":"This chapter covers the underlying philosophy and the types of complementary therapies which are used with patients who have palliative care needs. Complementary and alternative medicines (CAM) comprise a diverse array of treatment modalities that are not presently considered part of conventional/mainstream medicine. CAM emphasize a holistic approach towards healthcare, i.e. they are based on the belief that mind, body, and spirit are interconnected, and that health depends on wholeness and balance between them. The individual therapies described in this chapter are considered under four headings: alternative medical concepts; mind-body interventions, biologically based therapies, and manipulative therapies. The chapter also looks at some of the evidence associated with such therapies.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"50 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":"123625325","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}
{"title":"Heart failure","authors":"D. Hansen","doi":"10.1093/med/9780198745655.003.0017","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0017","url":null,"abstract":"This chapter covers the issues surrounding heart failure in patients with palliative needs, including definition of heart failure, Management of heart failure, end-of-life care, complex decision-making, and models of care. Chronic heart failure is a progressive, terminal syndrome and is the final common pathway of many cardiovascular diseases. There is difficulty in defining heart failure as there are many different criteria around the world used to define it. However, common criteria usually include history, physical examination, chest radiography, and echocardiography. The European Society of Cardiology defines heart failure as the presence of symptoms of heart failure at rest or during exercise, and objective evidence of cardiac dysfunction (usually on echocardiography).","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"60 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":"125434883","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":"Genitourinary problems","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0011","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0011","url":null,"abstract":"This chapter outlines the various problems that patients with palliative care needs may experience with the genitourinary system. It covers the anatomy and physiology of the bladder, and then details the common disturbances a patient may experience, including bladder, pelvic, and renal pain; problems with urination, catheterization, etc. It discusses the negative psychological effects on the patient, and how to manage distressing symptoms whilst maintaining patient-centred care. Patients with palliative care needs may suffer a variety of symptoms attributable to dysfunction of the urinary system. Disturbance of the genitourinary system can result not only to debilitating symptoms but also loss of confidence, embarrassment, and psychological distress. It is important to understand the basic anatomy and physiology to aid in the management of what can be a distressing range of symptoms.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"105 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":"116330371","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":"Spiritual care","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0023","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0023","url":null,"abstract":"This chapter includes discussion on the nature of spirituality in a secular and multicultural world. It describes the relationship between religion and spirituality and the role of faith practices, religion, and spiritual assessment. It also outlines the nature of spiritual pain, and its importance in holistic care. The word ‘spirit’ is widely used in our culture. Politicians speak about the ‘spirit’ of their party, veterans talk about the wartime ‘spirit’; religious people discuss the ‘spirit’ as that part of human being that survives death, whereas humanists might regard the human ‘spirit’ as an individual’s essential, but non-religious, life force. Related words are equally common and diverse: footballers describe their team as a spiritual home; spiritual music and spiritual art are fashionable; and there are spiritual healers, spiritual life coaches, spiritual directors, and even spiritually revitalizing beauty products. Spiritual care, particularly of those facing their own death, demands the response of a wise and compassionate ‘spiritual friend’. Not every member of the multidisciplinary team will want to or be equipped to offer this level of spiritual care. But each can contribute to enabling a patient to find a ‘way of being’ that will help them to go through the experience of dying in the way appropriate to them.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"1 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":"128754506","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}
{"title":"The contribution to palliative care of allied health professions","authors":"M. Watson, C. Lucas, A. Hoy, J. Wells","doi":"10.1093/MED/9780199234356.003.0034","DOIUrl":"https://doi.org/10.1093/MED/9780199234356.003.0034","url":null,"abstract":"This chapter outlines the key work of allied health professionals within the palliative care team. Palliative care has been very successful at taking ideas, values, and techniques from other disciplines in healthcare. Such borrowing of ideas has nearly always included considerable adaptation from the parent discipline. However, the notion of cross-boundary, interdisciplinary working is now highly developed in palliative care. Some disciplines such as medicine and nursing have become core parts of the specialist team, whereas others have been accessed on an as-required basis. Increasingly, individual allied health professions have seen the need to evolve the palliative care specialism within the generic discipline. Allied health professionals include occupational therapists, physiotherapists, nutritional experts, speech and language therapists, clinical psychologists, social workers, chaplains, pharmacists, and art and music therapists.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"29 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":"126110660","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":"Skin problems in palliative care","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0012","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0012","url":null,"abstract":"This chapter discusses skin disorders. Skin disorders affect patients with early and advanced malignant and non-malignant disease. In addition to distressing physical symptoms, the appearance of pressure sores, malignant wounds, and lymphoedema impact on patients’ social functioning, mood, and quality of life. Meticulous and prompt management of symptoms can make a huge difference. There is a growing body of research into drug treatments for pruritus in palliative care, and interventions for managing lymphoedema and wounds more effectively. Key principles in the management of wound care, lymphoedema, and pruritus are examined. Skin wounds are common in advanced malignancy. Pressure ulcers are most frequently seen, affecting an estimated one-third or more of patients in palliative care units. Malignant/fungating wounds occur in approximately 5–10% patients with metastatic cancer and are associated with significant physical and psychological distress. Loco-regional skin involvement (e.g. breast fungation) should be distinguished from generalized skin metastases which imply advanced disease.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"33 1-2 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":"116735735","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}
{"title":"Palliative care in non-malignant neurological disease","authors":"M. Watson, C. Lucas, A. Hoy, J. Wells","doi":"10.1093/MED/9780199234356.003.0029","DOIUrl":"https://doi.org/10.1093/MED/9780199234356.003.0029","url":null,"abstract":"This chapter covers the palliative care aspects of non-malignant neurological diseases, including multiple sclerosis, Parkinson’s disease, motor neurone disease, multiple system atrophy, progressive supranuclear palsy, and Creutzfeldt–Jakob disease. MS is a disease characterized by inflammation and demyelination affecting the central nervous system and ultimately injury and gliosis. Parkinson’s disease (PD) is the commonest neurodegenerative disease after Alzheimer’s disease, with an estimated incidence of 2/1000. It affects just under 1% of people over the age of 65 years. PD is probably not one disease but several with common clinical features. Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized by Parkinsonian features, plus autonomic dysfunction in the form of orthostatic hypotension, and/or urogenital dysfunction in the form of incontinence and incomplete bladder emptying. At times it can also include cerebellar symptoms. It is not hereditary, and affects adults usually in the fourth or fifth decade. Post-mortem studies of patients diagnosed with PD indicate that 10–25% had multiple system atrophy.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"35 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":"114540016","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":"The terminal phase","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0030","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0030","url":null,"abstract":"This chapter covers the common issues encountered in the last days of life relating to prognostication, anticipatory prescribing, common symptom management, spiritual care, and the five priorites of end-of-life care. Terminal phase is the period of inexorable and irreversible decline in functional status prior to death. It is the period when there is day-to-day deterioration, particularly of strength, appetite, and awareness. This may unfold gradually over days or weeks, or occur precipitously following an unexpected event, e.g. stroke. These challenges may present as sudden changes in the clinical status needing urgent attention. More often they are predictable, and reflect a final common pathway of many progressive illnesses.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"30 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":"126864299","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":"Emergencies in palliative care","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0029","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0029","url":null,"abstract":"This chapter covers the common oncological emergencies, including neutropenic sepsis, spinal cord compression, superior vena cava obstruction, hypercalcaemia, and haemorrhage. In most medical specialties, emergencies are those situations which, if left untreated, will immediately threaten life. In palliative care, where death is an expected outcome, emergencies are those conditions which, if left untreated, will seriously threaten the quality of remaining life. While this chapter focuses on the common oncological emergencies in palliative practice, emergencies may include a wider range of issues, such as the following: emergency discharge so a patient’s wish to die at home can be met; emotional emergencies, with high levels of expressed anxiety; spiritual/existential/social emergencies, with pressure to ‘sort things out’ before it is too late; pain crisis or other unrelieved symptoms. It is important to have a clear understanding of emergencies in palliative care, as their timely management is critical. A crisis situation filled with anxiety may be transformed to an atmosphere of comfort and well-being by pre-decided standardized team responses that demonstrate clarity and decisiveness to the patient and their family.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"1 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":"128869251","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":"Pain management","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0008","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0008","url":null,"abstract":"This chapter covers the theoretical and practical basis of managing patients with pain in the palliative setting. It includes a review of the common pharmacological, non-pharmacological and anaesthetic approaches to managing pain as well as emphasizing that all good care must be based on a holistic understanding. The concept of total pain has become a central tenet of palliative care practice. It recognizes that cancer pain is often a complex, chronic pain with multiple, coexisting causes. Effective management of cancer pain requires a multidisciplinary approach that addresses the patient’s concerns and fears, as well as treating the physical aspects of pain. As a result, the provision of analgesics should be combined with the provision of emotional, social, and spiritual supports.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"1 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":"131236442","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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