{"title":"Neurological problems in advanced cancer","authors":"M. Watson, C. Lucas, A. Hoy, J. Wells","doi":"10.1093/MED/9780199234356.003.0021","DOIUrl":"https://doi.org/10.1093/MED/9780199234356.003.0021","url":null,"abstract":"This chapter covers the common neurological symptoms encountered in patients with advanced malignancy such as seizures, local and central nerve damage, and paraneoplastic neurological syndromes. Non-convulsive status epilepticus (NCSE) is a possible cause of confusion or delirium in terminally ill patients. The clinical presentation varies from altered mental status to comatose patients, without visible convulsions. In comatose patients, unilateral tonic head and eye movement is often observed. Other symptoms include myoclonic contractions of the angle of the mouth, mild clonus of an extremity, or, rarely, epileptic nystagmus. EEG is the most important diagnostic tool to identify epileptiform activity. Treatment should be initiated following a stepwise model (e.g. phenytoin, sodium valproate, levetiracetam, together with benzodiazepines), avoid intubation, and transfer to the intensive care unit. Although mortality rates are high, in some patients NCSE can be reversed by treatment.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"8 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":"124525772","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":"Gastrointestinal symptoms","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0009","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0009","url":null,"abstract":"This chapter describes the most common gastrorintestinal symptoms encountered in the palliative care setting along with management strategies. A sizeable proportion of palliative care is concerned with the management of gastrointestinal symptoms. Traditionally, such symptoms have received less attention than pain management, yet the same principles apply. Patients with pain usually show a response, or a lack of response, to treatment within hours. Patients with gastrointestinal symptoms may take several days to respond to interventions, and the temptation is thus to have a more lax attitude to monitoring gastrointestinal problems. In reality, the doctor and nurse need to be much more attentive to these problems which deceptively cause significant patient morbidity, yet may not become obvious until major management difficulties arise.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"67 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":"116936884","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":"Renal failure","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0018","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0018","url":null,"abstract":"This chapter describes the issues associated with providing palliative care to patients with renal failure, and covers initiation of renal replacement therapy, conservative treatment, symptom management for patients with advanced renal disease, and issues surrounding stopping renal replacement therapy. As obesity and diabetes increase, so does the incidence of chronic renal disease and end-stage renal failure. Determining the exact number of patients dying of renal failure is challenging. Often the cause of death will be ascribed to an associated contributing factor, e.g. diabetes mellitus, or the final acute event resulting in death, e.g. myocardial infarction. However, we know that renal failure is an independent risk factor for cardiovascular disease and is associated with a high all-cause mortality.1 In addition, patients with end-stage renal failure have a significant symptom burden and therefore it is important that patients have access to palliative care services to assist with symptom management, advanced care planning, and, where appropriate, decisions around dialysis and transplantation.","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":"132735312","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":"Dementia and frailty","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0020","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0020","url":null,"abstract":"This chapter outlines the symptoms, epidemiology, aetiology, and differential diagnosis of dementia, with emphasis on advanced disease. It discusses the role of dementia treatments, the challenges faced with advanced disease, and guides to recognition and treatment of common symptoms, including behavioural and psychological symptoms of dementia and pain. The chapter also discusses pharmacological and non-pharmacological approaches to management of dementia symptoms, highlighting the role of palliative care, when it is appropriate to refer, and terminal care. The chapter illustrates some of the controversial aspects of care. At the current rate there will be 850,000 people with dementia in the UK by 2015, and this number is forecast to increase to over 1 million by 2025 and over 2 million by 2051.This is contributing to one in four hospital admissions, with the health and social costs of dementia estimated to be more than stroke, heart disease, and cancer combined. Along with these worrying progressive epidemiological figures, we need to take into account the immense caring burden for families, carers, and society. End-stage dementia often falls between the cracks of specialization, with professionals feeling under-prepared for the intricacies of end-stage dementia management strategies. Palliative care has been slow in its involvement for multiple reasons, but primarily because dementia has a much slower disease trajectory than cancer, with an unclear prognosis.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"7 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":"124182564","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":"Oncology and palliative care","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0006","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0006","url":null,"abstract":"This chapter provides an overview of current oncology practice as it pertains to palliative care. It covers the care of patients undergoing oncological interventions including some of the newer biological treatments and includes the management of the common side effects associated with the management of solid tumours in adults. It includes a succinct summary of the current management of common cancers. Cancer is an important cause of morbidity and mortality, particularly in industrialized countries. Currently in the UK, one person in two will be diagnosed with some form of cancer during their lifetime and one in four will die of the disease. Cancer incidence increases exponentially with age; with increasing life expectancy, cancer will become an even more common problem in the future. Cancers may develop in all body tissues. The chapter reviews the various ways that the cells that form cancers can be differentiated from cells in normal tissues.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"103 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":"116074951","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":"Psychiatric symptoms in palliative care","authors":"M. Watson, C. Lucas, A. Hoy, J. Wells","doi":"10.1093/MED/9780199234356.003.0024","DOIUrl":"https://doi.org/10.1093/MED/9780199234356.003.0024","url":null,"abstract":"This chapter covers the common psychiatric symptoms experienced in people with palliative care needs. It covers the challenges of diagnosis in this particular population and the need to take account of both the patients’ own coping mechanisms and the health challenges that they are facing as they approach the end of life. Palliative care is the provision of holisitic management to individuals and their carers/families who are facing issues associated with life-limiting illness. It embraces a biopsychosociocultural and spiritual approach with emphasis on quality of life. Consequently, the maintenance of psychological and emotional health and well-being is an essential component in the provision of comprehensive care. Initial diagnosis—and the circumstances surrounding this—is a time of great challenge for most patients, and the potential for strong emotional reactions and intense feelings of distress is heightened.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"12 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":"130239970","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":"Communication in palliative care","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0002","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0002","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, also gets inspired to initiate activities to enhance access to palliative care services.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"138 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":"115903949","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":"Research in palliative care","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0003","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0003","url":null,"abstract":"Research in palliative care is gaining momentum and good quality research is helping form an evidence base which clinicians will be able to work within. There are ongoing challenges with carrying out research in palliative care, including high attrition rates, culture and ethical views around research in patients with terminal illness, funding, and gatekeeping. However, it is essential that to provide the best care that robust research is carried out. This can take the form of qualitative and quantitative research, and both are useful and valid in developing a research base of evidence if they are used in the correct contexts.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":" 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120831270","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":"Respiratory symptoms","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0010","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0010","url":null,"abstract":"This chapter covers the common causes and management options for patients experiencing breathlessness in the palliative context. The breathlessness support service—a multiprofessional integrated service that combines respiratory, physiotherapy, occupational therapy, and palliative care assessment and management—has undergone a successful randomized control trial as early effective integrative service in the management of chronic breathlessness. It consisted of consultation to assess the patient in detail; a ‘breathlessness package’ including information, management, and pacing guidance; a hand-held fan or water spray; and a poem (a short mantra to help breathing and relaxation) as a crisis plan. Multidisciplinary team members made follow-up visits to assess need for additional home aids and adaptations, to reinforce self-management, and to provide confidence and further guidance on pacing and exercises. Review consultations were done at regular intervals to replan as required. The impact was significantly positive.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"118 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":"121758473","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":"Hospital liaison palliative care","authors":"M. Watson, R. Campbell, Nandini Vallath, S. Ward, J. Wells","doi":"10.1093/med/9780198745655.003.0027","DOIUrl":"https://doi.org/10.1093/med/9780198745655.003.0027","url":null,"abstract":"This chapter outlines the opportunities and challenges of providing a palliative care service within the acute hospital setting. It has been suggested that between one-third and two-thirds of people in developed world countries will die in hospital. The hospital, probably more than any other healthcare setting, is a challenging environment in which to support the human dimension in patient care. The focus is on investigation, treatment, and cure; priorities, such as quality-of-life issues, can get overshadowed. The chapter covers the particular issues associated with delivering palliative care in the intensive care unit and casualty department and the need to develop an understanding of the principles of palliative care across the many departments in an acute hospital involved in the care of dying patients. The chapter also looks at the difficulties in arranging urgent discharge for patients who wish to die at home.","PeriodicalId":436550,"journal":{"name":"Oxford Handbook of Palliative Care","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116408288","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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