Palliative Care

This book offers an overview of key aspects of palliative care, presented through a resilience perspective. Why do some patients and families break down while others surmount the challenges facing them? What interventions strengthen individual, family and community coping? The book aims to facilitate change with people facing the crisis of death, dying, and bereavement. Much of the existing literature has focused on risk, problems, and vulnerability; the emerging concept of resilience focuses on strengths and possibilities. The ‘total pain’/‘total care’ approach pioneered by Dame Cicely Saunders and St Christopher's Hospice now needs reinterpreting in the light of changing contexts and challenges. The realities of demographic change and resource-constrained health and social care environments have generated an increasingly risk focused approach to service delivery. A narrowly medicalised approach has inevitable limitations: professional care alone will be unable to meet need and demand in the face of ageing populations, changing patterns of illness and the need for equity. The resilience approach offers a counterbalance that harnesses the strengths of individuals and the communities in which they live and in which most of their dying will take place. Resilience thinking emphasises the importance of public health and creates a partnership between patients, professionals, and community structures, seeking to build community capacity and to deliver a preventive health care that will leave future generations less afraid of the dying and bereavement that will confront all of us.

Supportive care can be thought of as an extension of palliative care so that the person with dementia receives good quality, holistic care that makes no distinctions between the dichotomies of care and cure from the time of diagnosis until, and beyond, death. It recognizes the need for an inter-disciplinary approach and for continuity of care. Supportive care in dementia must, therefore, be broad in its scope and application. This book provides such a perspective, drawing upon the experience and expertise of a wide range of internationally-based professionals to outline a model of supportive care that will provide good quality and holistic care for people with dementia. Making use of real-life reports from both patients and carers to help readers fully understand the reality of dementia, the book examines the key principles that guide the practice of supportive care. It looks at how supportive care can be used, and specific benefits a care model of this type can bring to the complex problems that are frequently encountered when treating this condition.

This book provides an evidence-based overview of supportive care for the nephrology patient. An international group of contributors emphasize the continuum of palliative care from the time of diagnosis through to end-of-life care and the issues surrounding withdrawal of dialysis. The book addresses the psychological impact of the disease, the importance of involving the patient in making decisions about their care, ethical considerations, the role of the family and the multidisciplinary team. This second edition includes two new chapters on conservative management of advanced kidney disease (AKD) and dialysis in the very elderly. The chapters covering non pain symptoms, advance care planning, quality of life, psychological and psychiatric consideration, and end-of-life care have also be completely revised to include new evidence and current thinking.

This book provides a practical, evidence-based overview of the supportive care of patients with urological failure, focusing on chronic symptoms such as chronic prostatitis. It begins by looking at quality of life measurements, self-help strategies, the role of the interdisciplinary team, and psychological and social support. It then moves on to clinical chapters which cover issues such as patients who present with hematuria, urinary retention, urinary incontinence, neurological disease affecting the urinary tract, chronic prostatitis, and infertility; ending with a chapter on supportive care for the urology patient and family in the future. The book places a special emphasis on symptomatic interventions, particularly in the setting where the course of the illness cannot be modified.

Heart failure occurs in almost epidemic proportions, placing a huge burden on both the healthcare system, and sufferers and their families. The care of this group of patients has evolved significantly over recent years as our knowledge and understanding of the pathophysiology of heart failure has developed. This book provides an evidence-based overview of heart failure aetiology, its management, and the supportive care required by patients throughout the course of their disease. It also integrates the complexities of heart failure care, bridging knowledge bases from cardiology and cardiothoracic surgery, general medicine and palliative care. It reviews essential information about the epidemiology and pathophysiology of heart failure, and evidence-based medical, device, surgical, and interdisciplinary management. It addresses the evaluation and management of quality of life, common symptoms and problems associated with heart failure, and the holistic approach to supportive care throughout the course of the illness through to the end of life. Prognostication, communication, and ethical decision making are outlined in detail. By applying the principles of palliative medicine, it is possible to offer a supportive care approach that synthesizes the experience of both the heart failure specialist and the palliative care physician, and offers the best possible quality of care to this group of patients.

Respiratory symptoms such as breathlessness and cough are common in patients with advancing and incurable disease. For example, cancer, chronic cardiac and pulmonary disease, progressive neuromuscular disorders and degenerative disorders all give rise to varying degrees of respiratory distress, which adversely affects the patient's quality of life. In recent years, there has been significant growth in the palliation of respiratory symptoms, leading to practical ways of giving relief in hospices, hospitals, and at home. This book includes non-malignant respiratory diseases, such as tuberculosis in AIDS patients and cystic fibrosis, and focuses on aetiology and diagnosis and management, emphasising symptoms, quality of life, and psychosocial support. Its underlying theme is the application of modern research-based knowledge, in a humane way, for patients with advancing disease.

Respiratory symptoms such as breathlessness and cough are common in patients with advancing and incurable disease. For example, cancer, chronic cardiac and pulmonary disease, progressive neuromuscular disorders, and degenerative disorders all give rise to varying degrees of respiratory distress which adversely affects the patient's quality of life. In recent years, there has been significant growth into the palliation of respiratory symptoms leading to practical ways of giving relief in hospices, hospitals, and at home. The second edition of this title in the Supportive Care series includes non-malignant respiratory diseases such as tuberculosis in AIDS patients, cystic fibrosis and ventilator-dependent patients, and focuses on aetiology and diagnosis and management, emphasizing symptoms, quality of life, and psychosocial support. The underlying theme of the book is the application of modern research-based knowledge, in a humane way, for patients with advancing disease.

This book describes the principles and practice of surgery in the context of palliative and supportive care. Surgery is often considered too invasive to be useful in palliation and clinicians instinctively turn to radiotherapy, chemotherapy, and other drugs. Surgery, with increasingly minimal access to techniques, may be simpler and less invasive than other treatments and produces excellent palliation. Indeed, most types of surgery are not curative and the aim of this book is to alert all concerned with palliative care to the usefulness and appropriateness of a surgical option. The text is divided into two sections: the first deals with general issues, varying from quality-of-life measurement to spirituality; and the second illustrates their application in different specialties of surgery ranging from neurosurgery to urology. The book ends with a challenge to surgeons to change their perspective from curative surgery, in terms of simply cure or failure, to improvement in quality of life and relief of symptoms.

Teamwork is a complex but essential component of palliative care. The needs of people diagnosed with life threatening disease will vary greatly over time, and it is rarely possible for just one professional to be able to provide adequate care. In order to ensure an holistic approach, the whole multi-disciplinary team must be involved. Inevitable questions arise from such an approach, and this book seeks to address these. How does a team come into being? What different formats are there? How might the patient contribute to the effectiveness of their care and the way in which the team operates? What are the difficulties and frustrations encountered in developing and maintaining such teams? What models of working and styles of leadership have developed? How are power and authority handled within the team setting? The importance of team building, training, support, attention to group process, and stress management to protect the mental health of the team are explored. The ethical issues inherent in palliative care such as consent, autonomy, confidentiality, decision making within teams, and the legal implications of such are also discussed. The book concludes with one important question: Do we know if teams are the most effective way of providing care?

The connection between spirituality and health has received a lot of attention in both the scientific and lay presses. Is religion good for your health? Should doctors talk with their patients about their spiritual or religious beliefs? Should doctors pray with their patients? Through research and evidence, spirituality has been shown to be central to the care of the dying. It is therefore critical that healthcare providers know how to address a patient's spiritual needs. This book presents thinking on how spiritual care can be integrated into traditional caregiving in a practical and informed manner. Chapters that specifically address different religious and cultural perspectives are included. Patients' stories are used throughout to offer real-world experience. With a foreword by the Dalai Lama, the book is a guide for anyone involved in caring for the chronically ill or dying.