Challenging Cases In Palliative Care

Challenging Cases in Palliative Care is unique, as it uses examples of real-world cases from palliative care practices. It also includes expert commentary to support modern clinicians in managing the 'messiness' of clinical care, as well as the increasingly complex needs of patients today.

A clinical case-based handbook has a role in general clinicians’ practice of caring for patients with serious or life-limiting illness. The explosion of the field of Hospice and Palliative Medicine impacts all physicians and healthcare providers. Fellowship trained s- cialists graduate in greater numbers annually. These and more seasoned specialists are now certified by the American Board of Medical Specialties as subspecialists. Research in this field is expanding in scope and quantity, and peer reviewed journals devoted to this work are multiplying. Moreover, peer reviewed journals in primary care and other subspecialties of medicine regularly include papers that focus on end-of-life care, quality of life issues, and symptom management. Overall then, access to clinical information necessary to care for patients with life-limiting illness is not only essential, but also increasingly available. This case-based clinical book aims to help with the actual practice of caring for patients with life-limiting illness. Numerous texts and journals exist to provide the data to inform care, yet there remains a need to find practical points and information about the practical application of the principles of palliative care. Thus, we hope that the cases, key points, and practical tips will help health care providers who are not experts already in palliative care in the care of patients with serious illness and challenging problems. Some chapters follow one patient through the course of an illness to highlight the applicability of palliative care throughout the disease process.

This title is directed primarily towards health care professionals outside of the United States. Palliative Care: The Nursing Role is an introductory text for nurses and other health care professionals who deliver palliative care across a range of settings. It lays a clear foundation of knowledge focusing on the needs and perspectives of patients and families who face the challenge of advanced, incurable illness. The style is highly accessible yet challenges readers to analyze key issues that present within palliative care. Covering the wide range of care provision in hospices, hospitals and patients' homes, the book draws widely from practice based examples to explain and expand upon theoretical issues. Research evidence underpins each of the chapters. Guided activities encourage readers to reflect, in a focused way, on their clinical experience and current practice. This new edition has been fully updated to reflect ongoing developments and shifting trends in palliative care education and practice. It will suit the needs of both pre and post-qualifying students seeking to develop their knowledge and is well suited to practitioners working within either generalist or specialist palliative care settings, or within acute or community settings as well as those studying a range of palliative care educational curricula. The authors have a wide range of experience in palliative care and all are actively engaged in practice and/or education. A clear, broad-based approach offers a thorough introduction for the non-specialist nurse. Written and edited by an experienced team of nurses working in this field, grounding it in current practice. Learning outcomes listed at the start of each chapter aid learning and comprehension. Reflective practice activities and an outline of CPD is especially useful for students working independently. Case histories, recommended reading lists, and references provide a solid evidence base for clinically based practice and facilitate further study. Thoroughly revised and updated to reflect changes in policy direction. A new chapter on pain and symptom management. Revised content reflects the recent shift in the evidence base concerning spirituality. Includes psychosocial issues of loss for the patient, their family, and careers.

Hospice is the premiere end of life program in the United States, but its requirement that patients forgo disease-directed therapies and that they have a prognosis of 6 months or less means that it serves less than half of dying patients and often for very short periods of time. Palliative care offers careful attention to pain and symptom management, added support for patients and families, and assistance with difficult medical decision making alongside any and all desired medical treatments, but it does not include a comprehensive system of care as is provided by hospice. The practice of palliative care and hospice is filled with sometimes overt (requests for hastened death in an environment where such acts are legally prohibited) and other times covert (the delay in palliative care referral because the health care team believes it will undermine disease directed treatment) ethical issues. The contributors to this volume use a series of case presentations within each chapter to illustrate some of the palliative care and hospice challenges with significant ethical dimensions across the three overarching domains: 1) care delivery systems; 2) addressing the many dimensions of suffering; and 3) difficult decisions near the end of life. The contributors are among the most experienced palliative care, hospice and ethics scholars in North America and Western Europe. Each has been given relatively free reign to address what they feel are the most pressing ethical challenges within their domain, so a wide range of positions and vantage points are represented. As a result, the volume provides a very diverse ethical exploration of this relatively young field that can deepen, stretch, and at times confront any simple notion of the challenges facing patients, their families, professional caregivers, and policy makers.

Practice guidelines for management of conditions prevalent in long-term geriatric care are based, by and large, on expert consensus and rarely on controlled studies. Though enforced by tradition, some of the rules often applied in clinical practice fall short of scientific foundation. In lacking high-grade scientific evidence, geriatric practice might benefit from an 'evidence-balanced' approach. A step forward in this direction is by corroboration of observational data. In this book, we brought our share of observational data, input from our experience in geriatric care, to be merged with the profession's collective information base. Seventy-five case histories illustrate a variety of conditions met at the bedside, some of them challenging the clinician's expertise and judgement. We hope that illustrating clinical practice in the real-world might be a suitable addition for physicians.

The third edition of this successful book continues to offer a panoramic view of palliative care. It introduces a number of new topics including Neurological Disorders, The Last Days and Palliative Sedation. The contributors illustrate, through the case studies, the desired skills, attitudes, and knowledge required in palliative medicine.

The new global cancer data suggests that the global burden has risen to 18.1 million new cases per year and 9.6 million cancer deaths per year. A number of factors appear to be driving this increase, in particular, a growing and aging global population and an increase of exposure to cancer risk factors linked to social and economic development. For rapidly-growing economies, the data suggests a shift from poverty- or infection-related cancers to those associated with lifestyles more typical in industrialized countries. There is still large geographical diversity in cancer occurrence and variations in the magnitude and profile of the disease between and within world regions. There are specific types of cancer that dominate globally: lung, female breast and colorectal cancer, and the regional variations in common cancer types signal the extent to which societal, economic and lifestyle changes interplay to deferentially impact on the profile of this most complex group of diseases. Unfortunately, despite advances in cancer care, a significant proportion of patients at home, experience sub-optimal outcomes. Barriers to successful treatment outcomes include, but are not limited to: access to oncologists in the primary health centers, non-adherence, lack of experienced oncology and palliative care nurses in the community, inadequate monitoring and the lack of training of family and pediatric physicians. Telemedicine approaches, including telephone triage/education, telemonitoring, teleconsultation and status tracking through mobile applications, have shown promise in further improving outcomes, in particular for chronic cancer patients following their hospitalization. Lessons can be learned from existing hospices in North America, the United Kingdom, Australia, Centers of Excellence in African (Uganda) and modern community services in India (Kerala). An important goal of this book is to describe and encourage professionals to develop new community programs in palliative care, which include training and empowering physicians and nurses in the community on the principles of palliative care. The Middle East Cancer Consortium (MECC) together with the American Society of Clinical Oncology (ASCO) and the American Oncology Nursing Society (ONS) have conducted multiple courses ranging from basic palliative care to more specialized training in palliative care for multiple nationalities in Europe, Asia and Africa. Our experience clearly indicates that, to promote such activities, one needs strong leadership and confirmed political will to support the endeavor. The new book will emphasize the importance of having a core of multiple stakeholders including community leaders, government, NGOs and media to be actively involved in advocating for the cause and generating public awareness. This text will provide the reader with a comprehensive understanding of the outside-of-the-hospital treatment of cancer patients by medical, paramedical and volunteer personnel. In doing so, this text will encourage the creation of new palliative care services improving upon the existing ones and stimulate further research in this field. Part 1 of the text will begin with an overview of the current state of affairs of services provided to cancer patients while being cared for by primary health centers. It will also review the current literature regarding medical and psychological-based therapy options in the community for cancer patients at different stages of their disease. Part 2 will address the unique role of the community nurse, within the framework of the multidisciplinary team treating the patient, in the attempt to provide optimal evaluation and care in very challenging situations (such as with terminal patients). Part 3 will provide insightful models of this new discipline and serve as a valuable resource for physicians, nurses, social workers and others involved in the care of cancer patients. The book will take a multidisciplinary approach, integrating clinical and environmental data for practical management to enhance the efficacy of treatment while relieving suffering. Part 4 will also discuss the application of modern technological approaches to track symptoms, quality of life, diet, mobility, duration of sleep and medication use (including pain killers) in chronic cancer patients in the community. Part 5 of the book will also be devoted to modes of developing a collaborative program between governmental and non-governmental organization sectors. This includes volunteer workers in close collaboration with medical professionals for providing emotional and spiritual support, nursing care, nutritional support and empowering family caregivers. Such a model makes palliative care in the community a “people’s movement”, thus transferring part of the responsibility and ownership to the community.

This title is directed primarily towards health care professionals outside of the United States. Content has been thoroughly revised and updated in line with changes in practice and policy both locally and internationally, particularly the UK NICE guidance on Supportive and palliative care for people with cancer and the Care of the Dying Pathway. It reflects the rapid development of palliative nursing as an emerging specialty. It helps in the process of defining palliative nursing and how it interfaces with other disciplines within the specialty. The text is divided into three sections and comprehensively, yet sensitively, covers all aspects of palliative nursing. Key themes covered include pain control, symptom control, loss and grief, and handling loss. . A strong emphasis is placed on the integration of theory and practice and evidence based care. . Reconciliation of the theory and practice is achieved by the use of case studies. . It addresses malignant and non-malignant palliative care. . Research and extensive literature support each chapter. Content has been thoroughly revised and updated in line with changes in practice and policy both locally and internationally, particularly the UK NICE guidance on Supportive and palliative care for people with cancer and the Care of the Dying Pathway . Three new chapters on: . Sexuality . Care of the Dying Pathway . Changing roles of the nurse in palliative care . New appendix on North American drug names equivalents for the international market