Pub Date : 2021-12-08DOI: 10.1093/oso/9780198837008.003.0027
Anne B Boyle, David C. Henderson
Studies have shown that 70% of people would like to die at home, however most do not for various reasons. Knowing that so many people would like the option to die at home, it is very important we have the knowledge base and skill set to help facilitate this. This chapter will explore initiating a palliative approach early in a disease trajectory. This allows for a relationship to develop between patient, family and health care provider, advance directives to be discussed, and goals of care (including preferred place of death) to be established. The importance of anticipating needs and developing plans to meet these needs are explored to enable a well supported, compassionate, patient and family centered death at home.
{"title":"Palliative care in the community","authors":"Anne B Boyle, David C. Henderson","doi":"10.1093/oso/9780198837008.003.0027","DOIUrl":"https://doi.org/10.1093/oso/9780198837008.003.0027","url":null,"abstract":"Studies have shown that 70% of people would like to die at home, however most do not for various reasons. Knowing that so many people would like the option to die at home, it is very important we have the knowledge base and skill set to help facilitate this. This chapter will explore initiating a palliative approach early in a disease trajectory. This allows for a relationship to develop between patient, family and health care provider, advance directives to be discussed, and goals of care (including preferred place of death) to be established. The importance of anticipating needs and developing plans to meet these needs are explored to enable a well supported, compassionate, patient and family centered death at home.","PeriodicalId":149820,"journal":{"name":"Palliative Medicine: A Case-Based Manual","volume":"596 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126899142","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}
Pub Date : 2021-12-08DOI: 10.1093/oso/9780198837008.003.0021
C. Hann, A. Swaminath, J. Sussman
Radiation therapy is an effective treatment modality for cancer patients who have developed symptomatic metastatic disease. This chapter illustrates a variety of the most common scenarios and radiation therapy approaches through the use of a descriptive case study.
{"title":"Radiation therapy: advancing technologies","authors":"C. Hann, A. Swaminath, J. Sussman","doi":"10.1093/oso/9780198837008.003.0021","DOIUrl":"https://doi.org/10.1093/oso/9780198837008.003.0021","url":null,"abstract":"Radiation therapy is an effective treatment modality for cancer patients who have developed symptomatic metastatic disease. This chapter illustrates a variety of the most common scenarios and radiation therapy approaches through the use of a descriptive case study.","PeriodicalId":149820,"journal":{"name":"Palliative Medicine: A Case-Based Manual","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125986227","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}
Pub Date : 2021-12-08DOI: 10.1093/oso/9780198837008.003.0019
David C. Henderson, L. Herx
Palliative care’s goal is to improve and maintain quality of life for people living with life-threatening conditions and this includes living fully at the very end of life for those who die of their illnesses. Palliative care optimizes the symptom management associated with the dying process and also provides support to help people navigate the fears they may have about dying. It is therefore imperative that clinicians providing palliative care have the knowledge and skills to be able to help the patient, their family, and other healthcare professionals know what to expect during the dying process and how to manage the changes that come. This chapter will review the normal changes that can occur during the dying process, and how to recognize them and work with the patient and family to plan a good death.
{"title":"The last days and hours","authors":"David C. Henderson, L. Herx","doi":"10.1093/oso/9780198837008.003.0019","DOIUrl":"https://doi.org/10.1093/oso/9780198837008.003.0019","url":null,"abstract":"Palliative care’s goal is to improve and maintain quality of life for people living with life-threatening conditions and this includes living fully at the very end of life for those who die of their illnesses. Palliative care optimizes the symptom management associated with the dying process and also provides support to help people navigate the fears they may have about dying. It is therefore imperative that clinicians providing palliative care have the knowledge and skills to be able to help the patient, their family, and other healthcare professionals know what to expect during the dying process and how to manage the changes that come. This chapter will review the normal changes that can occur during the dying process, and how to recognize them and work with the patient and family to plan a good death.","PeriodicalId":149820,"journal":{"name":"Palliative Medicine: A Case-Based Manual","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126720086","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}
Pub Date : 2021-12-08DOI: 10.1093/oso/9780198837008.003.0004
Michael Downing
Virtually every person will experience abdominal pain at some point. Although symptoms of pain are often vague and entwined with emotional overtones, careful assessment, combined with knowledge of the relationship of embryology and pain characteristics, will be most helpful to the clinician in diagnosing and using optimal mechanism-based treatment. Some pains are localized, and others ‘referred’; some pains are acute and potentially lethal, while others are chronic and ‘miserable’. ‘Total pain’ components such as worry, anger or depression always accompany and may exacerbate the severity of actual physical pain etiology. This chapter focuses particularly on the understanding the complexities and assessment of pain to enhance clinical acumen, leading to best practice management.
{"title":"Visceral pain","authors":"Michael Downing","doi":"10.1093/oso/9780198837008.003.0004","DOIUrl":"https://doi.org/10.1093/oso/9780198837008.003.0004","url":null,"abstract":"Virtually every person will experience abdominal pain at some point. Although symptoms of pain are often vague and entwined with emotional overtones, careful assessment, combined with knowledge of the relationship of embryology and pain characteristics, will be most helpful to the clinician in diagnosing and using optimal mechanism-based treatment. Some pains are localized, and others ‘referred’; some pains are acute and potentially lethal, while others are chronic and ‘miserable’. ‘Total pain’ components such as worry, anger or depression always accompany and may exacerbate the severity of actual physical pain etiology. This chapter focuses particularly on the understanding the complexities and assessment of pain to enhance clinical acumen, leading to best practice management.","PeriodicalId":149820,"journal":{"name":"Palliative Medicine: A Case-Based Manual","volume":"83 9","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114023559","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}
Pub Date : 2021-12-08DOI: 10.1093/oso/9780198837008.003.0006
Danielle Kain, S. Macdonald, Shalini Nayar
Patients experiencing dyspnea are commonly referred for advance symptom management in palliative care. Dyspnea is a challenging symptom to manage and requires an understanding of both respiratory mechanics and disease process. This chapter will review strategies to identify, diagnose and prognosticate lung diseases that are associated with significant morbidity. In addition, strategies to effectively manage symptom burden will be reviewed in detail. Case examples are used to illustrate what a patient suffering from respiratory complications or end-stage lung disease could experience. By the end of this chapter, the reader will be able to effectively identify the complexity of prognostication in common end-stage lung diseases and provide ongoing management of patients with dyspnea.
{"title":"Dyspnoea and lung disease","authors":"Danielle Kain, S. Macdonald, Shalini Nayar","doi":"10.1093/oso/9780198837008.003.0006","DOIUrl":"https://doi.org/10.1093/oso/9780198837008.003.0006","url":null,"abstract":"Patients experiencing dyspnea are commonly referred for advance symptom management in palliative care. Dyspnea is a challenging symptom to manage and requires an understanding of both respiratory mechanics and disease process. This chapter will review strategies to identify, diagnose and prognosticate lung diseases that are associated with significant morbidity. In addition, strategies to effectively manage symptom burden will be reviewed in detail. Case examples are used to illustrate what a patient suffering from respiratory complications or end-stage lung disease could experience. By the end of this chapter, the reader will be able to effectively identify the complexity of prognostication in common end-stage lung diseases and provide ongoing management of patients with dyspnea.","PeriodicalId":149820,"journal":{"name":"Palliative Medicine: A Case-Based Manual","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125751216","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}
Pub Date : 2021-12-08DOI: 10.1093/oso/9780198837008.003.0009
Carl Bromwich
Malignant bowel obstruction is a common complication of malignancy and is particularly so in the context of gastrointestinal and gynaecological malignancies. It has a profound negative impact on the quality of life of affected patients. While it portends a grim prognosis in advanced disease, it may also be the presenting feature of an early stage of a gastrointestinal cancer. Management may include surgery and use of self-expanding stents, as well as pharmacological intervention. Malignant bowel obstruction is regarded by many to be among the clinical situations considered to be palliative care emergencies.
{"title":"Malignant bowel obstruction","authors":"Carl Bromwich","doi":"10.1093/oso/9780198837008.003.0009","DOIUrl":"https://doi.org/10.1093/oso/9780198837008.003.0009","url":null,"abstract":"Malignant bowel obstruction is a common complication of malignancy and is particularly so in the context of gastrointestinal and gynaecological malignancies. It has a profound negative impact on the quality of life of affected patients. While it portends a grim prognosis in advanced disease, it may also be the presenting feature of an early stage of a gastrointestinal cancer. Management may include surgery and use of self-expanding stents, as well as pharmacological intervention. Malignant bowel obstruction is regarded by many to be among the clinical situations considered to be palliative care emergencies.","PeriodicalId":149820,"journal":{"name":"Palliative Medicine: A Case-Based Manual","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131083883","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}
Pub Date : 2021-12-08DOI: 10.1093/oso/9780198837008.003.0035
D. Dudgeon, L. Herx, S. Macdonald
Suffering among those facing a life-limiting illness is a common phenomenon as terminal illness is an assault on the whole person. Suffering is experienced by the whole person and can be caused by, or manifest itself in, the physical, psychological, social, and/or spiritual/existential domains of an individual’s life. Suffering is unique to each individual and it is important to observe for emotional cues and assess the individual’s cultural background as it will also influence how suffering is expressed. Interventions to help reduce suffering can be categorized as: psycho-educational; meaning-centred; stress reduction; hope-centred; supportive–expressive; and spiritual and other. Non-physical forms of suffering may be intrinsic to the dying process and requires health professionals to be fully present in their encounters with patients; develop a trusting relationship and willingness to listen; and demonstrate that the patient’s concerns have been heard.
{"title":"Response to suffering","authors":"D. Dudgeon, L. Herx, S. Macdonald","doi":"10.1093/oso/9780198837008.003.0035","DOIUrl":"https://doi.org/10.1093/oso/9780198837008.003.0035","url":null,"abstract":"Suffering among those facing a life-limiting illness is a common phenomenon as terminal illness is an assault on the whole person. Suffering is experienced by the whole person and can be caused by, or manifest itself in, the physical, psychological, social, and/or spiritual/existential domains of an individual’s life. Suffering is unique to each individual and it is important to observe for emotional cues and assess the individual’s cultural background as it will also influence how suffering is expressed. Interventions to help reduce suffering can be categorized as: psycho-educational; meaning-centred; stress reduction; hope-centred; supportive–expressive; and spiritual and other. Non-physical forms of suffering may be intrinsic to the dying process and requires health professionals to be fully present in their encounters with patients; develop a trusting relationship and willingness to listen; and demonstrate that the patient’s concerns have been heard.","PeriodicalId":149820,"journal":{"name":"Palliative Medicine: A Case-Based Manual","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133335444","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}
Pub Date : 2021-12-08DOI: 10.1093/oso/9780198837008.003.0016
J. Pereira
Patients with serious illnesses such as advanced cancer experience many urological symptoms and complications that can significantly reduce their quality of life. This chapter will address several of these, including haematuria, urinary blood clots, strangury, tenesmus, vesicovaginal and vesicoenteric fistulae, and upper and lower urinary tract obstructions. A number of clinical assessment and treatment options are available for each of these. Clinicians need to be acquainted with the potential causes, and assessment and treatment options and consider their respective benefits versus burdens when deciding on the optimal management approach. The patient’s estimated survival and other factors such as wishes, setting of care and access to certain treatments should also be considered. This chapter describes the various assessment and treatment options for these complications in the context of cases, and their respective roles depending on the illness trajectory.
{"title":"Urological symptoms and complications in palliative care","authors":"J. Pereira","doi":"10.1093/oso/9780198837008.003.0016","DOIUrl":"https://doi.org/10.1093/oso/9780198837008.003.0016","url":null,"abstract":"Patients with serious illnesses such as advanced cancer experience many urological symptoms and complications that can significantly reduce their quality of life. This chapter will address several of these, including haematuria, urinary blood clots, strangury, tenesmus, vesicovaginal and vesicoenteric fistulae, and upper and lower urinary tract obstructions. A number of clinical assessment and treatment options are available for each of these. Clinicians need to be acquainted with the potential causes, and assessment and treatment options and consider their respective benefits versus burdens when deciding on the optimal management approach. The patient’s estimated survival and other factors such as wishes, setting of care and access to certain treatments should also be considered. This chapter describes the various assessment and treatment options for these complications in the context of cases, and their respective roles depending on the illness trajectory.","PeriodicalId":149820,"journal":{"name":"Palliative Medicine: A Case-Based Manual","volume":"9 35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128820047","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}
Pub Date : 2021-12-08DOI: 10.1093/oso/9780198837008.003.0001
J. Myers, J. Simon
Advance care planning (ACP) conversations and goals of care (GOC) discussions prepare patients and their substitute decision-makers for medical decision-making. When rooted in a patient’s values and person-centred in approach, ACP and GOC discussions can optimize the likelihood a person receives care that is concordant with their goals. This chapter explores the definitions and clinical processes for ACP and GOC discussions and describes how a patient’s values and goals can directly inform medical decision-making. Differences in ACP among healthy and seriously ill individuals, common communication challenges, and the pitfalls of a treatment-centred approach are described. The chapter underscores the importance of illness understanding and provides tips on addressing prognosis. Finally, healthcare system impacts of ACP and GOC are considered.
{"title":"Advance care planning and goals of care discussions","authors":"J. Myers, J. Simon","doi":"10.1093/oso/9780198837008.003.0001","DOIUrl":"https://doi.org/10.1093/oso/9780198837008.003.0001","url":null,"abstract":"Advance care planning (ACP) conversations and goals of care (GOC) discussions prepare patients and their substitute decision-makers for medical decision-making. When rooted in a patient’s values and person-centred in approach, ACP and GOC discussions can optimize the likelihood a person receives care that is concordant with their goals. This chapter explores the definitions and clinical processes for ACP and GOC discussions and describes how a patient’s values and goals can directly inform medical decision-making. Differences in ACP among healthy and seriously ill individuals, common communication challenges, and the pitfalls of a treatment-centred approach are described. The chapter underscores the importance of illness understanding and provides tips on addressing prognosis. Finally, healthcare system impacts of ACP and GOC are considered.","PeriodicalId":149820,"journal":{"name":"Palliative Medicine: A Case-Based Manual","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122166485","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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