European journal of cancer : official journal for European Organization for Research and Treatment of Cancer (EORTC) [and] European Association for Cancer Research (EACR)
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Review
Distress in palliative care patients: developing patient-centred approaches to clinical management.
It is widely recognised by clinicians that depression is a difficult symptom to identify amongst patients with advanced illness. Many of the symptoms of depression are difficult to elicit in patients who are approaching the end of life. ⋯ More recently the concept of demoralization as a separate entity to depression has been described which can be briefly described as a disorder of meaning and hope. In this paper, we review these diagnoses together with the latest screening tools which can help clinicians to recognise better such pathologies in their patients and discuss interventions that can be utilised to help patients with depression or demoralization to have a better quality of life.
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Individuals diagnosed with advanced cancer frequently experience physical and psychological distress. Hope has been identified as an essential resource in the lives of people with cancer, helping them to cope during times of suffering and uncertainty. ⋯ This paper summarises salient evidence pertaining to hope in advanced cancer patients and their families or informal caregivers. We examine the challenging issue of how to define hope, discuss the issue of measuring hope and review the state of evidence addressing interventions that may enhance or bolster hope in the face of advanced disease.
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Modern palliative care started with St Christopher's Hospice in 1967 and was initially regarded as 'terminal care'. This served as a template for a developing model of multidisciplinary clinical care, teaching and research. A decade later, several hospital Palliative Care Teams were established and different terms were used to describe them. ⋯ Over the last two decades we have seen an expansion in non-hospice palliative care. The terms used to describe this care have been variable and inconsistent. Our challenges in progress involve establishing clear terminology and an evolving improved evidence base, along with a realisation that there are large gaps in patient care.
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Palliative care is developed primarily outside academic institutions and with a primary focus upon service development. Initiatives to formalise the research structure were taken in Europe in 1996 by the European Association for Palliative Care (EAPC) through the establishment of the EAPC research network, and in 1998 in United Kingdom through the establishment of a palliative care research society. Most studies conducted in cancer palliative care up to now have been small and descriptive without the necessary quality to give input into evidence based medicine. ⋯ It is necessary to train a sufficient number of clinician scientists within palliative care research and to give these scientists the possibility of permanent research posts in particular combined clinical and research posts after the research training period. National and international funding needs to continue and successful collaboratives need to receive predictable, sustainable funding. Since the majority of palliative care patients come from oncology, it is important to establish a close collaboration between these two disciplines.
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Malignant bowel obstruction (MBO) is a common and distressing outcome particularly in patients with bowel or gynaecological cancer. Radiological imaging, particularly with CT, is critical in determining the cause of obstruction and possible therapeutic interventions. Although surgery should be the primary treatment for selected patients with MBO, it should not be undertaken routinely in patients known to have poor prognostic criteria for surgical intervention such as intra-abdominal carcinomatosis, poor performance status and massive ascites. ⋯ Vomiting may be controlled using anti-secretory drugs or/and anti-emetics. Somatostatin analogues (e.g. octreotide) reduce gastrointestinal secretions very rapidly and have a particularly important role in patients with high obstruction if hyoscine butylbromide fails. A collaborative approach by surgeons and the oncologist and/or palliative care physician as well as an honest discourse between physicians and patients can offer an individualised and appropriate symptom management plan.