Palliative Care - An Integrated Approach
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This evidence-based text brings together the theory and practice of palliative care. It examines at all aspects of palliative care i.e. psycho social, spiritual and physical in a highly practical way. The evidence base for cancer care has been developed within the Hospice Movement over the past 50 years and, in the main, it transfers across to patients dying of diseases other than cancer. The book addresses the palliative needs of any patient with any disease in any care setting, which gives it a generic approach. This is in line with current government directives. Contributions to care and treatment are considered in a multidisciplinary and complementary way.


Jenny Buckley is Head of Education at St Wilfrid's Hospice.


Foreword x

Contributors’ biographies xii

Acknowledgements xv

Dedications xvi

1 Historical and cultural perspectives on the evolution of palliative care 1

Key points 1

Introduction 2

Death in society 2

Dame Cicely Saunders and the origins of contemporary palliative care 3

An international perspective 6

Defi nitions 8

End-of-life care national programme 12

Culture 15

Service user involvement 18

Conclusion 19

Main implications for practice 19

Suggested further reading 19

2 Facing progressive disease and death 21

Key points 21

Psychosocial care 22

Partnership – maintaining the balance 23

Approaches to care 24

Giving the bad news 26

Denial/avoidance 29

Anger 32

Anxiety 33

Depression 33

Social pain 35

Conclusion 35

Main implications for practice 36

Suggested further reading 36

3 Communication skills 37

Key points 37

The impact of good communication 38

The impetus to teach communication skills 38

Facilitative styles 40

What Howard taught me about nursing dying people 45

Helpful strategies 46

Communicating with people with dementia 56

Conclusion 57

Main implications for practice 57

Suggested further reading 58

4 Self-awareness and self-care 59

Key points 59

Saving a life versus stealing a death 60

Facing death 62

Making space for decision-making 64

Self-awareness 66

How much did Nicky impact on my life? 68

Self-care 69

Main implications for practice 72

Suggested further reading 72

5 The sick role and partnership working 73

Key points 73

Introduction 73

Partnership care – what does it mean? 75

The sick role 76

Face-to-face partnership: attention to information giving 78

Written information 81

Decision aids 82

Special needs 83

Conclusion 83

Main implications for practice 83

Suggested further reading 84

6 Hope and spirituality 85

Key points 85

Introduction 86

Hope research 86

Spirituality 94

Religious practices concerned with death 100

Conclusion 104

Main implications for practice 104

Suggested further reading 105

7 Finding resilience together 106

Key points 106

Resilience in health care 107

Patient groups 108

Psychoneuroimmunology 108

The expert patient 111

Conclusion 114

Main implications for practice 115

Suggested further reading 115

8 Living with dying 116

Key points 116

Introduction 117

Social death 118

Vulnerable groups 119

Informational needs 121

Being heard and feeling supported 122

Companionship 123

Intimacy and caring 125

Health needs 125

Diffi cult thoughts and letting go 127

Conclusion 128

Main implications for practice 128

Suggested further reading 129

9 Bereavement 130

Key points 130

Defi nitions 131

Untimely deaths 131

Bereavement and health 132

Grief theorists 134

Mourning practices in different cultures 141

Bereaved children 143

Old age 143

Bereavement and dementia 143

Solitary grief 144

Bereavement services 145

Conclusion 148

Main implications for practice 149

Suggested further reading 149

10 Pain and other major symptoms: an integrated approach 150

Key points 150

Pain theories 152

Psychological approaches 154

Physical approaches 158

Complementary therapies 163

Creative therapies 170

Conclusion 172

Main implications for practice 172

Suggested further reading 172

11 The history of the use of strong opioids for cancer pain 173

Key points 173

Studies and narratives 174

WHO analgesia ladder 177

Side effects 182

Alternative routes for administration of strong opioids 184

Conclusion 187

Main implications for practice 188

Suggested further reading 188

12 Concordance and advance care planning 189

Key points 189

Patient-centred care: concordance 190

Advance care planning 192

The Mental Capacity Act 2005 196

Main implications for practice 196

Suggested further reading 197

13 Eleven prevalent symptoms 198

Key points 198

History 198

Pain 199

Nausea and vomiting 206

Constipation 212

Diarrhoea 216

Anorexia 218

Fatigue 223

Breathlessness 227

Confusion 232

Insomnia 236

Anxiety 238

Depression 240

Conclusion 244

Main implications for practice 244

Suggested further reading 245

Addendum: Doloplus 2 Scale 245

14 Palliative issues in some common diseases 248

Key points 248

Gold standard for all 248

Doing the right thing at the right time 249

Conclusion 280

Main implications for practice 280

Suggested further reading 280

Contents ix

15 Palliative emergencies 282

Key points 282

Palliative emergencies 282

Other symptoms 286

Main implications for practice 287

Suggested further reading 287

References 288

Index 315


“However, I have found myself referring to this book in recent months far more than some of the bigger, more established, textbooks – and if the measure of a good book is how well-thumbed the pages become, then the author is on to a winner.  (European Journal of Palliative Care, 2010)

"The author's warmth, enthusiasm and concern for patients, their families and the professionals who care for them, combined with her scholarship, shine throughout this book. I recommend it to anyone with an interest in the care of people approaching the end of their lives in any setting." (Palliative Medicine, 2009)

"This book will be a very welcome addition to the undergraduate curriculum for clinicians seeking to specialize in palliative care." (International Journal of Palliative Nursing, 2009)

"There is a wealth of knowledge and experience for nursing students and newly qualified nurses seeking direction.... I would recommend this for reference on general medical wards and units where patients are receiving end of life care." (Nursing Standard, April 2009)