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Theoretical models are examined from the medical school to the highly specialized practice, facilitation training and actor training are made explicit, and international approaches to communication skills training are compared and contrasted. Finally, research tools that assist in coding cancer consultations, evaluating training courses, and employing mixed methods in studies aid the reader in providing clear and sensitive communication when handling challenging situations whilst treating cancer sufferers and palliative care patients.

Eight hundred million people live in Africa, a continent which covers 22 percent of the world's surface and encompasses some fifty countries. Conflict, poverty, endemic diseases, and lack of clean Conflict, poverty, endemic diseases, and lack of clean water pose serious challenges for the population, made worse by a rampaging AIDS pandemic. Huge loss of life has impacted dramatically on both health systems and social and family structures. As the attention of the world focused increasingly on Africa, the International Observatory on End of Life Care was commissioned to conduct a timely review of hospice and palliative care development across the continent.

The Observatory undertook this review using an approach specially designed for resource-poor settings. Information was collected against an agreed template to allow comparisons between countries and regions. As a result, an insight is given into the challenges, opportunities and successes faced by hospice and palliative care workers, country by country, throughout the twenty-six countries in Africa where a palliative care initiative is underway.

Uma história que mostra o sentido dos Cuidados Paliativos

Strategies and models of care are explored, and the development of palliative care is viewed from various standpoints including ethnographic, historical, ethnic, demographic and epidemiological perspectives. This is the first book to focus exclusively on palliative care and hospice development in Africa.

Palliative care is rapidly evolving as a multidimensional therapeutic model devoted to improving the quality of life of all patients with life-threatening illness. Symptom control, management of Symptom control, management of psychosocial and spiritual concerns, decision making consistent with values and goals, and care of the imminently dying that is appropriate and sensitive to the unique needs of the individual and the family — these are among the critical issues addressed through palliative care. As this discipline has evolved, the need for research in all these areas has become widely acknowledged.

This book describes both the progress that has already been made in the investigation of these issues and the methodologic elements that must be addressed in future studies. The perspective is broad and the overriding goal is to inform about the state of the art in these rapidly evolving areas of research. This is an important book on a very important and increasingly relevant subject for all who are involved in any way with palliative and End of Life Care. It is about the realities, messiness, It is about the realities, messiness, uncertainties, contradictions, paradoxes and ambivalence that are part and parcel of living through advanced illness, dying and bereavement but also about what helps and heals.

It is about responding to feelings, hopes, fears and stresses associated with major illness, often experienced by patients and their carers, both family and professional. The content is largely drawn from research and clinical experience as a psychotherapist and pastoral carer in bereavement counselling and palliative care. It is not about technical medical procedures. Its value lies in the highlighting of the non-technical role and presence of caregivers.

The aim is to help carers in training both professional and volunteer or who are already in practice, to understand better the attitudes and behaviour of their patients or clients. It could also be of help to teachers and trainers in the field of hospice, palliative and bereavement care and to patients and their families and friends as they try to come to terms with their own situations and how they can cope better with them. The book reviews a range of responses to illness and loss, the challenges posed to countless patients, relatives and carers and the support both personal and organisational.

It is written in an accessible style using many stories shared with the authors. This publication offers an inspiring way for people in contemporary society to review death as part of life. Improvements in health care in the 21st century mean people are living longer, but with the paradox that chronic illness is increasingly prevalent. Dementia, a term used to describe various different Dementia, a term used to describe various different brain disorders that involve a loss of brain function which is usually progressive and eventually severe, is a condition associated with an ageing population and is becoming increasingly common.


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Worldwide, there are approximately 24 million people with dementia, expected to rise to 81 million by Inevitably, people living with dementia will die, but their needs at the end of life are not well known. This book describes what might be achieved if the values and best practice of both dementia care and palliative care are brought together, to achieve quality end-of-life care for this specific group of patients. The book examines the possibilities and the challenges faced when trying to improve quality of life for people with dementia, and presents examples of good practice from across the world.

There is a growing conflict in medicine between the research imperative, with its implicit goal of overcoming death itself, and the re-emergent clinical imperative to treat death as a part of life There is a growing conflict in medicine between the research imperative, with its implicit goal of overcoming death itself, and the re-emergent clinical imperative to treat death as a part of life and to make the process of dying as tolerable as possible. Central to this conflict is the rise of scientific medicine and the decline of religious and associated discourses.

Many Anglo Saxon countries are marked by a moral and religious pluralism that breeds controversy over bioethical issues such as euthanasia. Some scholars argue that modern medicine has put the cure of bodies before the care of persons. Some scholars attribute this to a metaphysical heritage of dualism and reductionism. This heritage has become problematic in the modern age, where waning belief in a divine order leaves the individual self as the bearer of meaning. At the same time, knowledge about nature and society has been increasing at such an accelerated pace that it has become difficult to develop a unified secular worldview.

Chapters One and Two address these larger issues. Chapter Three focuses on medicine's approach to cancer as an example of the strengths and weaknesses of the research imperative. Chapter Four looks at the diffusion of the theory and practice of palliative care throughout the Anglo Saxon world. The fifth chapter discusses the development of effective pain control. The sixth chapter addresses the changing meaning of euthanasia in Western history in the past century as it has transitioned from a philosophical position to a widely debated policy proposal.

The use of narrative methods has a long history in palliative care, pioneered by Dame Cicely Saunders, founder of the modern hospice movement. This book provides a multidisciplinary examination of This book provides a multidisciplinary examination of work with narrative and stories in contemporary health and social care, with a focus on the care of people who are ill and dying.

Cicely Saunders: Founder of the Hospice Movement : Selected Letters - Google книги

The book addresses and clarifies core issues: What is a narrative? What is a story? What are some of the main methods and models that can be used and for what purposes? What practical and ethical dilemmas can the methods entail in work with illness, death, and dying? As well as highlighting the power of stories to create new possibilities, the book also acknowledges the conceptual, methodological, and ethnical problems and challenges inherent in narrative work. As the hospice and palliative care movement evolves to meet the challenges of 21st century health care, this book highlights how narratives and stories can be attended to in ways that are productive, ethical, and caring.

Amyotrophic lateral sclerosis or motor neurone disease is a rare disease but one that can cause profound suffering for both the patient and their family. Whilst new treatments for ALS are being Whilst new treatments for ALS are being developed, these are not curative and offer only the potential to slow its progression. Palliative care must therefore be integral to the clinical approach to the disease. This book reflects the wide scope of this care; it must cover not just the terminal phase, but support the patient and their family from the onset of the disease.

Both the multidisciplinary palliative care team and the neurology team are essential in providing a high standard of care and allowing quality of life both patient and carer to be maintained. Clear guidelines are provided to address care throughout the disease process. Control of symptoms is covered alongside the psychosocial care of patients and their families, culminating in discussion of bereavement. The experience of patients and families is considered and case studies are provided to show the practical application of the theoretical knowledge.

Different models of care are explored, and this second edition of the text utilises the increase in both the evidence-base and available literature on the subject. Additional chapters on nursing, spiritual care, decision making, and ethical issues surrounding end of life care are included in this edition. Participatory research is a relatively new method of researching practice especially within palliative care.

It differs from other methodologies in that there is an expectation of action within the It differs from other methodologies in that there is an expectation of action within the research process. The values that underpin participatory research are collaboration, empowerment, and reflection. In the current climate of collaboration and working with people in healthcare, participatory research methods are gaining increasing interest when there is a desire to bring about change.

Organisational change is becoming an important focus as we look at ways of not only reducing costs but at the same time improving quality of care. While palliative care puts the patient and family at the centre, this book discusses a new research methodology that puts practitioners at the heart of the research process as collaborators who work together with researchers to resolve problems in practice. Divided into three sections, it provides theoretical groundings of action research, a greater focus on exemplars from studies within palliative care, and discusses prominent issues when using such a methodology.

All three sections are illustrated by an action research study undertaken by the author within a palliative care setting. Patient participation and user involvement are central to current thinking about the effective delivery of desired healthcare outcomes. Working with the person who lies behind every patient is core Working with the person who lies behind every patient is core to palliative care.

A voice can only become significant when it is listened to and acted upon. This book addresses key aspects in the provision of patient-centered palliative care and tracks significant developments in user involvement. It sets the philosophy within the cultural, social, and political context of modern healthcare, particularly addressing issues of quality, standards, education, and bereavement.

A key component in the delivery of high-quality palliative care is the multi-professional team. Following a discussion of teamwork, five core professions present a critical analysis of their working practices. The book concludes with a commentary from a palliative care user and a bereaved carer. It is often somewhat glibly asserted that the patient is, or should be, at the centre of care.

There have been few attempts to examine how to keep him or her there without professional needs and protocols crowding him or her out. This book asks how we listen and why we listen, and focuses on the challenges of how professionals can keep the needs of the patient central in clinical care. It is now being applied not only to cancer patients, but to all patients in end-of-life situations. As this palliative care approach advances, it is important to pause and comment on its effectiveness. It is a philosophy of patient care, and is therefore open to critique and evaluation.

Using the Oxford Textbook of Palliative Medicine, 3rd edition as their basic reference, the authors present their argument that the palliative care approach has become too busy and over-professionalised, and that it therefore has significant weaknesses. They examine the framework of the specialty — quality of life, autonomy, dignity, patient-centredness, and the priority assigned to relatives in the remit of care — and the moral problems associated with implementing such a philosophy.

The resource implications of various healthcare policies are also discussed in relation to the WHO definition. Whilst the authors defend the achievements of palliative care and those who work in the profession, they present suggestions for an alternative philosophy that prompts many ethical and philosophical questions about the future of palliative care.

This book addresses key questions about the need for palliative care, the current provision of services, and the evidence for the effectiveness of a range of alternative models of organisation in This book addresses key questions about the need for palliative care, the current provision of services, and the evidence for the effectiveness of a range of alternative models of organisation in palliative care. A broad approach is taken to include the needs of both cancer patients and patients with other terminal diseases, and the relationship between palliative care and other aspects of health care services.

The book is based on a comprehensive and detailed review of the international scientific literature on evaluation of palliative care, providing an essential evidence base for policy decisions. Caring for patients with a terminal illness and their families requires the skills of many professionals working together as a team. It is often the psychosocial issues surrounding patients and It is often the psychosocial issues surrounding patients and families that cause professionals even greater difficulty than the physical symptoms. The issues of psychosocial assessment, treatment, care, and support of palliative care patients differs from the care of patients with early, treatable cancer — time is short and the emphasis different both from a patient and carer perspective.

This second edition examines current practice and provision of psychosocial support as applied to palliative care patients. It is a practical text, reviewing the current literature and evidence in order to demonstrate good, and better, practice in psychosocial care.

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The text covers a number of areas including the nature of services required to provide effective psychosocial care; cultural issues of psychosocial care and adaptation; the importance of communication, including patients with communication difficulties; and socio-economic issues affecting the patient with advanced metastatic disease. Specific disorders such as anxiety and depression are included, as is the integration of service provision. The book also explores the evidence of specific psychotherapeutic interventions and includes guidelines on techniques that can be used in clinical practice.

Complementary therapies are widely sought by patients and families and the evidence base is slowly growing — a review of such therapies including herbal and homeopathic medicines is included. Whilst spiritual support and staff support are an integral part of all aspects of psychosocial care, and are incorporated throughout, these areas are also discussed in-depth in individual chapters.

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    Supportive care is the multidisciplinary holistic care of patients and their families from the time of diagnosis, through treatments aimed at cure or prolonging life, and into the phase currently acknowledged as palliative care. The opening chapters deal with the need for this type of supportive care for patients with end-stage renal disease ESRD and how to make it happen. The clinical practice guideline developed by the Renal Physicians Association and the American Society of Nephrology regarding decision making in end-stage renal disease is particularly instructive.

    There are useful chapters on the control of symptoms related to both the renal disease and to co-morbidities. These chapters and the separate chapter on the management of pain contain a number of useful tables for the adjustment of medication doses in ESRD. There are chapters that discuss advanced directives, health-related quality of life, psychological and psychiatric considerations, sexual dysfunction, and spiritual care. The closing chapters deal with traditional palliative end-of-life care for patients with ESRD. The introduction of this type of supportive care earlier in the course of the disease for patients with ESRD is long overdue and this book should be required reading for anybody training in nephrology.

    It certainly should have a place on the library shelf in any dialysis unit. It will also be useful to people who work in palliative care, as it will allow a better understanding of the particular problems and symptoms patients with ESRD bring to palliative care.

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    The chapters on symptom control and the information about medication adjustments are particularly useful. Selected Letters This volume provides a truly privileged view of the life and work of Dame Cicely Saunders, as seen through a selection of her correspondence, over the four decades that she has championed hospice and palliative care. The letters are grouped into three time periods: the years leading up to the opening of St. David Clark provides brief but informative biographical and professional notes at the beginning of each section but allows the letters, unedited and in chronological sequence, to speak for themselves.

    In the early letters, we hear of the development of St. How "The Scheme", the page outline of the vision that was to become St. Followed by ten years of tireless work and organisation. As the palliative care movement expands, we hear her talking to a large number of people from around the world. And whilst actively contributing to all the positive aspects of hospice and palliative care, there is a thread running through the years that underlines her unshakeable opposition to euthanasia; her letters to Jack Kevorkian and to the Dutch doctor who advocated that euthanasia was part of good palliative care are very clear.

    As wonderful as all the history is, the real jewel in these pages is Dame Cicely herself. Through her letters, we hear a truly remarkable person. Her vision and determination are legendary, and the indomitable energy and attention to detail are almost overpowering.

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    But we also hear a compassionate and kind person - caring towards patients, concerned about family, supportive of colleagues. And, considering her achievements, a person of some humility. This is a most enjoyable and interesting book. Listening to her on all manner of issues to do with hospice and palliative care over the years, one cannot help feeling some of her enthusiasm and motivation.

    Balfour Mount concludes his Foreword by saying "These letters have helped to shape medical history. We are indebted to Dame Cicely and David Clark for this precious gift". Very true. Andrew Davies and Ilora Finlay Eds.