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Symptom Relief in Palliative Care


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Table of Contents

Introduction - The consequences of advanced disease - Sharing the consequences of advanced disease - Principles of symptom relief in palliative care - Getting started - Setting the scene and starting the interview - Helping the person to share their problems - Answering difficult questions - Breaking difficult news - Helping the person with the effects of difficult news - Identifying distress in the person with severe communication difficulty - Discussing preferred priorities of care (advance care planning) - Managing pain - Diagnosing and treating pain - Choosing an analgesic - Using strong opioids - Managing the adverse effects of analgesics - Other physical symptoms - Ascites - Bleeding - Bowel obstruction - Constipation - Diarrhea - Dyspepsia - Dysphagia - Edema and lymphedema - Fatigue, drowsiness, lethargy and weakness - Malignant ulcers and fistulae - Nausea and vomiting - Nutrition and hydration problems - Oral problems - Respiratory problems - Skin problems - Terminal phase (the last hours and days) and bereavement - Urinary and sexual problems - Psychological symptoms - Anger - Anxiety - Confusional states (delirium and dementia) - Withdrawal and depression - Difficult decisions - Making ethical choices - Decisions around capacity - Issues around cardiopulmonary resuscitation - Drug information - Drug interactions - Effects of renal or hepatic impairment on common palliative care drugs - Drugs in children: starting doses - Using drugs off label - Alternative routes for drugs - Drugs commonly used by CSCI - Problems with pump infusions - Emergencies

About the Author

respectively: Palliative Care Physician, Western Memorial Regional Hospital, Corner Brook, NL, Canada; Director, Pain Medicine and Palliative Care, Claxton-Hepburn Medical Center, Richard E Winter Cancer Treatment Center, Ogdensburg, NY, USA; Consultant in Palliative Care Medicine, St. Oswald's Hospice, Newcastle Hospitals NHS Trust and Visiting Professor of Research at Northumbria University, Newcastle upon Tyne.

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