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Palliative Medicine

  • Principles of palliative care; their application in advanced disease.

 

Palliative Care
Morrison R. S., Meier D. E.
N Engl J Med 2004; 350:2582-2590, Jun 17, 2004. Clinical Practice

  • Liaison with multidisciplinary hospital, hospice and community palliative care services.
  • Physical aspects of palliative medicine:
    • Natural history, including symptomatology of common incurable diseases
    • Pain control, including assessment, psychological factors, treatment and monitoring
    • Management of conditions and symptoms common in incurable and life threatening disease - including hypercalcaemia, mouth problems, anorexia, weakness, nausea and vomiting, dyspnoea, intestinal obstruction, constipation, diarrhoea, incontinence, anxiety, depression, restlessness, malignant effusions and ascites, lymphoedema.
  • Management of emergencies in palliative care - acute confusional states, haemorrhage; acute severe pain; spinal cord compression; fits; superior venal caval obstruction.
  • Pharmacological aspects of palliative medicine:
    • WHO classification of analgesics, their dose equivalents and alternate routes of administration
    • Pharmacology of drugs commonly used in symptom control
    • Prescribing: knowledge of regulations governing the prescription of controlled drugs.
  • Psychosocial aspects of palliative medicine:
    • Communication with terminally ill patients, their relatives and health care professionals with respect to information transfer, therapeutic strategy development and support during a crisis
    • Quality of life issues and their relevance in late stage disease
    • Psychosocial responses of patients and relatives in illness and bereavement
    • The support of families in bereavement.
  • Religious and cultural aspects and influences on patient and family attitudes to death and dying.
  • Ethical issues: the ethical framework for appropriate interventions in patients with life threatening disease, including truth telling, consent, treatment choice, the question of euthanasia and advance directives, boundaries of palliative care.
  • Legal and organisational: certification of death; procedures after death.