Show Summary Details
Page of

Palliative care 

Palliative care

Chapter:
Palliative care
Author(s):

Bee Wee

DOI:
10.1093/med/9780199204854.003.03101_update_001

May 30, 2013: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

Page of

PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy).

date: 27 March 2017

Palliative care addresses the physical, psychological, social, and spiritual needs of someone with advanced, progressive, and fatal disease. Good symptom control requires meticulous assessment, effective two-way communication, and the wise use of drugs, supported by other therapeutic interventions.

Common symptoms are (1) pain—one of the most feared symptoms in patients with advanced malignant disease; managed with disease modifying treatments, nondrug measures (e.g. heat pads), and/or analgesics (see also Chapter 30.1); (2) nausea and/or vomiting—after exclusion/treatment of reversible causes, management is with antiemetics chosen to target the receptors likely to be involved in the particular case and delivered by an appropriate route (oral or nonoral); (3) breathlessness—a disabling symptom in many patients with chronic and progressive illnesses; management requires dealing with reversible causes (e.g. anaemia, chest infection), nondrug measures (e.g. relaxation techniques, fans), and/or drugs (e.g. strong opioids); (4) constipation—an under-recognized problem which must be handled proactively with rectal measures and/or oral laxatives; (5) depression—which is common but often not perceived; diagnosis and early treatment with antidepressants and psychological support are usually effective; (6) anorexia and fatigue—these are the ‘Cinderellas’ of symptom control, less amenable to drug therapy but requiring the management of the distress and frustration of the patient and family.

Medical emergencies are relatively uncommon in palliative care, but prompt diagnosis and (when appropriate) intervention are essential. However, it is vital to diagnose dying to avoid unrealistic attempts to cure or prolong life in hopeless situations. Once death is seen to be inevitable and imminent, the focus of care should change from sustaining life at all costs to supporting the natural process of dying.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can''t find the answer there, please contact us.