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25 - Palliative care

from Part III - Working with specific units

Published online by Cambridge University Press:  10 December 2009

By
Matthew Hotopf  and
Max Henderson
Edited by
Geoffrey Lloyd  and
Elspeth Guthrie
Geoffrey Lloyd
Affiliation:
Priory Hospital, London
Elspeth Guthrie
Affiliation:
University of Manchester
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Summary

Context

Palliative care arose as a discipline in the 1960s with the birth of the modern hospice movement. From its earliest origins palliative care championed what has come to be known as a ‘patient-centred’ approach to delivering care. In patients with advanced cancer (who remain the core patient group served by most palliative care services) the focus of care was to improve the quality, rather than the duration, of life. Symptom control – especially pain control – was key to this, but also a new approach to patient care in which the need for open and honest communication of diagnosis and prognosis was emphasized. The naïve view that by failing to inform the dying patient of his predicament, the doctor was somehow protecting him from unbearable distress was challenged. Palliative care also emphasizes the familial, social, cultural and spiritual context in which care is provided, and death and its aftermath are managed. Underpinning this is a multidisciplinary approach to the provision of care, with many hospices employing social workers, chaplains, other spiritual advisers, as well as bereavement counsellors, psychiatrists and psychologists.

Hospices are the most obvious means by which palliative care has been developed; however palliative care is not confined to them. The role of hospices is to provide more than terminal care; admissions may take place months or even years before death, in order to bring troublesome symptoms under control.

Keywords

advanced diseaseanxietydepressiondisturbed behaviourpalliative carepsychiatrists
Type
Chapter
Information
Handbook of Liaison Psychiatry , pp. 592 - 616
Publisher: Cambridge University Press
Print publication year: 2007

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References

Addington Hall, J. and Higginson, I. (2001). Palliative Care for Non-cancer Patients. Oxford: Oxford University Press.
American Psychiatric Association. (1999). Practice Guidelines for the Treatment of Patients with Delirium.
Barraclough, J. (1997). ABC of palliative care. Depression, anxiety, and confusion. British Medical Journal, 315 (7119), 1365–8.Google Scholar
Beck, A. T., Ward, C. H. and Mendelson, M. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–71.Google Scholar
Boyle, D. M., Abernathy, G., Baker, L., et al. (1998). End of life confusion in patients with cancer. Oncology Nurses Forum, 25, 1335–43.Google Scholar
Breitbart, W., Bruera, E., Chochinov, H., et al. (1995). Neuropsychiatric syndromes and psychological symptoms in patients with advanced cancer. Journal of Pain and Symptom Management, 10 (2), 131–41.Google Scholar
Breitbart, W., Rosenfeld, B. D. and Passik, S. D. (1996). Interest in physician-assisted suicide among ambulatory HIV-infected patients (see comments). American Journal of Psychiatry, 153 (2), 238–42.Google Scholar
Breitbart, W., Rosenfeld, B., Roth, A., et al. (1997). The Memorial Delirium Assessment Scale. Journal of Pain and Symptom Management, 13 (3), 128–37.Google Scholar
Breitbart, W., Rosenfeld, B., Pessin, H., et al. (2000). Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. Journal of the American Medical Association, 284, 2907–11.Google Scholar
Breitbart, W., Rosenfeld, B., Kaim, M., et al. (2001). A randomized, double-blind, placebo-controlled trial of psychostimulants for the treatment of fatigue in ambulatory patients with human immunodeficiency virus disease. Archives of Internal Medicine, 161 (3), 411–20.Google Scholar
Brown, J. H., Henteleff, P., Barakat, S., et al. (1986). Is it normal for terminally ill patients to desire death?American Journal of Psychiatry, 143 (2), 208–11.Google Scholar
Bruera, E., Miller, L., McCallion, J., et al. (1992). Cognitive failure in patients with terminal cancer: a prospective study. Journal of Pain and Symptom Management, 7 (4), 192–5.Google Scholar
Caraceni, A., Nanni, O., Maltoni, M., et al. (2000). Impact of delirium on the short term prognosis of advanced cancer patients. Italian Multicenter Study Group on Palliative Care. Cancer, 89 (5), 1145–9.Google Scholar
Casarett, D. J. and Inouye, S. K. (2001). Diagnosis and management of delirium near the end of life. Annals of Internal Medicine, 135 (1), 32–40.Google Scholar
Chochinov, H. M. (2000). Psychiatry and terminal illness. Canadian Journal of Psychiatry, 45 (2), 143–50.Google Scholar
Chochinov, H. M. and Breitbart, W. (2000). Handbook of Psychiatry in Palliative Medicine, 1st edn. Oxford: Oxford University Press.
Chochinov, H. M., Wilson, K. G., Enns, M., et al. (1994). Prevalence of depression in the terminally ill: effects of diagnostic criteria and symptom threshold judgements. American Journal of Psychiatry, 151 (4), 537–40.Google Scholar
Chochinov, H. M., Wilson, K. G., Enns, M., et al. (1995). Desire for death in the terminally ill. American Journal of Psychiatry, 152 (8), 1185–91.Google Scholar
Chochinov, H. M., Wilson, K. G., Enns, M., et al. (1997). Are you depressed? Screening for depression in the terminally ill. American Journal of Psychiatry, 154 (5), 674–6.Google Scholar
Chochinov, H. M., Tataryn, D., Clinch, J. J., et al. (1999). Will to live in the terminally ill. Comment. Lancet, 354 (9181), 816–19.Google Scholar
Cobb, J. L., Glanyz, M. J., Nicholas, P. K., et al. (2000). Delirium in patients with cancer at the end of life. Cancer Practice, 8, 172–7.Google Scholar
Corr, C. A. (1992). A task-based approach to coping with dying. Omega – Journal of Death and Dying, 24 (2), 82–94.Google Scholar
Corr, C. A. (1999). Dying and its interpreters: a review of selected literature and some comments on the state of the field. Omega – Journal of Death and Dying, 39 (4), 239–59.Google Scholar
Costa, D., Mogos, I. and Toma, T. (1985). Efficacy and safety of mianserin in the treatment of depression of women with cancer. Acta Psychiatrica Scandinavica, 72 (Suppl. 320), 85–92.Google Scholar
Crocetti, E., Arniani, S., Acciai, S., et al. (1998). High suicide mortality soon after diagnosis among cancer patients in central Italy. British Journal of Cancer, 77 (7), 1194–6.Google Scholar
Doka, K. J. (1995). Coping with life-threatening illness: a task model. Omega – Journal of Death and Dying, 32, 111–22.Google Scholar
Edmonds, P. M., Stuttaford, J. M., Peny, J., et al. (1998). Do hospital palliative care teams improve symptom control? Use of a modified STAS as an evaluation tool. Palliative Medicine, 12 (5), 345–51.Google Scholar
Emanuel, E. J., Fairclough, D. L. and Emanuel, L. L. (2000). Attitudes and desires related to euthanasia and physician-assisted suicide among terminally ill patients and their caregivers. Comment. Journal of the American Medical Association, 284 (19), 2460–8.Google Scholar
Endicott, J. (1984). Measurement of depression in patients with cancer. Cancer, 53 (Suppl.), 2243–8.Google Scholar
Faull, C. M., Johnson, I. S. and Butler, T. J. (1994). The hospital anxiety and depression (HAD) scale: its validity in patients with terminal malignant disease. Palliative Medicine, 8 (1), 69.Google Scholar
Ferrando, S. J. (2000). Commentary: integrating consultation-liaison psychiatry and palliative care. Journal of Pain and Symptom Management, 20 (3), 235–6.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12 (3), 189–98.Google Scholar
Fulton, C. L. (1997). The physical and psychological symptoms experienced by patients with metastatic breast cancer before death. European Journal of Cancer Care, 6 (4), 262–6.Google Scholar
Gagnon, B., Allard, P., Masse, B., et al. (2000). Delirium in terminal cancer: a prospective study using daily screening, early diagnosis and continuous monitoring. Journal of Pain and Symptom Management, 19, 412–26.Google Scholar
Ganzini, L., Johnston, W. S., McFarland, B. H., et al. (1998). Attitudes of patients with amyotrophic lateral sclerosis and their care givers toward assisted suicide. Comment. New England Journal of Medicine, 339 (14), 967–73.Google Scholar
Given, C. W., Stommel, M., Given, J., et al. (1993). The influence of cancer patients' symptoms and functional states on patients' depression and family caregivers reaction and depression. Health Psychology, 12 (4), 277–85.Google Scholar
Gordon, D. S., Carter, H. and Scott, S. (1997). Profiling the care needs of the population with dementia: a survey in central Scotland. International Journal of Geriatric Psychiatry, 12 (7), 753–9.Google Scholar
Greer, S. and Watson, M. (1987). Mental adjustment to cancer: its measurement and prognostic importance. Cancer Surveys, 6, 439–53.Google Scholar
Henderson, M. (2004). Mental health needs. In Death, Dying and Social Differences, ed. Monroe, B. and Oliviere, D.. Oxford: Oxford University Press.
Hendin, H. (1997). Seduced By Death: Doctors, Patients, and the Dutch Cure. New York: Norton.
Hinton, J. M. (1963). The physical and mental distress of the dying. Quarterly Journal of Medicine, 32, 1–21.Google Scholar
Hodkinson, H. M. (1972). Evaluation of a mental test score for assessment of mental impairment in the elderly. Age and Ageing, 1 (4), 233–8.Google Scholar
Holland, J. C., Romano, S. J., Heilgenstein, J. H., et al. (1998). A controlled trial of fluoxetine and desipramine in depressed women with advanced cancer. Psycho-oncology, 7, 291–300.Google Scholar
Hopwood, P., Howell, A. and Maguire, P. (1991a). Screening for psychiatric morbidity in patients with advanced breast cancer: validation of two self-report questionnaires. British Journal of Cancer, 64, 353–6.Google Scholar
Hopwood, P., Howell, A. and Maguire, P. (1991b). Psychiatric morbidity in patients with advanced cancer of the breast: prevalence measured by two self-rating questionnaires. British Journal of Cancer, 64, 349–52.Google Scholar
Hotopf, M., Ly, K. L., Chidey, J., et al. (2001). Depression in advanced disease – a systematic review: 1. Prevalence and case finding. Palliative Medicine, 16, 81–97.Google Scholar
House, A. (1988). Mood disorders in the physically ill – problems of definition and measurement. Journal of Psychosomatic Research, 32, 345–53.Google Scholar
Inouye, S. K., Dyck, C. H., Alessi, C. A., et al. (1990). Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine, 113 (12), 941–8.Google Scholar
Inouye, S. K., Bogardus, S. T. Jr, Charpentier, P. A., et al. (1999). A multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine, 340 (9), 669–76.Google Scholar
Inouye, S. K., Foreman, M.D., Mion, L.C., et al. (2003). Nurses recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Archives of Internal Medicine, 161, 2467–73.Google Scholar
Johnston, B. (1972). Relief of mixed anxiety – depression in terminal cancer patients: effect of thioridazine. New York State Journal of Medicine, 72 (18), 2315–17.Google Scholar
Kasper, S. and Resinger, E. (2001). Panic disorder: the place of benzodiazepines and selective serotonin reuptake inhibitors. European Neuropsychopharmacology, 11 (4), 307–21.Google Scholar
Kelly, B., Burnett, P., Pelusi, D., et al. (2002). Terminally ill cancer patients' wish to hasten death. Palliative Medicine, 16, 339–45.Google Scholar
Kibiger, G., Kirsh, K. L., Wall, J. R., et al. (2003). My mind is as clear as it used to be: a pilot study illustrating the difficulties of employing a single-item subjective screen to detect cognitive impairment in outpatients with cancer. Journal of Pain and Symptom Management, 26 (2), 705–15.Google Scholar
Kübler-Ross, E. (1969). On Death and Dying, 1st edn. New York: Macmillan.
Kurtz, M. E., Kurtz, J. C., Given, C. W., et al. (1995). Relationship of caregiver reactions and depression to cancer patients' symptoms, functional states and depression: a longitudinal study. Social Science and Medicine, 40, 837–46.Google Scholar
Lavery, J. V., Boyle, J., Dickens, B. M., et al. (2001). Origins of the desire for euthanasia and assisted suicide in people with HIV-1 or AIDS: a qualitative study. Comment. Lancet, 358 (9279), 362–7.Google Scholar
Lawlor, P. G., Fainsinger, R. L. and Bruera, E. D. (2000a). Delirium at the end of life: critical issues in clinical practice and research. Journal of the American Medical Association, 284 (19), 2427–9.Google Scholar
Lawlor, P. G., Gagnon, B., Mancini, I. L., et al. (2000b). Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study. Archives of Internal Medicine, 160 (6), 786–94.Google Scholar
Leventhal, H. and Cameron, L. (1987). Behavioural theories and the problem of compliance. Patient Education and Counselling, 10, 117–38.Google Scholar
Lloyd-Williams, M., Friedman, T. and Rudd, N. (1999). A survey of antidepressant prescribing in the terminally ill. Palliative Medicine, 13, 243–8.Google Scholar
Lloyd-Williams, M., Dennis, M., Taylor, F., et al. (2003). Is asking patients in palliative care, Are you depressed? appropriate? Prospective study. British Medical Journal, 327 (7411), 372–3.Google Scholar
Ly, K. L., Chidey, J., Addington Hall, J., et al. (2002). Depression in palliative care – a systematic review: 2. Treatment. Palliative Medicine, 16, 279–84.Google Scholar
Lyketsos, C. G. and Olin, J. (2002). Depression in Alzheimer's disease: overview and treatment. Biological Psychiatry, 52 (3), 243–52.Google Scholar
Massie, M. J. (1989). Depression. In Handbook of Psychooncology, ed. Holland, J. and Rowland, J.. New York: Oxford University Press.
Massie, M. J., Holland, J. and Glass, E. (1983). Delirium in terminally ill cancer patients. American Journal of Psychiatry, 140 (8), 1048–50.Google Scholar
Mattis, S. (1988). Dementia Rating Scale Professional Manual. Odessa, FL: Pychological Assessment Resources Inc.
McClain, C. S., Rosenfeld, B. and Breitbart, W. (2003). Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Comment. Lancet, 361 (9369), 1603–7.Google Scholar
McDaniel, J. S., Musselman, D. L., Porter, M. R., et al. (1995). Depression in patients with cancer. Diagnosis, biology, and treatment. Archives of General Psychiatry, 52, 89–99.Google Scholar
Melvin, T. A., Ozbek, I. N. and Eberle, D. E. (1995). Recognition of depression. Hospice Journal, 10 (3), 39–46.Google Scholar
Minagawa, H., Uchitomi, Y., Yamawaki, S., et al. (1996). Psychiatric morbidity in terminally ill cancer patients. A prospective study. Cancer, 78 (5), 1131–7.Google Scholar
Moorey, S., Frampton, M. and Greer, S. (2003). The Cancer Coping Questionnaire: a self-rating scale for measuring the impact of adjuvant psychological therapy on coping behaviour. Psycho-oncology, 12, 331–44.Google Scholar
Musselman, D. L., Miller, A. H., Porter, M. R., et al. (2001). Higher than normal plasma interleukin-6 concentrations in cancer patients with depression: preliminary findings. American Journal of Psychiatry, 158, 1252–7.Google Scholar
Nowels, D. E., Bublitz, C., Kassner, C. T., et al. (2002). Estimation of confusion prevalence in hospice patients. Journal of Palliative Medicine, 5 (5), 687–95.Google Scholar
Pinquart, M. and Sorensen, S. (2003). Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. Psychology and Aging, 18 (2), 250–67.Google Scholar
Plumb, M. and Holland, J. (1981). Comparative studies of psychological function in patients with advanced cancer. II. Interviewer-rated current and past psychological symptoms. Psychosomatic Medicine, 43, 243–54.Google Scholar
Power, D., Kelly, S., Gilsenan, J., et al. (1993). Suitable screening tests for cognitive impairment and depression in the terminally ill – a prospective prevalence study. Palliative Medicine, 7 (3), 213–18.Google Scholar
Raymont, V., Bingley, W., Buchanan, A., et al. (2004). The prevalence and predictors of mental incapacity in medical in-patients. Lancet, 364, 1421–7.Google Scholar
Ripamonti, C., Filiberti, A., Totis, A., et al. (1999). Suicide among patients with cancer cared for at home by palliative-care teams. Lancet, 354 (9193), 1877–8.Google Scholar
Roth-Roemer, S., Fann, J. and Syrjala, K. (1997). The importance of recognizing and measuring delirium. Journal of Pain and Symptom Management, 13 (3), 125–7.Google Scholar
Sarhill, N., Walsh, D., Nelson, K. A., et al. (2001). Assessment of delirium in advanced cancer: the use of the bedside confusion scale. American Journal of Hospice and Palliative Care, 18 (5), 335–41.Google Scholar
Shuster, J. L. Jr. (2000). Palliative care for advanced dementia. Clinics in Geriatric Medicine, 16 (2), 373–86.Google Scholar
Sze, F. K., Wong, E., Lo, R., et al. (2000). Do pain and disability differ in depressed cancer patients?Palliative Medicine, 14, 11–17.Google Scholar
Watson, M., Greer, S., Rowden, L., et al. (1991). Relationships between emotional control, adjustment to cancer and depression and anxiety in breast cancer patients. Psychological Medicine, 21, 51–7.Google Scholar
Zigmond, A. S. and Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–70.Google Scholar

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