This book is written for doctors and nurses offering palliative care in the home, to help them deliver the best care possible and so to get the maximum professional satisfaction
from this responsibility. It evolves from Doyle’s ‘Domiciliary Palliative Care’ (1994).
The chapters on the treatment of pain, other physical symptoms and emergencies in palliative care provide clear and reasoned guidelines for management of these problems in the
home situation, geared to the level of doctors who are called on to provide palliative care only occasionally. Other chapters deal with psychosocial, spiritual, ethical, and communication issues,
all with the same clarity and practicality. The chapter on "Home, Hospital or Hospice?" gives a clear explanation of what has to be considered in helping the patient and family make
decisions about the site of care.
In writing for doctors who are only occasionally involved with palliative care, this book sets out the fundamental principles and practices of palliative care in a very clear
and readable manner. Some of the dot-point and heading lists are gems. Take the list setting the scene for symptom palliation: patients only report about 50% of their symptoms/ patients mention
different symptoms to nurses to what they report to doctors/ patients stop reporting symptoms if no interest is shown or treatment fails/ patients want to know the significance [to their illness]
of each symptom/ patients mention physical problems before psychosocial ones before spiritual ones/ patients do not want a prescription for each symptom but feel better for having reported the
things troubling them. Not much more to be said, is there?
This little book contains the essence of the practice of good palliative care. Here, clearly set out, is an explanation of what the problems are, what causes them, how they
differ from acute medicine, and how one might deal with them. Anybody who works in palliative care will benefit from reading this book. For GPs, it might almost be required reading. If they read
it once they might absorb the fundamentals of palliative care and how it differs from the rest of their medical practice. Then it can be put on the shelf until they are next required to provide
palliative care for one of their patients, when it will provide an excellent quick reference.
Highly recommended.
Roger Woodruff
Past Chairman, International Association for Hospice and Palliative Care (IAHPC)
Director of Palliative Care, Austin & Repatriation Medical Centre, Melbourne, Australia
April 2002
David Jeffrey is Macmillan Lead Palliative Care Consultant, 3 Counties Centre, Cheltenham General Hospital, and Honorary Senior Lecturer in Palliative Medicine, University of Bristol.
Table of Contents
1. The challenge of providing palliative care in the home 1
2. Symptom palliation 5
3. Pain palliation 52
4. Psychosocial issues 68
5. Spiritual and religious issues 77
6. Emergencies in palliative care 83
7. Ethical issues 95
8. Communication issues 101
9. Home, hospital or hospice? 112
10. Nursing issues at home 121
11. Grief and bereavement 132
12. Professional stress in palliative care 140
13. The final days: terminal care at home 144
Appendices 151
Index 165
