Challenging Cases in Palliative Care

Palliative care has evolved rapidly in recent years. Not only is the field dealing with an increasingly elderly and multi-morbid population, it is also addressing a wider variety of complex diagnoses such as heart failure, renal failure, advanced lung disease, frailty, and dementia. Challenging Cases in Palliative Care is unique, as it uses examples of real-world cases from palliative care practices. It also includes expert commentary to support modern clinicians in managing the 'messiness' of clinical care, as well as the increasingly complex needs of patients today. As part of our Challenging Cases series, the cases in this book not only cover a range of physical and psychosocial problems seen in palliative care, they also reflect the core curriculum for UK speciality trainees. Each case brings together expert interpretation of the available evidence, management strategies, guidelines and best practice, while discussing complexities in clinical decision-making and controversies in approach.

1 - Cancer-related bone pain
2 - Cancer-related neuropathic pain
3 - Interventional pain
4 - Pain in people with drug dependence
5 - Chronic non-cancer pain
6 - Breathlessness
7 - Nausea, vomiting and hiccups
8 - Cancer cachexia
9 - Palliative bowel obstruction
10 - Pruritis
11 - Mouth care
12 - Constipation
13 - Diarrhoea
14 - Clinical uncertainty and prognostication
15 - De-escalation from ITU
16 - Community patient transferred into ED/AMU - rapid assessment and decision-making
17 - Prescribing review
18 - Co-ordination and transfer of care
19 - Giving remote advice to families and other professional providers
20 - What to expect with death at home
21 - Individualised end of life care plans
22 - Depression in the context of life-limiting illness
23 - Hoarding
24 - Delirium
25 - Dementia
26 - Learning disabilities
27 - Serious mental health and the palliative care patient, including patients under section
28 - Symptom management in organ failure (renal failure)
29 - Rigidity
30 - Sialorrhoea
31 - Frailty/multi-morbidity
32 - Diabetic management at end of life
33 - Palliative management of malignant spinal cord compression (MSCC)
34 - Seizures
35 - Care planning and goal setting
36 - Advance care planning
37 - Pandemics and disaster response
38 - Spiritual care
39 - Cultural care
40 - Supportive care/survivorship
41 - Specific challenges: homelessness
42 - Transition from children's to adult palliative care
43 - Developing compassionate communities
44 - Bereavement
45 - A desire for hastened death
46 - Treatment escalation plans and CPR decisions
47 - Withdrawal of treatment
48 - Autonomy in children

Dr Edmonds has been a consultant at King's College Hospital NHS Foundation Trust since 1997. As honorary senior lecturer at King's College London she was heavily involved in development of the palliative care component of the undergraduate medical curriculum and examinations. She has been a training programme director for London, overseeing the delivery of postgraduate medical training and is currently the chair of the national Specialist Advisory Committee for Palliative Medicine. Dr Gillon has been a consultant in Palliative Medicine since 2015; chairs the Association of Palliative Medicine Education and Training Committee; is the Palliative Care education lead for the trust and is an active member of the regional Specialty Training Committee. She is regularly involved in local and national research projects and quality improvement initiatives. Dr Miller qualified from University College Cork, Ireland in 1988. Mary trained and worked in palliative medicine in Ireland, Sweden and the UK and has been a consultant in palliative medicine in Oxford since 1998. Mary has a strong interest in education; completing a Diploma in Learning and Teaching at Oxford University 2005, was Training Programme Director and Regional Specialty Advisor (2002 - 2008) and has led the Oxford Advanced Courses in Pain and Symptom Management since 2005. Mary is an elected member of the Education Committee of the Association of Palliative Medicine and joint lead of the postgraduate education special interest forum. Since the inception of OxCERPC in 2017, Mary and the team are focusing on building an exciting portfolio of courses, building research readiness and reaching out to practitioners across the globe. Dr Hawkins has been a Consultant in Palliative Medicine since 2020. She has previously completed a number of educational research projects alongside an MSc in Medical Education. She has experience of qualitative research studies and has undertaken a systematic review. She is currently a member of the Association of Palliative Medicine Education and Training Committee. Dr Yardley is a clinical academic interested in how patients, families, carers, and healthcare professionals do the work of frontline day-to-day healthcare and make sense of their experiences; hospital-community and specialist-generalist interfaces in palliative care; and patient transitions between hospital and community care, including palliative care in Emergency Departments and Acute Medical Units. Her research seeks to understand and improve human-dependent healthcare such as the impact therapeutic and professional collegiate relationships have on current and future care. Dr Felicity Dewhurst is a Consultant in Palliative Medicine at St Oswald's Hospice and an NIHR Advanced Fellow and Senior Clinical Lecturer in the Population Health Sciences Institute at Newcastle University. Following her Dunhill doctoral fellowship, she lobbied for the creation of the first NIHR Academic Clinical Lectureship in Palliative Medicine in Newcastle, and subsequently successfully applied for the first NIHR Advanced Fellowship in Palliative Medicine nationally (January 2024-6.25 years). Felicity has a Master's in Health Professions Education and is on the education committee of the Association of Palliative Medicine (APM) and the organising committee for the Palliative Care Congress (PCC). She is passionate about trying to improve care through research, education and service modification.