Skip to main content
SpringerLink
Log in
Book cover

Palliative Care and Rehabilitation of Cancer Patients pp 185–201Cite as

Palliative care education: a global imperative

  • Chapter

Part of the book series: Cancer Treatment and Research ((CTAR,volume 100))

Abstract

Palliative care has primarily addressed the needs of patients with cancer during their last days of life. Indeed, in one country, it is mandated that formal hospice programs can only enroll patients who are expected to die within 6 months. The model wherein palliative care works only with cancer patients and their families towards the end of the patients’ existence is not logical, and may be expected to change dramatically over the next 10 years. Data from the SUPPORT study [1] clearly indicate that aspects of suffering common to cancer are also uniformly noted in patients dying of other advanced chronic disorders. Moreover, symptoms at the end of life have their genesis earlier in the course of illness. For a number of these symptoms, including pain, the cachexia—anorexia syndrome, and delirium, evidence exists [2–5] that early diagnosis and impeccable management may prevent or alleviate the full flowering of a devastating symptom. Logically, the myriad psychosocial problems that come to the fore during the course of illness should also be recognized and addressed before the end stage of an illness.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). 1995. A controlled trial to improve care for seriously ill hospitalized patients. JAMA 274(20):1591–1598.

    Article  Google Scholar 

  2. Liebeskind JC 1991 Pain can kill. Pain 44:3–4.

    Article  PubMed  CAS  Google Scholar 

  3. Lillemoe KD. 1998. Palliative therapy for pancreatic cancer. Surg Oncol Clin North Am 7(1):199–216.

    CAS  Google Scholar 

  4. Gogos CA, Ginopoulos P, Salsa B et al. 1998. Dietary omega-e polyunsaturated fatty acids plus vitamin E restore immunodeficiency and prolong survival for severely ill patients with generalized malignancy: a randomized control trial. Cancer 82(2):395–402.

    Article  PubMed  CAS  Google Scholar 

  5. Bruera E, Franco JJ, Maltoni M, et al. 1995. Changing pattern of agitated impaired mental status in patients with advanced cancer.association with cognitive monitoring, hydration, and opiate rotation. J Pain Symptom Manage 10(4):287–291

    Article  PubMed  CAS  Google Scholar 

  6. Cohen SR, Mount BM, Thomas JJN, Mount LF. 1996. Existential well-being is an important determinant of quality of life. Cancer 77:576–586.

    Article  PubMed  CAS  Google Scholar 

  7. Cohen SR, Mount BM. 1992. Quality of life in terminal illness: finding and measuring subjective well-being in the dying. J Palliat Care 8(3):40–45.

    PubMed  CAS  Google Scholar 

  8. Byock I. 1997. Dying Well. The Prospect for Growth at the End of Life. New York: Riverhead Books.

    Google Scholar 

  9. Kagawa-Singer M. 1993. Redefining health: living with cancer. Soc Sci Med 37:295–304.

    Article  PubMed  CAS  Google Scholar 

  10. World Health Organization. 1996. Cancer Pain Relief: With a Guide to Opioid Availability, 2nd ed. Geneva: World Health Organization.

    Google Scholar 

  11. World Health Organization. 1996. Symptom relief in terminal illness. Geneva: World Health Organization.

    Google Scholar 

  12. Sikora K. 1998. Developing a global strategy for cancer. Presented at ‘Cancer Strategies for the New Milennium.’ London: World Health Organization, October.

    Google Scholar 

  13. Liu BQ, Peto R, Chen ZM, et al. 1998. Emerging tobacco hazards in China: 1 Retrospective proportional mortality study of one million deaths. Br Med J 317(7170):1411–1422.

    Article  CAS  Google Scholar 

  14. Portenoy RK, Miransky J, Thaler HT, et al. 1992. Pain in ambulatory patients with lung or colon cancer. Cancer 70(6):1616–1624.

    Article  PubMed  CAS  Google Scholar 

  15. Von Roenn JH, Cleeland CS, Gonin R, Hatfield AK, Pandya KJ. 1993. Physician attitudes and practice in cancer pain management. A survey from the Eastern Cooperative Oncology Group. Ann Intern Med 119(2):121–126.

    Google Scholar 

  16. MacDonald N, Findlay HP, Bruera E, Dudgeon D, Kramer J. 1997. A Canadian survey of issues in cancer pain management. J Pain Symptom Manage 14(6):332–342.

    Article  PubMed  CAS  Google Scholar 

  17. Vainio A. 1995. Treatment of terminal cancer pain in France: a questionnaire study. Pain 62:155–162.

    Article  PubMed  CAS  Google Scholar 

  18. Larue F, Colleau SM, Brasseur L, Cleeland CS. 1995. Multicentre study of cancer pain and its treatment in France. Comment. Br Med J 311(7001):387.

    Google Scholar 

  19. Bass EB, Fortin AH, Morrison G, Wills S, Mumford LM, Goroll AH. 1997. National survey of clerkship directors in internal medicine on the competencies that should be addressed in the medicine core clerkship. Am J Med 102(6):564–571

    Article  PubMed  CAS  Google Scholar 

  20. American Board of Internal Medicine. 1996. Caring for the dying: identification and promotion of physician competency: Educational research documents. Philadelphia: American Board of Internal Medicine.

    Google Scholar 

  21. Callahan D. 1993. The Troubled Dream of Life: In Search of a Peaceful Death. New York: Simon & Schuster.

    Google Scholar 

  22. Cane W. 1952. Medical euthanasia: A paper, published in Latin in 1826; translated and reintroduced to the medical profession. J Hist Med Allied Sci 2:401–416.

    Article  Google Scholar 

  23. MacDonald N. 1991 The Canadian Palliative Care Curriculum. The Canadian Committee on Palliative Care Education.

    Google Scholar 

  24. National Council for Hospice and Specialist Palliative Care Services. 1996. Education in Palliative Care. Occasional Paper 9. London, February.

    Google Scholar 

  25. Doyle D, Hanks G, MacDonald N (eds). 1998. The Oxford Textbook of Palliative Medicine, 2nd ed. New York: Oxford University Press.

    Google Scholar 

  26. Berger A, Portenoy RK, Weissman DE. 1998. Principles and Practice of Supportive Oncology. New York: Lippincott Williams & Wilkins.

    Google Scholar 

  27. Carron AT, Lynn J, Keaney P. 1999. End of Life Care in Medical Textooks. Ann Intern Med 130:82–86.

    PubMed  CAS  Google Scholar 

  28. Sontag S. 1989. Illness as Metaphor and AIDS and its Metaphors. New York: Anchor Books, Doubleday.

    Google Scholar 

  29. Garrison, 1993. Quoted in Field MJ, Cassel CK (eds). 1997. Approaching Death: Improving Care at the End of Life. Committee on Care at the End of Life, Division of Health Care Services, Institute of Medicine. Washington, DC: National Academy Press, 214.

    Google Scholar 

  30. Block SD, Sullivan AM. 1998. Attitudes about end of life care: a national cross-sectional study. J Palliat Med 1:347–355.

    Article  PubMed  CAS  Google Scholar 

  31. Rogers EM. 1983. Diffusion of Innovations, 3rd ed. New York: The Free Press.

    Google Scholar 

  32. Billings JA, Block S. 1997. Palliative care in undergraduate medical education. Status report and future directions. JAMA 278(9):733–738.

    Article  PubMed  CAS  Google Scholar 

  33. Miles M (ed). 1964. Innovations in Education. New York: Teachers College Press. Quoted in Palliative Care in Victoria: A Vision. Report of the Palliative Care Task Force to the Minister for Aged Care, The Hon. Robert Knowles, Department of Health and Community Services, June 1995, 30.

    Google Scholar 

  34. Pocinky EG. 1998. Dialogue on core clinical skill (letter; comment). Ann Intern Med 129(3):253–254.

    Google Scholar 

  35. Manian FA. 1999. Where does the buck stop? N Engl J Med 340(3):240–241

    Article  Google Scholar 

  36. Manian FA. 1998. Should we accept mediocrity? N Engl J Med 338(15):1067–1069.

    Article  PubMed  CAS  Google Scholar 

  37. Wright SM, Kern DE, Kolodner K, et al. 1998. Attributes of excellent attending physician-role models. N Engl J Med 339(27): 1986–1993.

    Article  PubMed  CAS  Google Scholar 

  38. MacDonald N. 1998. A march of folly. Can Med Assoc J 158(13):1699–1701

    CAS  Google Scholar 

  39. Roy DJ, MacDonald N. 1998. Ethical issues in palliative care. In Doyle D, Hanks G, MacDonald N (eds), Oxford Textbook of Palliative Medicine, 2nd ed. New York: Oxford University Press, 97–138.

    Google Scholar 

  40. Iglehart JK. 1999. The American health care system — expenditures. N Engl J Med 340(l):70–76.

    Article  PubMed  CAS  Google Scholar 

  41. MacDonald N. 1995. Suffering and dying in cancer patients. West J Med 163(3):278–286.

    PubMed  CAS  Google Scholar 

  42. Fogarty LA, Curbow BA, Wingard JR, et al. 1999. Can 40 seconds of compassion reduce patient anxiety? J Clin Oncol 17(l):371–379.

    PubMed  CAS  Google Scholar 

  43. Weissman DE. 1997. Consultation in palliative medicine. Arch Intern Med 157:733–737.

    Article  PubMed  CAS  Google Scholar 

  44. Hefferty FW, Franks R. 1994. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med 69(11):861–871

    Article  Google Scholar 

  45. Cantor JC, Cohen AB, Barker DC, Shuster AL, Reynolds RC. 1991 Medical educators’ views on medical education reform. JAMA 265(8): 1002–1006.

    Article  PubMed  CAS  Google Scholar 

  46. Seifer SD. 1998. Recent and emerging trends in undergraduate medical education. Curricular responses to a rapidly changing health care system. West J Med 168(5):400–410.

    PubMed  CAS  Google Scholar 

  47. MacDonald N, Boisvert M, Dudgeon D, Hagen N. 1999. The Canadian Palliative Care Education Group: letter. Submitted.

    Google Scholar 

  48. The EPEC Project. 1998. Education for Physicians on End-of-Life Care Resource Guide. American Medical Association, Institute for Ethics, Section on End-of-Life Care, May, 24.

    Google Scholar 

  49. The EPEC Project. 1998. Education for Physicians on End-of-Life Care Resource Guide. American Medical Association, Institute for Ethics, Section on End-of-Life Care, May, 51

    Google Scholar 

  50. MacDonald N. 1991 Palliative care — the fourth phase of cancer prevention. Cancer Detect Prev 15(3):253–255.

    PubMed  CAS  Google Scholar 

  51. Cohen SR, Bultz BD, Clarke J, et al. 1997. Well-being at the end of life: Part 1 A research agenda for psychosocial and spiritual aspects of care from the patient’s perspective. Cancer Prev Control l(5):334–342.

    Google Scholar 

  52. Gill TM, Feinstein AR. 1994. A critical appraisal of the quality of quality of life measurement. JAMA 272(8):619–626.

    Article  PubMed  CAS  Google Scholar 

  53. Bruera E. 1996. Patient assessment in palliative cancer care. Cancer Treat Rev 22(Suppl A):3–12.

    Article  PubMed  Google Scholar 

  54. Teno JM, Byock I, Field MJ. 1999. Research agenda for developing measures to examine quality of care and quality of life of patients diagnosed with life-limiting illness. J Pain Symptom Manage 17(2):75–82.

    Article  PubMed  CAS  Google Scholar 

  55. Ad Hoc Committee on Cancer Pain of the American Society of Clinical Oncology. 1992. Cancer Pain Assessment and Treatment Curriculum Guidelines. J Clin Oncol 10(12): 1976–1982.

    Google Scholar 

  56. Anonymous. 1998. Cancer care during the last phase of life. J Clin Oncol 16(5):1986–1996.

    Google Scholar 

Download references

Authors
  1. Neil MacDonald
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Center for Palliative Studies, San Diego Hospice, San Diego, California, USA

    Charles F. von Gunten M.D., Ph.D, FACP

Rights and permissions

Reprints and permissions

Copyright information

© 1999 Springer Science+Business Media New York

About this chapter

Cite this chapter

MacDonald, N. (1999). Palliative care education: a global imperative. In: von Gunten, C.F. (eds) Palliative Care and Rehabilitation of Cancer Patients. Cancer Treatment and Research, vol 100. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-5003-7_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4615-5003-7_10

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-7272-1

  • Online ISBN: 978-1-4615-5003-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation