James L. Hallenbeck
- Published in print:
- 2003
- Published Online:
- November 2011
- ISBN:
- 9780195165784
- eISBN:
- 9780199999897
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195165784.001.0001
- Subject:
- Palliative Care, Patient Care and End-of-Life Decision Making, Pain Management and Palliative Pharmacology
Drawing from his extensive clinical experience and many years of teaching, the author of this book has written a guide to palliative care for clinicians. The topics addressed range from an overview ...
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Drawing from his extensive clinical experience and many years of teaching, the author of this book has written a guide to palliative care for clinicians. The topics addressed range from an overview of death and dying to specific approaches to symptom management. As an introduction to both the art and science of palliative care, the book reflects the perspectives of one physician who has dedicated his career to this rapidly evolving field. It links real stories of illness with practical advice, thereby delineating clinical practice in a way that reflects the daily concerns of clinicians.Less
Drawing from his extensive clinical experience and many years of teaching, the author of this book has written a guide to palliative care for clinicians. The topics addressed range from an overview of death and dying to specific approaches to symptom management. As an introduction to both the art and science of palliative care, the book reflects the perspectives of one physician who has dedicated his career to this rapidly evolving field. It links real stories of illness with practical advice, thereby delineating clinical practice in a way that reflects the daily concerns of clinicians.
Jennifer Chard, Peter Hoskin, and Sam H. Ahmedzai
- Published in print:
- 2012
- Published Online:
- May 2012
- ISBN:
- 9780199591763
- eISBN:
- 9780191739149
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199591763.003.0020
- Subject:
- Palliative Care, Patient Care and End-of-Life Decision Making
Supportive care is a major component in the management of malignant diseases that affect the respiratory system. It should be included in the overall management plan for the patient from the very ...
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Supportive care is a major component in the management of malignant diseases that affect the respiratory system. It should be included in the overall management plan for the patient from the very outset. Many patients who present with new respiratory or systemic symptoms of lung cancer will need urgent palliation of these problems, even before a definitive histological diagnosis can be made. Indeed, some patients who present late with advanced disease may be too ill for invasive diagnostic investigations, and palliative interventions will be planned on the basis of a working diagnosis of lung cancer, guided on radiological findings and clinical history. This chapter discusses the prevalence of symptoms in cancer, causes and assessment of symptoms in cancer, approaches to symptom management, technical advances in radiotherapy delivery, chemotherapy, comprehensive palliation of symptoms, and management of effusions.Less
Supportive care is a major component in the management of malignant diseases that affect the respiratory system. It should be included in the overall management plan for the patient from the very outset. Many patients who present with new respiratory or systemic symptoms of lung cancer will need urgent palliation of these problems, even before a definitive histological diagnosis can be made. Indeed, some patients who present late with advanced disease may be too ill for invasive diagnostic investigations, and palliative interventions will be planned on the basis of a working diagnosis of lung cancer, guided on radiological findings and clinical history. This chapter discusses the prevalence of symptoms in cancer, causes and assessment of symptoms in cancer, approaches to symptom management, technical advances in radiotherapy delivery, chemotherapy, comprehensive palliation of symptoms, and management of effusions.
David J. Bearison and Raymond K. Mulhern
- Published in print:
- 1994
- Published Online:
- November 2011
- ISBN:
- 9780195079319
- eISBN:
- 9780199999804
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195079319.003.0004
- Subject:
- Palliative Care, Paediatric Palliative Medicine, Patient Care and End-of-Life Decision Making
Problems associated with pain and symptom management among children undergoing treatment for cancer is a major area of concern for clinicians. This chapter discusses methods of assessing and treating ...
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Problems associated with pain and symptom management among children undergoing treatment for cancer is a major area of concern for clinicians. This chapter discusses methods of assessing and treating chemotherapy-induced nausea and vomiting, pain secondary to invasive procedures, and other distressing symptoms. It also reviews methods of evaluating individual differences among pediatric cancer patients in their vulnerability to pain symptoms, managing children's procedure-related pain and distress according to the needs of the individual child, and relationships between children's acute and chronic pain reactions. Focusing on acute pain, the chapter builds a framework for understanding variation in symptoms across children undergoing the same procedure or chemotherapy and variation in symptoms for the same child at different points in time. It also provides a brief review of the anatomy and physiology of pain transmission and inhibition.Less
Problems associated with pain and symptom management among children undergoing treatment for cancer is a major area of concern for clinicians. This chapter discusses methods of assessing and treating chemotherapy-induced nausea and vomiting, pain secondary to invasive procedures, and other distressing symptoms. It also reviews methods of evaluating individual differences among pediatric cancer patients in their vulnerability to pain symptoms, managing children's procedure-related pain and distress according to the needs of the individual child, and relationships between children's acute and chronic pain reactions. Focusing on acute pain, the chapter builds a framework for understanding variation in symptoms across children undergoing the same procedure or chemotherapy and variation in symptoms for the same child at different points in time. It also provides a brief review of the anatomy and physiology of pain transmission and inhibition.
James L. Hallenbeck
- Published in print:
- 2003
- Published Online:
- November 2011
- ISBN:
- 9780195165784
- eISBN:
- 9780199999897
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195165784.003.0005
- Subject:
- Palliative Care, Patient Care and End-of-Life Decision Making, Pain Management and Palliative Pharmacology
This chapter discusses the management of non-pain symptoms in terminally ill patients. These symptoms include nausea and vomiting, constipation, bowel obstruction, dyspnea, and cachexia. The chapter ...
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This chapter discusses the management of non-pain symptoms in terminally ill patients. These symptoms include nausea and vomiting, constipation, bowel obstruction, dyspnea, and cachexia. The chapter explains the pathophysiology, principles of therapy and recommended treatment for each of these symptoms. It also suggests that palliative care should not be so much about what the practitioners do as about why they do it.Less
This chapter discusses the management of non-pain symptoms in terminally ill patients. These symptoms include nausea and vomiting, constipation, bowel obstruction, dyspnea, and cachexia. The chapter explains the pathophysiology, principles of therapy and recommended treatment for each of these symptoms. It also suggests that palliative care should not be so much about what the practitioners do as about why they do it.
Susan M. Huff and Nancy Hutton
- Published in print:
- 2008
- Published Online:
- November 2011
- ISBN:
- 9780195340709
- eISBN:
- 9780199999927
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195340709.003.0003
- Subject:
- Palliative Care, Paediatric Palliative Medicine, Pain Management and Palliative Pharmacology
This chapter examines pain and symptom management for infants and children with a variety of life-limiting conditions. It explains that caring for infants and children with terminal illness is a ...
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This chapter examines pain and symptom management for infants and children with a variety of life-limiting conditions. It explains that caring for infants and children with terminal illness is a complex challenge that requires a coordinated interdisciplinary effort across the continuum of care and that it is necessary for health professionals to work closely with the child and the family to meet this challenge. The chapter recommends a multimodal approach to treatment that includes integrating pharmacological and psychosocial care with intentional consideration of the child's physical, cognitive, emotional, and spiritual levels of development.Less
This chapter examines pain and symptom management for infants and children with a variety of life-limiting conditions. It explains that caring for infants and children with terminal illness is a complex challenge that requires a coordinated interdisciplinary effort across the continuum of care and that it is necessary for health professionals to work closely with the child and the family to meet this challenge. The chapter recommends a multimodal approach to treatment that includes integrating pharmacological and psychosocial care with intentional consideration of the child's physical, cognitive, emotional, and spiritual levels of development.
James L. Hallenbeck
- Published in print:
- 2003
- Published Online:
- November 2011
- ISBN:
- 9780195165784
- eISBN:
- 9780199999897
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195165784.003.0003
- Subject:
- Palliative Care, Patient Care and End-of-Life Decision Making, Pain Management and Palliative Pharmacology
This chapter presents an overview of symptom management in palliative care. It explains that when considering symptom management of known, chronic illnesses, what is usually more important is to ...
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This chapter presents an overview of symptom management in palliative care. It explains that when considering symptom management of known, chronic illnesses, what is usually more important is to understand what clues the disease process can provide to understand and treat the symptoms of the patient. In the palliative setting, the relationship between the disease and the symptom is reversed; it is the disease process that becomes a clue to the symptom or patient experience.Less
This chapter presents an overview of symptom management in palliative care. It explains that when considering symptom management of known, chronic illnesses, what is usually more important is to understand what clues the disease process can provide to understand and treat the symptoms of the patient. In the palliative setting, the relationship between the disease and the symptom is reversed; it is the disease process that becomes a clue to the symptom or patient experience.
Russell K. Portenoy and Eduardo Bruera
- Published in print:
- 2003
- Published Online:
- November 2011
- ISBN:
- 9780195130652
- eISBN:
- 9780199999842
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195130652.003.0023
- Subject:
- Palliative Care, Palliative Medicine Research, Patient Care and End-of-Life Decision Making
The World Health Organization (WHO) defines palliative care as the active total care of patients whose disease is not responsive to curative treatment. Control of pain, other symptoms, and ...
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The World Health Organization (WHO) defines palliative care as the active total care of patients whose disease is not responsive to curative treatment. Control of pain, other symptoms, and psychological, social, and spiritual problems is paramount. Multiple perspectives, obtained through a variety of research methods, are necessary to provide a greater understanding of the whole person. The goal of palliative care is to achieve the best quality of life for patients and their families. In pediatric palliative care, where systematic knowledge development is only in its infancy, such perspectives become even more critical. This chapter identifies extant research in pediatric palliative care and suggests additional methods or approaches for gaining multiple perspectives.Less
The World Health Organization (WHO) defines palliative care as the active total care of patients whose disease is not responsive to curative treatment. Control of pain, other symptoms, and psychological, social, and spiritual problems is paramount. Multiple perspectives, obtained through a variety of research methods, are necessary to provide a greater understanding of the whole person. The goal of palliative care is to achieve the best quality of life for patients and their families. In pediatric palliative care, where systematic knowledge development is only in its infancy, such perspectives become even more critical. This chapter identifies extant research in pediatric palliative care and suggests additional methods or approaches for gaining multiple perspectives.
R.J. DUNLOP and J.M. HOCKLEY
- Published in print:
- 1998
- Published Online:
- November 2011
- ISBN:
- 9780192629807
- eISBN:
- 9780191730061
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780192629807.003.0009
- Subject:
- Palliative Care, Patient Care and End-of-Life Decision Making, Pain Management and Palliative Pharmacology
The guidelines presented in this book should give some insight into the advantages that result from an atmosphere of mutual cooperation. The discussion notes that managing the distress and the ...
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The guidelines presented in this book should give some insight into the advantages that result from an atmosphere of mutual cooperation. The discussion notes that managing the distress and the symptoms of advancing cancer, and being prepared to work alongside the primary team, may greatly reassure patients. Families and the professional are most likely to appreciate the extra dimension of supportive care that can be offered. This allows one to become part of a truly integrated service; offering a balanced approach to patients and families who are struggling to come to terms with the devastating impact of advanced cancer.Less
The guidelines presented in this book should give some insight into the advantages that result from an atmosphere of mutual cooperation. The discussion notes that managing the distress and the symptoms of advancing cancer, and being prepared to work alongside the primary team, may greatly reassure patients. Families and the professional are most likely to appreciate the extra dimension of supportive care that can be offered. This allows one to become part of a truly integrated service; offering a balanced approach to patients and families who are struggling to come to terms with the devastating impact of advanced cancer.
Cicely Saunders
- Published in print:
- 2006
- Published Online:
- November 2011
- ISBN:
- 9780198570530
- eISBN:
- 9780191730412
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780198570530.001.0001
- Subject:
- Palliative Care, Palliative Medicine Research
Cicely Saunders is universally acclaimed as a pioneer of modern hospice care. Trained initially in nursing and social work, she qualified in medicine in 1958 and subsequently dedicated the whole of ...
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Cicely Saunders is universally acclaimed as a pioneer of modern hospice care. Trained initially in nursing and social work, she qualified in medicine in 1958 and subsequently dedicated the whole of her professional life to improving the care of the dying and bereaved people. Founding St Christopher's Hospice in London in 1967, she encouraged a radical new approach to end of life care combining attention to physical, social, emotional and spiritual problems, captured in her concept of ‘total pain’. Her ideas about clinical care, education and research have been hugely influential, leading to numerous prizes and awards in recognition of her humanitarian achievements. This book includes a selection of Cicely Saunders' most important writings throughout a period of over forty years. Full articles, chapters, editorials, reviews, and commentaries include important clinical themes relating to the care of dying people such as pain and symptom management, issues of communication and truth telling, and the needs of particular patient groups, such as those with cancer and other diseases. The book includes pieces that reflect on the wider development of the palliative care field and on policy and organisational issues. Some of the papers take up the theme of spiritual care at the end of life, as well as the question of euthanasia, raising in turn issues of a wider theological and philosophical nature. The book is a testimony to the personal contribution of Cicely Saunders and the influence she has had upon the modern field of palliative and end of life care.Less
Cicely Saunders is universally acclaimed as a pioneer of modern hospice care. Trained initially in nursing and social work, she qualified in medicine in 1958 and subsequently dedicated the whole of her professional life to improving the care of the dying and bereaved people. Founding St Christopher's Hospice in London in 1967, she encouraged a radical new approach to end of life care combining attention to physical, social, emotional and spiritual problems, captured in her concept of ‘total pain’. Her ideas about clinical care, education and research have been hugely influential, leading to numerous prizes and awards in recognition of her humanitarian achievements. This book includes a selection of Cicely Saunders' most important writings throughout a period of over forty years. Full articles, chapters, editorials, reviews, and commentaries include important clinical themes relating to the care of dying people such as pain and symptom management, issues of communication and truth telling, and the needs of particular patient groups, such as those with cancer and other diseases. The book includes pieces that reflect on the wider development of the palliative care field and on policy and organisational issues. Some of the papers take up the theme of spiritual care at the end of life, as well as the question of euthanasia, raising in turn issues of a wider theological and philosophical nature. The book is a testimony to the personal contribution of Cicely Saunders and the influence she has had upon the modern field of palliative and end of life care.
David J. Bearison and Raymond K. Mulhern (eds)
- Published in print:
- 1994
- Published Online:
- November 2011
- ISBN:
- 9780195079319
- eISBN:
- 9780199999804
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195079319.001.0001
- Subject:
- Palliative Care, Paediatric Palliative Medicine, Patient Care and End-of-Life Decision Making
As the practice of pediatric oncology continues to advance and prognoses continue to improve, the course of treatment for children with poor prognoses becomes more biologically aggressive, more ...
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As the practice of pediatric oncology continues to advance and prognoses continue to improve, the course of treatment for children with poor prognoses becomes more biologically aggressive, more stressful, and more uncertain. Even for children who cannot be cured, new treatments have prolonged the survival of those with active disease and, consequently, medical interventions have complicated the dying process. For those who are cured, there are the lingering uncertainties of having undergone medical regimens whose adverse late effects are not yet fully understood. Consequently the field of pediatric oncology now encompasses more than strictly medical concerns. The conditions of treatment, survival, and dying have become the concerns of all health-care practitioners, including psychiatrists. This volume addresses a range of psychological issues—coping with pediatric cancer, pain and symptom management, medication compliance, sibling and family relations, care of the dying child, among others—pertaining to the practice of pediatric oncology. Each topic encompasses a substantial body of research that has theoretical and applied significance. Each chapter contextually defines the research area, discusses its theoretical and methodological concerns, critically reviews and integrates research findings in the area, discusses unresolved research issues, and suggests future research. The topics included are currently supported by sufficient empirical research to allow useful generalization of findings in the clinical setting.Less
As the practice of pediatric oncology continues to advance and prognoses continue to improve, the course of treatment for children with poor prognoses becomes more biologically aggressive, more stressful, and more uncertain. Even for children who cannot be cured, new treatments have prolonged the survival of those with active disease and, consequently, medical interventions have complicated the dying process. For those who are cured, there are the lingering uncertainties of having undergone medical regimens whose adverse late effects are not yet fully understood. Consequently the field of pediatric oncology now encompasses more than strictly medical concerns. The conditions of treatment, survival, and dying have become the concerns of all health-care practitioners, including psychiatrists. This volume addresses a range of psychological issues—coping with pediatric cancer, pain and symptom management, medication compliance, sibling and family relations, care of the dying child, among others—pertaining to the practice of pediatric oncology. Each topic encompasses a substantial body of research that has theoretical and applied significance. Each chapter contextually defines the research area, discusses its theoretical and methodological concerns, critically reviews and integrates research findings in the area, discusses unresolved research issues, and suggests future research. The topics included are currently supported by sufficient empirical research to allow useful generalization of findings in the clinical setting.
Justin Amery (ed.)
- Published in print:
- 2009
- Published Online:
- November 2011
- ISBN:
- 9780199567966
- eISBN:
- 9780191730566
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199567966.001.0001
- Subject:
- Palliative Care, Paediatric Palliative Medicine, Patient Care and End-of-Life Decision Making
Children's palliative care has developed rapidly as a discipline, as health-care professionals recognise that the principles of adult palliative care may not always be applicable to children at the ...
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Children's palliative care has developed rapidly as a discipline, as health-care professionals recognise that the principles of adult palliative care may not always be applicable to children at the end of life. The unique needs of dying children are particularly evident across Africa, where the scale of the problem is overwhelming and the figures so enormous that they are barely comprehensible: over 400,000 children in Africa died from AIDS in 2003, and out of the 166,000 children a year diagnosed with cancer, 84% of these are in the developing world. Despite the enormous need, provision of children's palliative care in Africa is almost non-existent, with very few health workers trained and confident to provide care for dying children. The challenges of providing palliative care in this setting are different to those in more developed countries, contending with the shortage of physical and human resources in addition to the vast scope of the care needed. Written by a group with wide experience of caring for dying children in Africa, this book provides guidance on improving access to, and delivery of, palliative care in this demanding setting. It looks at the themes common to palliative care — including communication, assessment, symptom management, psychosocial issues, ethical dilemmas, end-of-life care, and tips for the professional on compassion and conservation of energy — but always retains the focus on the particular needs of the health-care professional in Africa. Whilst containing some theory, the emphasis is on practical action throughout.Less
Children's palliative care has developed rapidly as a discipline, as health-care professionals recognise that the principles of adult palliative care may not always be applicable to children at the end of life. The unique needs of dying children are particularly evident across Africa, where the scale of the problem is overwhelming and the figures so enormous that they are barely comprehensible: over 400,000 children in Africa died from AIDS in 2003, and out of the 166,000 children a year diagnosed with cancer, 84% of these are in the developing world. Despite the enormous need, provision of children's palliative care in Africa is almost non-existent, with very few health workers trained and confident to provide care for dying children. The challenges of providing palliative care in this setting are different to those in more developed countries, contending with the shortage of physical and human resources in addition to the vast scope of the care needed. Written by a group with wide experience of caring for dying children in Africa, this book provides guidance on improving access to, and delivery of, palliative care in this demanding setting. It looks at the themes common to palliative care — including communication, assessment, symptom management, psychosocial issues, ethical dilemmas, end-of-life care, and tips for the professional on compassion and conservation of energy — but always retains the focus on the particular needs of the health-care professional in Africa. Whilst containing some theory, the emphasis is on practical action throughout.
Ann Armstrong-Dailey and Sarah Zarbock (eds)
- Published in print:
- 2008
- Published Online:
- November 2011
- ISBN:
- 9780195340709
- eISBN:
- 9780199999927
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195340709.001.0001
- Subject:
- Palliative Care, Paediatric Palliative Medicine, Pain Management and Palliative Pharmacology
Children with life-threatening and terminal illnesses—and their families—require a unique kind of care to meet a wide variety of needs. This book, now in its third edition, provides an authoritative ...
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Children with life-threatening and terminal illnesses—and their families—require a unique kind of care to meet a wide variety of needs. This book, now in its third edition, provides an authoritative source for the many people involved in the care of dying children. Written by leading authorities in pediatrics and palliative medicine, it emphasizes practical topics and covers the entire range of issues related to hospice care, from psychological stress to pain and symptom management. The text has been fully updated and includes an international perspective chapter and a chapter written by Children's Hospice International with detailed all-inclusive care plans.Less
Children with life-threatening and terminal illnesses—and their families—require a unique kind of care to meet a wide variety of needs. This book, now in its third edition, provides an authoritative source for the many people involved in the care of dying children. Written by leading authorities in pediatrics and palliative medicine, it emphasizes practical topics and covers the entire range of issues related to hospice care, from psychological stress to pain and symptom management. The text has been fully updated and includes an international perspective chapter and a chapter written by Children's Hospice International with detailed all-inclusive care plans.
Cathy Alban-Jones and Lorraine Moth
- Published in print:
- 2003
- Published Online:
- November 2011
- ISBN:
- 9780198528081
- eISBN:
- 9780191730399
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780198528081.003.0014
- Subject:
- Palliative Care, Patient Care and End-of-Life Decision Making
This chapter discusses the transition from palliative care in the hospital setting to terminal care in the home setting. After the decision to stop chemotherapy or aggressive treatment, families and ...
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This chapter discusses the transition from palliative care in the hospital setting to terminal care in the home setting. After the decision to stop chemotherapy or aggressive treatment, families and patients often seek the comfort of their homes in the hopes of finding familiar surroundings. In instances such as this, rapid hospital discharge is a must; however, adequate support must be provided to avoid emergency situations. This chapter covers: how to determine if the patient and their families want a home-care setting; guidelines on creating good communication with the patients and the families, particularly on difficult issues; symptom management for patients with advanced haematological malignancies; how to plan a smooth and efficient hospital discharge; and how to determine risk factors associated with complicated bereavement.Less
This chapter discusses the transition from palliative care in the hospital setting to terminal care in the home setting. After the decision to stop chemotherapy or aggressive treatment, families and patients often seek the comfort of their homes in the hopes of finding familiar surroundings. In instances such as this, rapid hospital discharge is a must; however, adequate support must be provided to avoid emergency situations. This chapter covers: how to determine if the patient and their families want a home-care setting; guidelines on creating good communication with the patients and the families, particularly on difficult issues; symptom management for patients with advanced haematological malignancies; how to plan a smooth and efficient hospital discharge; and how to determine risk factors associated with complicated bereavement.
Bee Wee
- Published in print:
- 2007
- Published Online:
- November 2011
- ISBN:
- 9780198569855
- eISBN:
- 9780191730443
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780198569855.003.0013
- Subject:
- Palliative Care, Palliative Medicine Research, Patient Care and End-of-Life Decision Making
Bedside teaching is quintessentially patient-centred. This chapter describes how bedside teaching can affect patients, learners, and teachers; introduces selected models of bedside teaching; and ...
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Bedside teaching is quintessentially patient-centred. This chapter describes how bedside teaching can affect patients, learners, and teachers; introduces selected models of bedside teaching; and discusses how these models might be used in teaching palliative care. Palliative care is an ideal setting in which to teach and demonstrate whole patient care through bedside teaching. It is a useful mode of teaching for all aspects of palliative care, including symptom assessment and management, psychosocial and spiritual support, communication skills, ethical decision-making, and patient and carer involvement and education.Less
Bedside teaching is quintessentially patient-centred. This chapter describes how bedside teaching can affect patients, learners, and teachers; introduces selected models of bedside teaching; and discusses how these models might be used in teaching palliative care. Palliative care is an ideal setting in which to teach and demonstrate whole patient care through bedside teaching. It is a useful mode of teaching for all aspects of palliative care, including symptom assessment and management, psychosocial and spiritual support, communication skills, ethical decision-making, and patient and carer involvement and education.
