Textbook of Palliative Medicine

Welcome to palliative.tools' Textbook of Palliative Medicine. This under-construction wikibook seeks to be an accurate source of up-to-date information about the field of palliative medicine with a focus on the symptoms, investigations, treatment and prognosis of terminal illnesses and their complications as well as on symptom relief issues and pharmacology that is relevant to palliative medicine.

For a very concise summary of treatment guidelines for palliative care patients, see A Pocketbook of Palliative Medicine

This is a textbook that contains knowledge and perspective, but will not be useful for a deeper understanding of the art of palliative medicine, of communication and of the emotional and spiritual aspects of palliative care. For this aspect of palliative medicine, experience and respected colleagues will be of far more value.

Quick Links:

Palliative Illness (see chapter 2 below for details of different palliative illnesses).


Communication (see chapter 5 below for details of management including communication)

Quality of Life and Symptom Control (see chapters 3 to 5 for details on symptoms, signs, investigation and management).

End of Life Care - Care in the Last Few Days of Life (see chapter 6 for details on ethical and spiritual issues).

Thoracic Malignancies

Breast cancer

Gynaecological Malignancies

Urological Malignancies

Prostate Cancer

Transitional Cell Cancer - Bladder Cancer

Renal Cell Cancer

Gastrointestinal Malignancies

Hepatobiliary Malignancies

Skin Malignancies

Primary CNS Tumours

Head and Neck Cancers

Haematological Malignancies


Other Cancers

Metastases and Mass Effects

Heart Failure

Liver Failure

Renal failure

Respiratory Failure

Degenerative Neurological Conditions

Multi-Organ Failure

Microbiology and Infectious Diseases

Neurological Conditions

Surgical Conditions

Serious complications of medical treatments / iatrogenic problems

- General signs

  1. Cachexia
  2. Tachycardia
  3. Hypotension

- Hand signs

  1. Peripheral cyanosis
  2. Flapping tremor

- Facial signs

  1. Jaundice
  2. Pemberton’s sign

- Chest signs

  1. +Pleural effusion

- Abdominal signs

  1. Abdominal distension

- Leg signs

  1. Peripheral oedema

Plain films


Computer tomography


Magnetic resonance


Nuclear imaging

Other imaging


Full blood count

Coagulation studies


Miscellaneous blood tests


Nausea drugs



Medications for diarrhoea and constipation

Psychiatric Drugs

Drugs for infections

Drugs for heart and respiratory conditions


Heart failure medications

- Breaking bad news - Discussing resuscitation and escalation of treatment

- Procedures performed by palliative care physicians

  1. Ascitic tap
  2. Pleural tap
  3. Acupuncture
  4. Subcutaneous fluid drainage

- Procedures performed by palliative care nurses and allied health staff

  1. Wound dressings
  2. Subcutaneous line insertion
  3. Manual lymphatic drainage

- Allied health

  1. Physiotherapy and Mobility devices
  2. Occupational therapy
  3. Speech pathology and Communication devices

- Chemotherapy - Radiotherapy - Gastrointestinal endoscopic procedures

  1. Peg and Venting gastrostomy
  2. Endoscopic stent

- Bronchoscopic procedures

  1. Bronchial stent

- Pain Specialist procedures

  1. Nerve blocks
    1. Coeliac plexus block and Splanchnic block
    2. Intrathecal analgesia
    3. +Cordotomy

- Interventional radiology

  1. PICC line
  2. IVC filter
  3. RIG

- Surgical and orthopaedic procedures

  1. Prophylactic pin and Pathological fracture
  2. Tracheostomy

- Other interventions

  1. Pericardiocentesis

Religious world-views and their impacts in the medical care of the dying ====

Pentecostal Christianity, the Prosperity Gospel and Faith Healing

Jehovah’s Witnesses and Blood Transfusion

Cultural world-views and issues in palliative care

Ethical issues in palliative care

- Euthanasia, Physician Assisted Suicide and Continuous Deep Sedation - Withdrawal of Life-Supportive Treatment - Relief of Suffering and Potential Hastening of Death - Family discord in palliative care

  • textbook_of_palliative_medicine.txt
  • Last modified: 2019/07/10 13:19
  • by Graham Grove