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:
- Continuous Subcutaneous Infusions (and compatibilities)
- Opioids (including equivalence tables)
- Prognostication (including tools to help)
1. Introduction to Palliative Medicine
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).
2. Conditions and Complications
2.1 Cancer
Thoracic Malignancies
Breast cancer
Gynaecological Malignancies
Urological Malignancies
Gastrointestinal Malignancies
Hepatobiliary Malignancies
Skin Malignancies
Primary CNS Tumours
Head and Neck Cancers
Haematological Malignancies
Lymphomas
Leukaemias
Plasma Cell Disorders
CUP
Other Cancers
2.2 Metastases and Specific Complications of Cancer and Other Advancing Terminal Illnesses
Metastases and Mass Effects
Brain metastases and Leptomeningeal metastases
Bone metastases and Pathological fracture
Pleural Effusion and Pericardial Effusion
Pulmonary metastases, Lymphangitis Carcinomatosis, Bronchial Obstruction and Superior Vena Cava Obstruction
Ascites and Malignant bowel obstruction
Liver metastases and Biliary Tract Obstruction
Pelvic Metastases and Obstructive uropathy
Subcutaneous Metastases and Malignant Ulcers
Bleeding and Clotting Complications of Cancer
Biochemical Complications of Cancer
Neurological Complications of Cancer
Other paraneoplastic syndromes (also see the conditions noted above)
Other Complications in Advanced Terminal Illnesses
- Arrhythmias and Atrial Fibrillation
- Fistulae
2.3 Organ Failure
Heart Failure
Liver Failure
- Ascites and Paracentesis
Renal failure
Respiratory Failure
Degenerative Neurological Conditions
Multi-Organ Failure
2.4 Miscellaneous Conditions
Microbiology and Infectious Diseases
Neurological Conditions
Surgical Conditions
Serious complications of medical treatments / iatrogenic problems
Pneumothorax post-pleural drainage
Haemorrhage secondary to anti-coagulation
Subcutaneous-line associated abscess
Cancer treatment complications occasionally seen in palliative care patients:
3. Symptoms and Signs
3.1 Symptoms
- Constitutional symptoms
- Respiratory symptoms
- Gastrointestinal symptoms
- Neurological, psychological and psychiatric symptoms
- Other symptoms
3.2 Signs
- General signs
- Cachexia
- Tachycardia
- Hypotension
- Hand signs
- Peripheral cyanosis
- Flapping tremor
- Facial signs
- Jaundice
- Pemberton’s sign
- Chest signs
- +Pleural effusion
- Abdominal signs
- Abdominal distension
- Leg signs
- Peripheral oedema
4. Investigations and diagnosis
4.1 Imaging
Plain films
Ultrasound
Computer tomography
Magnetic resonance
Nuclear imaging
Other imaging
4.2 Blood tests
Haematology
Full blood count
Coagulation studies
Biochemistry
- Sodium - Hyponatraemia
- Potassium Hypokalaemia and Hyperkalaemia
- Calcium - Hypercalcaemia and Hypocalcaemia
- Renal function - Urea and Creatinine
- Bilirubin - Jaundice
- Inflammatory markers - CRP
- Cell turnover markers - LDH
Miscellaneous blood tests
4.3 Pathology tests
4.4 Miscellaneous tests
5. Pharmacology, Procedures and Communication
5.1 Principles of Pharmacology
Routes of administration
5.2 Medication Index
Analgesia
Co-analgesics
Miscellaneous analgesics
Nausea drugs
Steroids
Anti-convulants
Medications for diarrhoea and constipation
Psychiatric Drugs
Drugs for infections
Drugs for heart and respiratory conditions
5.3 Communication
- Breaking bad news - Discussing resuscitation and escalation of treatment
5.4 Procedures and other treatments
- Procedures performed by palliative care physicians
- Ascitic tap
- Pleural tap
- Acupuncture
- Subcutaneous fluid drainage
- Procedures performed by palliative care nurses and allied health staff
- Wound dressings
- Subcutaneous line insertion
- Manual lymphatic drainage
- Allied health
- Physiotherapy and Mobility devices
- Occupational therapy
- Speech pathology and Communication devices
- Chemotherapy - Radiotherapy - Gastrointestinal endoscopic procedures
- Peg and Venting gastrostomy
- Endoscopic stent
- Bronchoscopic procedures
- Bronchial stent
- Pain Specialist procedures
- Nerve blocks
- Coeliac plexus block and Splanchnic block
- Intrathecal analgesia
- +Cordotomy
- Interventional radiology
- PICC line
- IVC filter
- RIG
- Surgical and orthopaedic procedures
- Prophylactic pin and Pathological fracture
- Tracheostomy
- Other interventions
- Pericardiocentesis
6. Ethics, Philosophy, Culture and Spirituality
6.1 Religion
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
6.2 Culture
Cultural world-views and issues in palliative care
6.3 Ethics
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