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End of life issues

  • Nigel Sykes
    Correspondence
    Tel.: +44 20 8768 4500; fax: +44 20 8659 8680.
    Affiliations
    Palliative Medicine, St. Christopher’s Hospice, Lawrie Park Road, London SE26 6DZ, United Kingdom
    Palliative Medicine, King’s College University of London, United Kingdom
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Published:March 28, 2008DOI:https://doi.org/10.1016/j.ejca.2008.02.035

      Abstract

      Despite advances in cancer survival rates, end of life care remains a vital aspect of cancer management. The use of integrated care pathways can facilitate effective care of dying patients in a generalist setting. However, it remains important that staff are able to recognise the onset of the dying process, not only in order to make symptom control provision, but also that appropriate communication can occur with patients and those close to them. This allows the exercise of choice over place and style of care. The key symptoms at the end of life are restlessness, agitation, breathlessness, pain and noisy respiration from retained airway secretions. Ethical tensions arise from the assumptions that the use of opioids and sedatives hastens dying, but this is contradicted by available evidence.

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