Palliative care education: a global imperative

  • Neil MacDonald
Part of the Cancer Treatment and Research book series (CTAR, volume 100)


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.


Palliative Care Palliative Care Service Palliative Medicine Comprehensive Cancer Control Cancer Pain Management 
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  1. 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.CrossRefGoogle Scholar
  2. 2.
    Liebeskind JC 1991 Pain can kill. Pain 44:3–4.PubMedCrossRefGoogle Scholar
  3. 3.
    Lillemoe KD. 1998. Palliative therapy for pancreatic cancer. Surg Oncol Clin North Am 7(1):199–216.Google Scholar
  4. 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.PubMedCrossRefGoogle Scholar
  5. 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):287–291PubMedCrossRefGoogle Scholar
  6. 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.PubMedCrossRefGoogle Scholar
  7. 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.PubMedGoogle Scholar
  8. 8.
    Byock I. 1997. Dying Well. The Prospect for Growth at the End of Life. New York: Riverhead Books.Google Scholar
  9. 9.
    Kagawa-Singer M. 1993. Redefining health: living with cancer. Soc Sci Med 37:295–304.PubMedCrossRefGoogle Scholar
  10. 10.
    World Health Organization. 1996. Cancer Pain Relief: With a Guide to Opioid Availability, 2nd ed. Geneva: World Health Organization.Google Scholar
  11. 11.
    World Health Organization. 1996. Symptom relief in terminal illness. Geneva: World Health Organization.Google Scholar
  12. 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. 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.CrossRefGoogle Scholar
  14. 14.
    Portenoy RK, Miransky J, Thaler HT, et al. 1992. Pain in ambulatory patients with lung or colon cancer. Cancer 70(6):1616–1624.PubMedCrossRefGoogle Scholar
  15. 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. 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.PubMedCrossRefGoogle Scholar
  17. 17.
    Vainio A. 1995. Treatment of terminal cancer pain in France: a questionnaire study. Pain 62:155–162.PubMedCrossRefGoogle Scholar
  18. 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. 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):564–571PubMedCrossRefGoogle Scholar
  20. 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. 21.
    Callahan D. 1993. The Troubled Dream of Life: In Search of a Peaceful Death. New York: Simon & Schuster.Google Scholar
  22. 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.CrossRefGoogle Scholar
  23. 23.
    MacDonald N. 1991 The Canadian Palliative Care Curriculum. The Canadian Committee on Palliative Care Education.Google Scholar
  24. 24.
    National Council for Hospice and Specialist Palliative Care Services. 1996. Education in Palliative Care. Occasional Paper 9. London, February.Google Scholar
  25. 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. 26.
    Berger A, Portenoy RK, Weissman DE. 1998. Principles and Practice of Supportive Oncology. New York: Lippincott Williams & Wilkins.Google Scholar
  27. 27.
    Carron AT, Lynn J, Keaney P. 1999. End of Life Care in Medical Textooks. Ann Intern Med 130:82–86.PubMedGoogle Scholar
  28. 28.
    Sontag S. 1989. Illness as Metaphor and AIDS and its Metaphors. New York: Anchor Books, Doubleday.Google Scholar
  29. 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. 30.
    Block SD, Sullivan AM. 1998. Attitudes about end of life care: a national cross-sectional study. J Palliat Med 1:347–355.PubMedCrossRefGoogle Scholar
  31. 31.
    Rogers EM. 1983. Diffusion of Innovations, 3rd ed. New York: The Free Press.Google Scholar
  32. 32.
    Billings JA, Block S. 1997. Palliative care in undergraduate medical education. Status report and future directions. JAMA 278(9):733–738.PubMedCrossRefGoogle Scholar
  33. 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. 34.
    Pocinky EG. 1998. Dialogue on core clinical skill (letter; comment). Ann Intern Med 129(3):253–254.Google Scholar
  35. 35.
    Manian FA. 1999. Where does the buck stop? N Engl J Med 340(3):240–241CrossRefGoogle Scholar
  36. 36.
    Manian FA. 1998. Should we accept mediocrity? N Engl J Med 338(15):1067–1069.PubMedCrossRefGoogle Scholar
  37. 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.PubMedCrossRefGoogle Scholar
  38. 38.
    MacDonald N. 1998. A march of folly. Can Med Assoc J 158(13):1699–1701Google Scholar
  39. 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. 40.
    Iglehart JK. 1999. The American health care system — expenditures. N Engl J Med 340(l):70–76.PubMedCrossRefGoogle Scholar
  41. 41.
    MacDonald N. 1995. Suffering and dying in cancer patients. West J Med 163(3):278–286.PubMedGoogle Scholar
  42. 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.PubMedGoogle Scholar
  43. 43.
    Weissman DE. 1997. Consultation in palliative medicine. Arch Intern Med 157:733–737.PubMedCrossRefGoogle Scholar
  44. 44.
    Hefferty FW, Franks R. 1994. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med 69(11):861–871CrossRefGoogle Scholar
  45. 45.
    Cantor JC, Cohen AB, Barker DC, Shuster AL, Reynolds RC. 1991 Medical educators’ views on medical education reform. JAMA 265(8): 1002–1006.PubMedCrossRefGoogle Scholar
  46. 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.PubMedGoogle Scholar
  47. 47.
    MacDonald N, Boisvert M, Dudgeon D, Hagen N. 1999. The Canadian Palliative Care Education Group: letter. Submitted.Google Scholar
  48. 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. 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, 51Google Scholar
  50. 50.
    MacDonald N. 1991 Palliative care — the fourth phase of cancer prevention. Cancer Detect Prev 15(3):253–255.PubMedGoogle Scholar
  51. 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. 52.
    Gill TM, Feinstein AR. 1994. A critical appraisal of the quality of quality of life measurement. JAMA 272(8):619–626.PubMedCrossRefGoogle Scholar
  53. 53.
    Bruera E. 1996. Patient assessment in palliative cancer care. Cancer Treat Rev 22(Suppl A):3–12.PubMedCrossRefGoogle Scholar
  54. 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.PubMedCrossRefGoogle Scholar
  55. 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. 56.
    Anonymous. 1998. Cancer care during the last phase of life. J Clin Oncol 16(5):1986–1996.Google Scholar

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© Springer Science+Business Media New York 1999

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  • Neil MacDonald

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