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MSc, PG Diploma and PG Certificate in Palliative Care
Biology and Management of Symptoms in Advanced
Disease module overview
18th February – 1st March 2019
© Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation
SUMMARY OF MODULE This module reviews the epidemiology and pathophysiology of progressive incurable illnesses, which are relevant to specialists in palliative care. It then reviews the aetiology, mechanisms and management of common symptoms in palliative care leaving participants with the skills to assess and manage symptoms and appraise new therapies appropriate to their professional group.
LEARNING OUTCOMES 1. To be familiar with the epidemiology of progressive incurable diseases; the biology and
staging of cancer with particular emphasis on the most common malignancies. 2. To have obtained sound knowledge in the pathophysiological effects of progressive non-
malignant diseases, including the clinical effects of dysfunction and failure of the major organs.
3. To understand the association between pathological processes and prognosis. 4. To be able to assess and manage common symptoms as appropriate for the profession. 5. To recognise the contribution of different professions and disciplines in the
management of symptoms. 6. To have confidence in using the basic principles outlined in this unit to evaluate any new
or unfamiliar condition encountered in clinical practice.
MODULE CO-ORDINATORS Dr Matthew Maddocks, Senior Lecturer in Palliative Care, Cicely Saunders Institute, King’s College London Dr Sabrina Bajwah, Consultant and Senior Lecturer, Cicely Saunders Institute, King’s College London
LOCATION
The module will mainly be at the Cicely Saunders Institute, Dinwoodie 1 & 2, ground floor, except on
Tuesday 19th February, where the teaching will take place at St Christopher’s Hospice in the lecture
Theatre room.
PRE-MODULAR TASKS Before the module begins, some lecturers have asked you to do some pre-modular tasks, please see which sessions below. (The tasks will be explained in their session summary).
1. Evidence Based Health Care Professor Roger Kerry, Associate Professor, University of
Nottingham
Key References • Sykes N, Edmonds P, Wiles WJ. Management of Advanced Disease (4th edition). London: Arnold,
2004
• Derek Doyle, Geoffrey Hanks, Nathan I. Cherny, Kenneth Calman (eds). The Oxford Textbook of Palliative Medicine. Oxford: Oxford Medical Publications, OUP, 2003 (3rd
edition).
• Eduardo Bruera, Irene Higginson, Charles von Gunten, Carla Ripamonti Textbook of Palliative Medicine, Hodder Arnold, 2006
Biology & Management of Symptoms in Advanced Disease timetable 2019
18th February – 1st March 2019
Week 1
9.30-11.00 11.15-12.45 1.30-3.00 3.15-4.45
CSI Monday 18th
February
1. Introduction to module (Dr Matthew Maddocks) followed by:
2. Epidemiology and interaction of symptoms and implications for management (Javiera Martelli)
3. Emergency in Palliative Care (Dr Ruth Ting)
4. Evidence Based Health Care (Professor Roger Kerry)
5. Old Age (Professor Steve Jackson)
St
C’s
Tuesday 19th
February
6. Clinical case discussions Alison Landon & Jan Thirkettle
7. Library session 8. Intractable symptoms (Professor Rob George)
9. Sedation (Professor Rob George)
CSI Wednesday
20th February
10. Physiology of pain and pain processing (Professor Katie Urch)
11. Ethnicity, culture & pain (Dr Jonathan Koffman)
12. Nausea & Vomiting (Dr Paul Perkins)
13. Management of neuropathic pain (Dr Lynne Marsh)
CSI Thursday 21st
February
14. Cancer related fatigue (Professor Paddy Stone)
15. Library 16. Systematic review revisited (Dr Matthew Maddocks)
CSI Friday 22nd
February
17. Pain control – what is evidence of effectiveness? (Dr Amy Proffitt)
18. Referencing software (E-learning session)
19. Library session
Biology & Management of Symptoms in Advanced Disease timetable 2019
18th February – 1st March 2019
Week 2
9.30-11.00 11.15-12.45 1.30-3.00 3.15-4.45
CSI Monday 25th
February
20. Library session 21. Cachexia (Dr Matthew Maddocks)
22. Breathlessness (Dr Sara Booth)
CSI Tuesday 26th
February
23. COPD (Dr Patrick White)
24. Pruritus (Dr Martin Davidson)
25. Heart Failure (Dr James Beattie)
26. End of Life Discussions (Dr Fiona Ring)
CSI Wednesday
27th February
27. HIV/AIDS (Professor Julia Downing & Professor Richard Harding)
28. Depression & Anxiety (Dr Christian Schulz-Quach)
29. Stroke (Dr Jonathan Birns)
30. Seminar Series (will start a 4pm)
CSI Thursday
28th February
31. Management of constipation (Dr Nick Gough)
32. Dementia (Dr Clare Ellis-Smith)
33. Library session 34. Management of MND (Dr Rachel Burman)
CSI Friday 1st
March
35. Other Symptoms (Dr Victor Pace)
36. Module evaluation discussion Dr Matthew Maddocks (Follows immediately after last session)
Monday 18th February
Session 1: Introduction of module followed by Epidemiology and interaction of
symptoms and implications for management Dr Matthew Maddocks, Senior lecturer in Health Services Research, Cicely Saunders
Institute
Javiera Martelli, Research Assistant, Cicely Saunders Institute
Summary:
Not yet available
Session 2: Emergencies in Palliative Care Dr Ruth Ting, consultant in palliative care, King’s College Hospital
Summary:
1. Review the concept of what constitutes an emergency in palliative care 2. Understand factors which may help guide an appropriate response 3. Consider specific examples of emergencies within the field of oncology, long-term/chronic
conditions and also non-medical emergencies (social, spiritual, psychological)
Session 3: Evidence Based Health Care
Professor Roger Kerry, Associate Professor, University of Nottingham
Evidence based medicine (EBM) is clearly a major clinical "buzz-phrase" of our time. There is a great
deal of rhetoric about the term. Increasingly clinicians are being asked to apply it. MSc courses are
being built around it. But it is contentious. What actually is evidence based medicine? Does it replace
good assessment and practice? Where can you find out information about it?
This session will examine what evidence-based medicine is, and what it isn’t. It will discuss how the
core principles of EBM align (or not) with the complexity and context-sensitivity of clinical decision
making. We will also have the chance to review traditional models of clinical reasoning, and being a
good doctor, and see how tension between clinical reasoning models and EBM might be reconciled.
Learning outcomes:
At the end of the session, participants should be able to:
• Describe what evidence-based medicine is and what it isn’t
• Appraise the role of evidence-based medicine in palliative care practice, and the barriers to it
• Identify sources of evidence relevant to their practice
Pre-modular task:
Watch these videos and think about the wider / misinterpretations of EBM:
Trish Greenhalgh - ‘Real v Rubbish EBM’ (29mins): https://youtu.be/qYvdhA697jI
Evidence Based Medicine with Jane and Billy-Joe (6mins): https://youtu.be/tsk788hW2Ms
Michael Loughlin - Argument, Platitude, Caricature & Ridicule in the EBM Debate (1hr04mins): https://youtu.be/KhI7P0gCneY
Recommended reading list:
Kerry R. Expanding our perspectives on research in musculoskeletal science and practice. Musculoskelet Sci Pract. 2017 Dec;32:114-119. doi: 10.1016/j.msksp.2017.10.004.
Greenhalgh T. Is my practice evidence-based? BMJ 1996; 313: 957-8.
Sackett DL et al. Evidence-based medicine: what it is and what it isn't. BMJ 1996; 312: 71-2.
Further reading and resources:
The European Society for Person Centered Healthcare (ESPCH) http://pchealthcare.org.uk/
CauseHealth: https://causehealthblog.wordpress.com/
Session 4: Old Age
Professor Steve Jackson, Professor of Clinical Gerontology, King’s College University
Summary:
No information available
Tuesday 19th February (At St Christopher’s Hospice)
Session 5: clinical case discussion Alison Landon Speciality Doctor in. Palliative Medicine and Jan Thirkettle, Consultant Nurse
at St Christopher’s Hospice
Summary:
This session will be facilitated jointly by a consultant in Palliative Medicine and a Clinical Nurse Specialist from a community Palliative Care team and will take an interactive approach. Most people, if asked, say they would like to be cared for at home at the end of their life. Together we will look at an actual case in order to consider the practical challenges of palliative care outside an inpatient unit. Recommended reading:
• Gomes B, Higginson IJ. Factors influencing death at home in terminally ill patients with cancer: a systematic review. BMJ, 2006; 332: 515-521.
• Taubert M, Noble S, Nelson A. What challenges good palliative care provision out-of-hours? A qualitative interview study of out-of-hours general practitioners. BMJ Supportive and Palliative
Care, 2011; 1: 13-18.
Session 6: Library session
Session 7: Intractable symptoms Professor Rob George, Consultant Physician Palliative Care, Guy's and St Thomas'
Foundation Trust, Honorary Professor of Palliative Care
Summary:
No information available
Session 8: Sedation Professor Rob George, Consultant Physician Palliative Care, Guy's and St Thomas'
Foundation Trust, Honorary Professor of Palliative Care
Summary:
No information available
Wednesday 20th February
Session 9: Physiology of pain and pain processing Professor Katie Urch, Consultant in Palliative Medicine, Palliative Care Team, Oncology Chief
of Service, ICHT
Summary: This session will provide students with an understanding of the pathophysiology of pain, the mechanistic basis of pain and current theories on peripheral neuropathic pain, NMDA receptor antagonists, and cannabinoids. The session will also explore possible therapeutic interventions to manage pain. Recommended reading:
• Besson JM. The neurobiology of pain, Lancet 1999; 353: 1610-1615. Further reading:
• Petrovic P, Ingvar M. Imaging cognitive modulation of pain processing, Pain 2002, 95: 1-5
• Suzuki R, Dickenson AH. Neuropathic pain: nerves bursting with excitement NeuroReport 2000 11(12)
• Scholz J, Woolf CJ. Can we conquer pain? Nature neuroscience supplement 5, November 2002
• Ren K, Dubner R. Descending modulation in persistent pain: an update, Pain 2002, 100: 1-6
• Bantick SJ, Wise RG, Ploghaus A, Clare A, Smith SM, Tracey I. Imaging how attention modulates pain in humans using functional MRI, Brain 2002, 125; 310-319
Session 10: Ethnicity, culture and pain Dr Jonathan Koffman, Reader in Palliative Care, Cicely Saunders Institute
Summary:
Theories of pain have traditionally been dominated by biomedicine concentrating upon its
neurophysiological aspects, both in diagnosis and treatment. Scientific medicine has reduced the
experience of pain to an elaborate broadcasting system of signals rather than seeing it as moulded
both by the individual and their socio-cultural context. Pain, however also lies at the intersection
between biology and culture. In this session we will explore evidence, quantitative and qualitative, to
show that:
i. not all social/cultural groups respond to pain in the same way; ii. the perception and response to pain can be largely influenced by our cultural
background; iii. how, and whether, people communicate their pain to health professionals and to
others, is influenced by cultural factors. The implications for palliative care will be discussed.
Recommended reading:
•Anderson, K. O., Richman, S. P., Hurley, J., Palos, G., Valero, V., Mendoza, T. R., Gning, I., &
Cleeland, C. S. 2002, Cancer pain management among underserved minority outpatients: Perceived
needs and barriers to optimal control Cancer, vol. 94, pp. 2295-2304.
•Koffman, J., Higginson, I. J., & Donaldson, N. 2003, Symptom severity in advanced cancer assessed
in two ethnic groups by interviews with bereaved family members and friends, Journal of the Royal
Society of Medicine, vol. 96, pp. 10-16.
•Koffman, J., Morgan, M., Edmonds, P., Speck, P., & Higginson, I. J. 2008 Cultural meanings of pain: a
qualitative study of Black Caribbean and White British patients with advanced cancer. Palliative
Medicine, vol. 22, pp. 350-359.
•koffman J, Goddard C. Is the experience of cancer-related pain shaped by ethnicity or cultural
background? European Journal of Palliative Care 2011:18: 130-135.
Further reading and esources: CINTRON, A. & MORRISON, R. S. 2006. Pain and ethnicity in the United States: A systematic review. Journal of Palliative Medicine, 9, 1454-1473.
Session 11: Nausea & Vomiting Dr Paul Perkins, Consultant in Palliative Care, Sue Ryder Hospice in Leckhampton, Cheltenham
Summary:
This session will focus on the diagnosis and management of nausea and vomiting in advanced
disease. The latest evidence will be discussed.
References:
• Collis E, Mather H Nausea and vomiting in palliative care BMJ 2015;351:h6249
• Currow DC et al. A multi-site, fixed dose, parallel arm, double-blind, placebo controlled, block randomised trial of the addition of infusional octreotide or placebo to regular ranitidine and dexamethasone for the evaluation of vomiting associated with bowel obstruction at the end of life. Journal of Pain & Symptom Management. 2015; 49: 814-21.
• Saxby C et al. How should we measure emesis in palliative care? Palliative Medicine 2007; 21: 369–383
• Glare PA, et al. Treatment of nausea and vomiting in terminally ill cancer patients. Drugs, 2008;68:2575-90.
• AMS Gastroparesis Task Force: Abell TL et al. Treatment of Gastroparesis: A Multidisciplinary Review. Neurogastroenterology and Motility 2006;18(4):263-83
• Bentley A, Boyd K. Use of clinical pictures in the management of nausea and vomiting: a prospective audit. Palliative Medicine 2001; 15: 247-253
Session 12: Management of Neuropathic Pain Dr Lynne Marsh, consultant in palliative care, Guy’s St Thomas’ Hospital
Summary:
No information available
Thursday 21st February
Session 13: Cancer related fatigue Professor Paddy Stone, Professor of palliative and end of life care at UCL
Summary: This session is concerned with the definition, aetiology, assessment and management of cancer-related fatigue. At the end of the session participants should be able to; describe how to assess and measure cancer-related fatigue; understand the role of drug and non-drug management strategies; know how to access and interpret evidence based treatment guidelines Recommended reading list:
1. Mücke M, Mochamat, Cuhls H, Peuckmann-Post V, Minton O, Stone P, Radbruch L. Pharmacological treatments for fatigue associated with palliative care. Cochrane Database of Systematic Reviews 2015, Issue 5. Art. No.: CD006788. DOI: 10.1002/14651858.CD006788.pub3
2. Minton O, Richardson A, Sharpe M, Hotopf M and Stone P (2010). "Drug therapy for the management of cancer-related fatigue." Cochrane Database of Systematic Reviews 7 (DOI: 10.1002/14651858.CD006704.pub3).
3. Cramp, F. and J. Daniel, Exercise for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews, 2008(2): p. CD006145
4. Goedendorp, M.M., et al., Psychosocial interventions for reducing fatigue during cancer treatment in adults. Cochrane Database of Systematic Reviews, 2009(1): p. CD006953
5. Roji R and Centeno C. The use of methylphenidate to relieve fatigue. Curr Opin Support Palliat Care 2017, 11:299–305
Further reading and resources: Suggest looking at NCCN supportive care guidelines on cancer-related fatigue which can be accessed at: https://www.nccn.org/professionals/physician_gls/default.aspx
Session 14: Library session
Session 15: Systematic Review revisited and assignment discussion Dr Matthew Maddocks, Senior lecturer in Health Services Research, Cicely Saunders Institute
Summary:
The session will revisit the aims and objectives from the Research Methods module:
1. Describe the rationale/place for systematic reviews
2. Provide a general description of the methodology of carrying out a systematic review and to
illustrate this with reference to a recent review of interventions to improve symptoms and quality of
life in interstitial lung disease.
3. Describe (and appraise) some of the instruments for assessing quality of studies
4. Explore your ideas for carrying out your own reviews and where appropriate clarify the questions
you may want to address (please think of a topic that you would like to discuss during this session)
Friday 22nd February
Session 16: Pain Control – what is the evidence of effectiveness? Dr Amy Proffitt, Consultant in Palliative Medicine at the Barts Health NHS Trust
Summary:
Not information available
Session 17: Referencing software (self-learning)
This session will take place at the IOP, Computer room A & B and will be e-learning based.
Session 18: Library session
Monday 25th February
Session 19: Library session
Session 21: Cachexia Dr Matthew Maddocks, Senior lecturer in Health Services Research, Cicely Saunders Institute
Summary:
Cancer cachexia is defined as a multifactorial syndrome characterised by an ongoing loss of skeletal
mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional
support and leads to progressive functional impairment. In this session, we will the following:
- Pathophysiology - Screening & Assessment - Management
Session 22: Breathlessness Dr Sara Booth, Honorary Senior Lecturer, King’s College London and University of Cambridge
I have sent a suggested general bibliography for this session and some preliminary reading of e.g. the
ATS position statement on Dyspnea from 2012 would be helpful. However, I would like to spend some
time (probably half an hour) during the module thinking about the role of opioids (mainly) and other
drugs in treating breathlessness. It has become a ‘hot topic’ in this area of practice.
I have suggested four papers that I would like you to read beforehand and be prepared to talk about
(in the group): there are some older ones mentioned on general reading. All attached.
We will also consider theoretical basis and practical use of Breathing, Thinking, Functioning (Spathis
et al, 2016).
1. Which patients with breathlessness get most benefit from morphine and other opioids?
2. What are the optimum dosing regimens for morphine in breathlessness?
3. What do you think of the points outlined in the papers by Pattinson (letter) and Rocker
(editorial) about the social dangers or lack of them and opioids and possible adverse effects.
4. Do you think the change in the use of opioids in chronic pain management has changed has
relevance to dyspnoea management?
Key reading for discussion (and see others on general list)
Pattinson et al, (2018) Adverse respiratory effects of opioids for chronic breathlessness. Learning
lessons from chronic pain. ERJ in press, author’s permission to use
Rocker G., Bourbeau J, & Downar J. (2018) ‘The New ‘‘Opioid Crisis’’:Scientific Bias, Media
Attention, and Potential Harms for Patients with Refractory Dyspnea’ Journal of Pall
Med 21;2:120-121
Verberkt et al, (2017) Respiratory adverse effects of opioids for breathlessness a systematic review
and meta-analysis ERJ 50; https://doi.org/10.1183/13993003.01153-2017
Vozoris et al, (2016) Incident opioid drug use and adverse respiratory outcomes among older adults
with COPD Eur Respir J 2016; 48: 683–693
Tuesday 26th February
Session 23: COPD
Dr Patrick White, Senior Lecturer, Division of Health and Social Care Research, Department
of Primary Care and Public Health Sciences, King’s College London
Summary:
No information available
Session 24: Pruritus Dr Martin Davidson, Registrar in palliative care, King’s College London
Summary:
No information available
Session 25: Heart Failure Dr James Beattie, Consultant, Heart of England NHS Trust, Birmingham
Participants will:
1) Become aware of the nature and challenges posed by advanced heart failure, the characteristics of the affected clinical cohort, and the complexity of comprehensive therapy, including the use of implanted cardiac devices.
2) Be able to identify clinical features which might help distinguish those close to the end of life to facilitate timely prospective palliative care intervention.
3) Appreciate potential conflicts which might arise in the maintenance of established therapies when goals of care change as patients decline along the heart failure disease trajectory, the importance of shared decision making, and the potential role of advance care planning.
Recommended reading:
• Barclay S, Momen N, Case-Upton S, Kuhn I, Smith E. End of life care conversations with heart failure patiens: a systematic literature review and narrative synthesis. British Journal of General Practice. Jan 2011
• Allen LA, Stevenson LW, Grady KL, Goldstein NE, Matlock DD, Arnold RM, Cook NR, Felker M, Francis GS, Hauptman PJ, Havranek EP, Krumholz HM, Mancini D, Riegel B and Spertus JA. Decision making in advanced heart failure: A Scientific Statement from the American Heart Association. Circulation 2012; 125:1928-1952
• Beattie J. Implantable cardioverter defibrillators in patients who are reaching the end of life.: A discussion document for health professionals. British Heart Foundation 2007
• Goodlin SJ. Palliative Care in Congestive Heart Failure. Journal of the American College of Cardiology 2009; 54; 386-396
• Jaarsma T, Beattie JM, Ryder M, Rutten FH, McDonagh T, Mohasci P, Murray SA, Grodzicki T, Bergh I, Metra M, Ekman I, Angermann C, Leventhal M, Pitsis A, Anker SD, Gavazzi A, Ponikowski P, Dickstein K, Delacretaz E, Blue L, Strasser F, McMurray J. Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure (2009) 11; 433-443
• Low J, Patttenden J, Candy B, Beattie JM, Jones L. Palliative care in advanced heart failure: An international review of the perspectives of recipients and health professional on care provision. Journal of Cardiac Failure 2010 (in press)
• Guidelines for Symptom Control and Specialist palliative Care Referral for adult patients with end-stage heart failure. South East London Cardiac and Stroke Network, South East London Cancer Network 2009.
Session 26: End of life decisions and diagnosis of dying
Dr Fiona Ring, Consultant in Palliative Medicine, Princess Royal University Hospital
Summary:
No information available
Wednesday 27th February
Session 27: HIV/AIDS Professor Julia Downing, Honorary Research Fellow & Professor Richard Harding, Herbert Dunhill
Professor of Palliative Care & Rehabilitation, Cicely Saunders Institute
Summary:
This session will give an overview of the need for palliative care at different stages of the HIV disease
trajectory. It will cover palliative care for those living with HIV/AIDS in well-resourced and low resource
settings and give an insight into the challenges of providing palliative care to people living with
HIV/AIDS in a low resource setting.
References:
1. Simms V, Higginson I and Harding, R. What Palliative Care related problems do patients
experience at HIV diagnosis? A systematic review of the evidence JPSM 2011;42:734- 753
2. Stjernsward J, Foley K and Ferris F. The Public Health Strategy for Palliative Care JPSM
2007;33:486-493.
3. Harding R, Karus D, Easterbrook P, Higginson IJ, Raveis V, Marconi K
.Does palliative care improve outcomes for patients with HIV/AIDS?: a systematic review of the
evidence. Sex Transm Infect 2005 Feb; 81(1): 5–14.
4. Gwyther L, Brennan F, Harding R. Advancing palliative care as a human right. JPSM 2009
Nov;38(5):767-74.
5. Harding R, Powell RA, Kiyange F, Downing J, Mwangi-Powell F. Provision of pain- and symptom-
relieving drugs for HIV/AIDS in sub-Saharan Africa. J Pain Symptom Manage 2010; 40: 405–415
6. UNAIDS Gap Report 2014. Access at:
http://www.unaids.org/en/resources/campaigns/2014/2014gapreport/gapreport
Session 28: Depression Dr Christian Schulz-Quach, Psychotherapists, King’s College London
Summary:
No Information available
Session 29: Stroke
Dr Jonathan Birns, Consultant in Stroke, Guy’s and St Thomas’ NHS Foundation trust
Summary:
This session will provide an overview of stroke, discuss the challenges of palliative care for stroke
patients and assess the palliative care needs of stroke patients. Key issues that will be covered include
the concept of palliative care in the hyperacute hospital setting, the integration of managing complex
symptoms, facilitating open communication, artificial feeding decisions, the location and means of
palliative care provision and caregiver burden
Recommended reading list:
See attached.
Session 30: Rehabilitation and palliative care - companions, competitors, or
collaborators?' (Seminar Series) Professor Derick Wade, Consultant in Neurological Rehabilitation
The Cicely Saunders Institute hosts a FREE monthly seminar with speakers presenting on a range of
palliative care and rehabilitation related research topics. The series aims to optimise opportunities for
local, national and international networking within palliative care and rehabilitation. We welcome
King's staff, students and the public. The Seminars have CPD (1 credit) Royal College of Physicians
accreditation.
Thursday 28th February
Session 31: Management of constipation
Dr Nick Gough, Consultant in palliative care at Guys and St Thomas' NHS Foundation Trust
Summary:
This session will look in some detail at the definition of constipation, its causation in palliative care, its
investigation and the options for its management. The aim will be to encourage participants to
conduct more audit and research related to this distressing symptom, and to adopt a logical approach
to its relief.
Recommended reading:
• Larkin P, Sykes N, Centeno C et al. The management of constipation in palliative care: clinical practice recommendations. Palliative Medicine, 2008; 22: 796-807.
• Hawley P, Barwich D, Kirk L. Implementation of the Victoria Bowel Performance Scale. J Pain and Symptom Management, 2011; 42: 946-953.
• Twycross R, Sykes N, Mihalyo M, Wilcock A. Stimulant laxatives and opioid-induced constipation. J Pain and Symptom Management, 2012; 43: 306-313.
• Thomas J, Karver S, Cooney GA et al. A randomised, placebo-controlled trial of subcutaneous methylnaltrexone for the treatment of opioid-induced constipation in patients with advanced illness. New England Journal of Medicine, 2008; 358: 2332-2334.
• Clark K, Byfieldt N, Dawe M, Currow DC. Treating constipation in palliative care: the impact of other factors aside from opioids. Am J Hospice and Pall Med, 2012; 29: 122-125.
Session 32: Dementia Dr Clare-Ellis Smith, Research Associate, Cicely Saunders Institute
Summary of session:
Dementia is a progressive and terminal condition characterised by loss of cognitive function and
resulting in increased dependence throughout the disease trajectory. Behavioural and psychological
symptoms at all stages is common. Dementia is predominantly a disease of older age and
consequently many with dementia experience high levels of comorbidity. This means that people with
dementia may have high physical and psychological symptom burden, and significant care needs.
There is international recognition that palliative care can benefit people with dementia, however
there is a lack of evidence as to the best model of palliative care provision for this population.
In this session we will examine the epidemiology of dementia, the role of palliative care through the
course of disease trajectory, and assessment and management of some of the common symptoms.
Learning outcomes:
• Familiar with epidemiology of dementia
• Knowledge of the pathophysiology and symptom presentation throughout the course of dementia
• Understanding of the challenges of assessment
• Knowledge of evidence-based interventions for common symptoms Recommended reading list:
• van der Steen, J. T., Radbruch, L., Hertogh, C. M., de Boer, M. E., Hughes, J. C., Larkin, P., Francke, A. L., Junger, S., Gove, D., Firth, P., Koopmans, R. T. and Volicer, L. (2014) 'White paper defining optimal palliative care in older people with dementia: A Delphi study and recommendations from the European Association for Palliative Care', Palliative Medicine, 28 (3), 197-209.
• van der Steen JT, Lemos Dekker N, Gijsberts MHE, Vermeulen LH, Mahler MM, The BA. Palliative care for people with dementia in the terminal phase: a mixed-methods qualitative study to inform service development. BMC Palliat Care 2017; 16(1): 28.
Further reading and resources:
• Biessels GJ, Scheltens P. Vascular cognitive impairment. In Hussain M and Schott JM, editors. Cognitive Neurology and Dementia. Oxford: Oxford University Press; 2016. p275-284.
• Hanağasi HA, Bilgic B, Emre M. Dementia with Lewy bodies and Parkinson's dsease dementia. In Hussain M and Schott JM, editors. Cognitive Neurology and Dementia. Oxford: Oxford University Press; 2016. p399-412.
• Minett T, Brayne C. Epidemiology of dementia. In Hussain M and Schott JM, editors. Cognitive Neurology and Dementia. Oxford: Oxford University Press; 2016. p211-219.
• Revesz T, Lashley T, Holton J. Pathology of degenerative dementias. In Hussain M and Schott JM, editors. Cognitive Neurology and Dementia. Oxford: Oxford University Press; 2016. p315-327.
• Rountree S, Doody RS. Presentation and management of Alzheimer's disease. In Hussain M and Schott JM, editors. Cognitive Neurology and Dementia. Oxford: Oxford University Press; 2016. p361-380
Session 33 Library session
Session 34: Management of MND Dr Rachel Burman, Consultant in Palliative Care and Honorary Senior Lecturer, Cicely
Saunders Institute, King’s College London
Summary:
This session will examine the natural history of Motor Neurone Disease and the symptoms to which
it can give rise. There will be consideration of the methods of symptom relief available and the
evidence for their effectiveness. It will not be overlooked that some treatments give rise to ethical
issues and may also have resource implications for palliative care in the future.
Recommended reading:
• Sykes N. End of life care [and other chapters]. In: Oliver D, Borasio GD, Walsh D (eds.). Palliative Care in Amyotrophic Lateral Sclerosis (2nd edition). Oxford: University Press, 2006; 287-300.
• Kiernan MC, Vuvic S, Cheah BC et al. Amyotrophic Lateral Sclerosis. Lancet, 2011; 377: 942-955.
Friday 1st March
Session 35: Other Symptoms
Dr Victor Pace, Consultant in palliative care, Greenwich & Bexley Hospital
Summary:
No information available
Session 36: Module feedback Dr Matthew Maddocks, Senior Lecturer in Palliative Care, Cicely Saunders Institute, King’s College London
Assignment Questions:
You will be required to produce a 3,000 word assignment which answers one of the following two questions below:
1. A limited systematic review of the effectiveness of the management of a symptom or symptoms which are relevant in your work setting, with reference to the underlying pathophysiology and epidemiology.
2. Discuss the pathophysiology of a key symptom or symptoms in a condition of your choice.
Critique the pathological process involved within and outside the organ(s) directly affected by the condition. Appraise how the information may be applied in your clinical practice.
We are able to permit a variation of 5% in the word count either way. However, 5% is deducted from
the final percentage mark for work which is up to 10% over the word limit. Moreover, 50% of the mark
awarded is deducted from the final percentage for work that is more than 10% over the word limit.
Tables, references, bibliographies and appendices are not included in the word count but it is
recommended that longer tables should be added as an appendix. Abstracts should be kept brief and
are NOT part of the word count.
Please see the Course Handbook for more information on how to write an assignment.
Requirements for electronic submission:
Upload your assignment, no later than Friday 12th April by 5pm via Keats (see below).
Please ensure you put your Student ID Number on your assignment (not your name).
Please do not put your KCL user number (K number) on your assignment.
Upload your assignment as one separate file in a Word or PDF format.
Your assignment file should contain all the annexes, figures, etc. Do not upload them as separate files.
You will receive feedback by 10th May 2019
Marking scheme 1
A limited systematic review of the effectiveness of the management of a symptom or symptoms which are relevant in your work setting, with reference to the underlying pathophysiology and epidemiology.
Marking Scheme 2
Criterion
Marks
Clear, succinct abstract or summary
5 marks
Clear, succinct review question and rationale for review
10 marks
Methods: Clear protocol, including search strategy, years searched, key words, hand search, inclusion/exclusion criteria, innovative search methods, methods for data extraction, grading of quality, and analysis method
20 marks
Results: identification of literature, flowchart, grading, assimilation of papers, and good synthesis (per objectives)
20 marks
Critique of literature, including quality assessment, integration of evidence and limitations of literature
15 marks
Critique of own review, including succinct, coherent arguments. Evidence of original appraisal
10 marks
Conclusions appropriate to findings
5 marks
Clinical implications and relevance to own practice
10 marks
Presentation and referencing etc
5 marks
TOTAL MARKS
100 marks
Additional Comments:
Discuss the pathophysiology of a key symptom or symptoms in a condition of your choice. Critique the pathological process involved within and outside the organ(s) directly affected by the condition. Appraise how the information may be applied in your clinical practice.
Criterion
Marks
Clear, succinct abstract or summary
5 marks
Appropriate & clear definition of symptom
5 marks
Assessment of epidemiological, pathological and physiological information to understand aetiology of symptom
10 marks
Critical appraisal of research into process involved within and outside the organ(s) directly affected by the condition and of relevance of these findings to own practice
20 marks
Detailed critique of research, limitations, strengths, into pathophysiology
20 marks
Recommendations for own practice based on conclusions 10 marks
Critique of literature
15 marks
Critique of own review
10 marks
Presentation and referencing etc
5 marks
TOTAL MARKS
100 marks
Additional Comments:
Denmark Hill location map and Cicely Saunders Institute.
Please click on the link below, which will show you different travel options to get to
Denmark Hill.
https://www.kcl.ac.uk/study/campus/denmark-hill.aspx.
Institute of Psychiatry, Psychology & Neuroscience detail map
You will be attending the in the computer A and B room in IoPPN main building (number 1 on map).
The administrator will take you over to the building for the first session
St Christopher’s Hospice Map
Address:
St Christopher’s Hospice
51-59 Lawrie Park Road
Sydenham
London
SE26 6DZ
Contact details:
Telephone us on: 020 8768 4500
Fax us on: 020 8659 8680
Email us at [email protected]
Transportation:
Parking
There is some parking in the hospice grounds, including disabled bays. There is also free parking in
adjoining residential roads.
There is a drop off and pick up bay directly outside the main entrance.
Buses
Bus numbers 197 and 176 pass by the hospice. Bus number 227 stops at the end of Lawrie Park
Road.
Trains
London Victoria to Penge East
Two trains an hour, journey time about 18 minutes. Around 15 minutes walk to St Christopher’s.
Don’t get off the train at Sydenham Hill, stay on to Penge East.
London Bridge to Sydenham
Four trains an hour, journey time about 15 minutes, plus 10 minutes walk.
East Croydon to Penge West
Two trains an hour, journey time about 30 minutes, plus 10 minutes walk.
Overground Train
Overground train every 15 minutes starting from Highbury & Islington, via Canada Water
Link to Map of St Christopher’s
https://www.google.com/maps/place/St+Christopher's+Personal+Care+Services+Ltd/@51.419998,-
0.055064,353m/data=!3m1!1e3!4m2!3m1!1s0x0:0x86bd83974be17510?hl=en
