Preface to the first edition

Most clinical professionals have been affected by caring for patients with palliative care needs. Such patients may challenge us at both a professional and at a personal level in areas where we feel our confidence or competence is challenged.

As in every other branch of medicine, knowledge and training can help us extend our comfort zone, so that we can better respond to such patients in a caring and professional manner. However, in picking up this Handbook and reading thus far you have already demonstrated a motivation that is just as important as a thirst for knowledge, the central desire to improve the care of your patients.

It was out of just such a motivation that the modern hospice movement began 40 years ago, and it is that same motivation that has fuelled the spread of the principles of palliative care—in fact the principles of ALL good care—across the globe: respect for the person, attention to detail, scrupulous honesty and integrity, holistic care, team caring and consummate communications (often more about listening than telling and talking).

Increasingly it is being recognized that every person has the right to receive high-quality palliative care whatever the illness, whatever its stage, regardless of whether potentially curable or not. The artificial distinction between curative and palliative treatments has rightly been recognized as an unnecessary divide, with a consequent loss of the border crossings that previously signified a complete change in clinical emphasis and tempo.

Medical knowledge is developing rapidly, with ever more opportunities for and emphasis on curative treatment, to the point when any talk of palliative care can sometimes be interpreted as ‘defeatist’.

Today the principles of palliative care interventions may be employed from the first when a patient’s illness is diagnosed. Conversely, a patient with predominantly palliative care needs, late in their disease journey, may benefit from energetic treatments more usually regarded as ‘curative’.

Governments and professional bodies now recognize that every nurse and doctor has a duty to provide palliative care and, increasingly, the public and the media have come to expect—as of right—high-quality palliative care from their healthcare professionals irrespective of the clinical setting.

Many of these palliative care demands can best be met, as in the past, by the healthcare professionals who already know their patients and families well. This Handbook is aimed at such hospital- or community-based professionals, and recognizes that the great majority of patients with palliative needs are looked after by doctors and nurses who have not been trained in specialist palliative care but who are often specialist in the knowledge of their patients.

Junior healthcare staff members throughout the world have used the Oxford Handbook series as their own specialist pocket companion through the lonely hours of on-call life. The format, concise (topic-a-page), complete and sensible, teaches not just clinical facts but a way of thinking. Yet for all the preoccupation with cure, no healthcare professional will ever experience greater satisfaction or confirmation of their choice of profession, than by bringing comfort and dignity to someone at the end-of-life.

The demands on inexperienced and hard-pressed doctors or nurses in looking after patients with palliative care needs can be particularly stressful. It is our hope that this text, ideally complemented by the support and teaching of specialist palliative care teams, will reduce the often expressed sense of helplessness, a sense of helplessness made all the more poignant by the disproportionate gratitude expressed by patients and families for any attempts at trying to listen, understand and care.

While it is our hope that the Handbook will help the reader access important information quickly and succinctly, we hope it will not replace the main source of palliative care knowledge: the bedside contact with the patient.

It is easier to learn from books than patients, yet what our patients teach us is often of more abiding significance: empathy, listening, caring, existential questions of our own belief systems and the limitations of medicine. It is at the bedside that we learn to be of practical help to people who are struggling to come to terms with their own mortality and face our own mortality in the process.

Readers may notice some repetition of topics in the Handbook. This is not due to weariness or oversight on the part of the editors, but is an attempt to keep relevant material grouped together—to make it easier for those needing to look up information quickly.

It is inevitable that in a text of this size some will be disappointed at the way we have left out, or skimped on, a favourite area of palliative care interest. To these readers we offer our apologies and two routes of redress: almost 200 blank pages to correct the imbalances; and the OUP website, http://www.oup.co.uk/isbn/0-19-850897-2, where your suggestions for how the next edition could be improved would be gratefully received.