All change: cancer services in transition

Palliative care provision and its impact on psychological morbidity in cancer patients

In response to many influences, palliative care services in the UK are evolving rapidly, and are increasingly challenged to demonstrate equity, access and effectiveness. This article discusses the principles, philosophy and status of palliative care in the UK in the context of recent NHS developments. A case study is employed in order to critically evaluate the implementation of the palliative care approach, focusing on the specific issue of the assessment of anxiety and depression in the cancer setting. The provision of a comprehensive and integrated clinical service is a constant challenge in this patient group. In order to increase awareness and facilitate further development of patient services, and ultimately improve clinical practice, several factors are highlighted. These include the impact of multiprofessional team care, the problems inherent in the diagnosis of depression and the question of whether cancer nurses are adequately prepared to handle patients' psychological morbidity.

A programme of individualized and self-administration of medicines in a hospice

Hospice care is changing. Statistics show that people are surviving longer with cancer and many more are choosing to be cared for in the community. The hospice is no longer an institution solely for the care of people in the terminal phase of their illness but is involved in the palliation of symptoms, so allowing patients to return home to independent living. It was with this in mind that we recognized the need for the introduction of a programme of individualized and self-administration of medication at the hospice where we work. Although self-administration of medication was our first aim, the individuality of care brought about by its introduction, the adaptations required to include all palliative care patients and the resulting enhancement of holistic patient care, has become the main thrust of the project. This article will explore the term 'self-administration of medication'; the evidence of its use in other areas of health care; the rationale for change within the hospice movement; consequences to practice; and the staged implementation of a programme of individualized and self-administration of medication.