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PALLIATIVE CARE

CANCER CONTROL 2014 121

societal constraints make it important for health care

professionals who work with patients with advanced life

threatening or life-limiting illnesses to take on the role of

advocating for palliative care and to encourage patients and

family members to speak out and let their plight be known.

To speak particularly about oncologists, oncology nurses

and oncology social workers and palliative care workers

engaged in the care of cancer patients, there are a number of

important ways we can improve care of cancer patients as

their illness progresses. We should ensure our own

knowledge and skills of clinical oncology and of palliative care

are well developed and up-to-date and recognize that

palliative care is not only for the end of a life. We should

incorporate palliative care into everyday practice, while

recognizing that difficult symptoms or psychosocial problems

may warrant specialized palliative care. We should explore

our own comfort in working with patients whose disease is no

longer curable. We should ask about distressing symptoms,

manage them effectively and review the response to

symptom management. We should develop the skills and find

the courage to have difficult conversations about

withdrawing treatment that is no longer able to cure or

contain the cancer. We should discuss options for care and

explore patients' fears so that we can either reassure them or

explain how we will deal with problems that might develop. It

would be of benefit to have a palliative care nurse or

physician as part of the oncology unit team.

Conclusion

In summary, we should offer individualized care appropriate

to patient preference and stage of illness that includes quality

palliative care.

We should also be the voice for the voiceless and advocate

for palliative care policies in our countries, for clinical

guidelines and protocols guiding palliative care practice; for

palliative care training in our nursing and medical schools; for

access to essential palliative care medicines in our own

countries, and in countries worldwide, in order to relieve the

suffering of patients in pain; and we should advocate for

appropriate palliative care services in health care facilities,

care homes and for home palliative care services so that

patients and families can access the care they need. l

Dr Liz Gwyther has postgraduate qualifications in family practice

and palliative medicine. She is CEO of Hospice Palliative Care

Association of South Africa (HPCA); a Trustee of the Worldwide

Hospice Palliative Care Alliance (WPCA); and a director of the

following organizations - African Palliative Care Association,

ehospice, Networking AIDS Community of South Africa

(NACOSA), and Pain Society of South Africa.

She is a senior lecturer at the University of Cape Town where

she heads the Palliative Care team within the School of Public

Health and Family Medicine. She is also the convener for the

postgraduate programmes in palliative medicine. Her special

interests are women's health and palliative care and human

rights in health care. In 2007, she was awarded the SA Medical

Association's Gender Award for Human Rights in Health and the

SA Institute of Health Managers Leadership in Health Systems

award. She is a member of the editorial board of the Journal of

Pain & Symptom Management published in the USA.

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