January Focus

摘要

To start off the new year, we have a remarkable small cluster of papers dealing with palliative care. The history of research in this area has been marked by disappointment, with a number of studies running into problems of recruitment. Here there are three shedding some much needed light into that corner of primary care whose importance is emphasised by the editorial on page 3. If the existence of these papers is something of a surprise, the content will tend to confirm the gut feelings of many clinicians. On page 20, the study from the Netherlands identified four elements of good palliative care: availability; competence; continuity; and teamwork. As one of the participating doctors said: ‘For me, good terminal care is … good clinical care.’ The study on page 6 looks specifically at the need for good palliative care out-of-hours, and the dilemmas that patients and their carers have to deal with when availability and continuity can be elusive. The editorial underlines the importance of good care out-of-hours: failures can reduce the likelihood of patients dying at home. The practical business of good symptom control is under the microscope on page 27. When assessment of symptoms by patients and professionals was compared, there was more agreement for physical symptoms than mental ones, where the professionals rated the severity higher than the patients did. On a related theme, the debate over euthanasia has recently been reopened. At present it doesn't look very likely that the law in the UK will be changed, but the study on page 14 from Belgium (where it is already legal) illustrates the care that has to be taken over end-of-life decisions, and the sort of process that we should have to implement if it ever became legal here.