Challenging Cases in Palliative Care

Palliative care has evolved rapidly in recent years. Not only is the field dealing with an increasingly elderly and multi-morbid population, it is also addressing a wider variety of complex diagnoses such as heart failure, renal failure, advanced lung disease, frailty, and dementia.

Challenging Cases in Palliative Care is unique, as it uses examples of real-world cases from palliative care practices. It also includes expert commentary to support modern clinicians in managing the 'messiness' of clinical care, as well as the increasingly complex needs of patients today.

As part of our Challenging Cases series, the cases in this book not only cover a range of physical and psychosocial problems seen in palliative care, they also reflect the core curriculum for UK speciality trainees. Each case brings together expert interpretation of the available evidence, management strategies, guidelines and best practice, while discussing complexities in clinical decision-making and controversies in approach.

Felicity Dewhurst, St Oswald's hospice and Newcastle university,Polly Edmonds, Consultant in Palliative Medicine, King's College Hospital NHS Foundation Trust,Suzie Gillon, Consultant in Palliative Medicine, Leeds Teaching Hospitals NHS Trust,Amy Hawkins, Consultant in Palliative Medicine, Royal Trinity Hospice,Mary Miller, Consultant in Palliative Medicine & End of Life Care Lead (OUH) Clinical Lead for National Audit of Care at the End of Life, NHS Benchmarking Honorary Senior Clinical Lecturer in Palliative Medicine, University of Oxford Director OxCERPC (Oxford Centre for education and research in palliative care),Sarah Yardley, Associate Professor of Palliative Medicine, Marie Curie Palliative Care Research Department, University College London and Honorary Consultant in Palliative Medicine, Symptom Control and Palliative Care Service, University College London Hospital

Dr Edmonds has been a consultant at King's College Hospital NHS Foundation Trust since 1997. As honorary senior lecturer at King's College London she was heavily involved in development of the palliative care component of the undergraduate medical curriculum and examinations. She has been a training programme director for London, overseeing the delivery of postgraduate medical training and is currently the chair of the national Specialist Advisory Committee for Palliative Medicine.

Dr Gillon has been a consultant in Palliative Medicine since 2015; chairs the Association of Palliative Medicine Education and Training Committee; is the Palliative Care education lead for the trust and is an active member of the regional Specialty Training Committee. She is regularly involved in local and national research projects and quality improvement initiatives.


Dr Miller qualified from University College Cork, Ireland in 1988. Mary trained and worked in palliative medicine in Ireland, Sweden and the UK and has been a consultant in palliative medicine in Oxford since 1998. Mary has a strong interest in education; completing a Diploma in Learning and Teaching at Oxford University 2005, was Training Programme Director and Regional Specialty Advisor (2002 - 2008) and has led the Oxford Advanced Courses in Pain and Symptom Management since 2005. Mary is an elected member of the Education Committee of the Association of Palliative Medicine and joint lead of the postgraduate education special interest forum. Since the inception of OxCERPC in 2017, Mary and the team are focusing on building an exciting portfolio of courses, building research readiness and reaching out to practitioners across the globe.

Dr Hawkins has been a Consultant in Palliative Medicine since 2020. She has previously completed a number of educational research projects alongside an MSc in Medical Education. She has experience of qualitative research studies and has undertaken a systematic review. She is currently a member of the Association of Palliative Medicine Education and Training Committee.

Dr Yardley is a clinical academic interested in how patients, families, carers, and healthcare professionals do the work of frontline day-to-day healthcare and make sense of their experiences; hospital-community and specialist-generalist interfaces in palliative care; and patient transitions between hospital and community care, including palliative care in Emergency Departments and Acute Medical Units. Her research seeks to understand and improve human-dependent healthcare such as the impact therapeutic and professional collegiate relationships have on current and future care.

Dr Felicity Dewhurst is a Consultant in Palliative Medicine at St Oswald's Hospice and an NIHR Advanced Fellow and Senior Clinical Lecturer in the Population Health Sciences Institute at Newcastle University.
Following her Dunhill doctoral fellowship, she lobbied for the creation of the first NIHR Academic Clinical Lectureship in Palliative Medicine in Newcastle, and subsequently successfully applied for the first NIHR Advanced Fellowship in Palliative Medicine nationally (January 2024-6.25 years).
Felicity has a Master's in Health Professions Education and is on the education committee of the Association of Palliative Medicine (APM) and the organising committee for the Palliative Care Congress (PCC). She is passionate about trying to improve care through research, education and service modification.

1. Pain Management1. Cancer-related bone pain, Anna Schuberth and Matt Mulvey2. Cancer-related neuropathic pain, Rebecca Gemmell and Craig Montgomery3. Interventional pain, Lucy Hetherington and Alison Mitchell4. Pain in people with drug dependence, Lucy Hetherington and Chris Farnham5. Chronic non-cancer pain, Lauri Simkiss and Iain Jones2. Management of symptoms in advanced illness6. Breathlessness, Natasha Lovell and Sabrina Bajwah7. Nausea, vomiting and hiccups, Holly McGuigan and Anna Sutherland8. Cancer cachexia, Lucy Ison and Barry Laird and Richard Skipworth9. Palliative bowel obstruction, Sarah Webster and Emily Rea and Emma Husbands10. Pruritis, Rose O'duffy and Maggie Presswood11. Mouth care, Grace Rowley and Phil Lodge12. Constipation, Anna Bradley and Jason Boland13. Diarrhoea, Rob McConnell, Michael Connolly and Leona Butterly3. Management of the dying patient14. Clinical uncertainty and prognostication, Simon Etkind and Paddy Stone15. De-escalation from ITU, Sarah Longwell and Lucy Wyld16. Community patient transferred into ED/AMU - rapid assessment and decision-making, Alice Copley and Sarah Yardley17. Prescribing review, Luke Nathaniel Hatton and Melinda Presland18. Co-ordination and transfer of care, Rosanna Hill and Adam Hurlow19. Giving remote advice to families and other professional providers, Shaun Qureshi, Philippa Guppy, Georgina Osborne and Rasha Al-Qurainy20. What to expect with death at home, Tammy Oxley and Katherine Malia21. Individualised end of life care plans, Steph Hicks and Ben Bowers4. Interface between palliative care and mental health22. Depression in the context of life-limiting illness, Felicity Wood and Annabel Price23. Hoarding, Manraj Bhamra and Khalida Ismail24. Delirium, Kitty Jackson and Felicity Wood25. Dementia, Kirsty Tolmie and Karen Harrison Dening26. Learning disabilities, Jamie Richardson and Valerie Potter27. Serious mental health and the palliative care patient, including patients under section, Dan Hughes and Maggie Bisset5. Challenging physiology/physical conditions28. Symptom management in organ failure (renal failure), Steph Lister Flynn and Emma Murphy29. Rigidity, Constantina Pitsillides and Lou Wiblin30. Sialorrhoea, Kirsty Douglas and Rachel Burman31. Frailty/multi-morbidity, Felicity Dewhurst and Caroline Nicholson32. Diabetic management at end of life, Jaspal Mann and Alastair Lumb33. Palliative management of malignant spinal cord compression (MSCC), Mairi Finlay, Oliver Jackson and Mark Teo34. Seizures, Geoff Wells and Jane Neerkin6. Personalised palliative care35. Care planning and goal setting, Rebecca Tiberini and Jon Martin36. Advance care planning, Georgina Osborne and Bee Wee37. Pandemics and disaster response, Athul Manuel and Sunitha Daniel38. Spiritual care, Sarah Maan, Alice Gray and Andrew Goodhead39. Cultural care, Max Charles and Jonathan Koffman40. Supportive care/survivorship, Lara Datta-Paulin, Mark Warren and Richard Berman41. Specific challenges: homelessness, Toni Mortimer and Caroline Shulman42. Transition from children's to adult palliative care, Gurpreet Gupta and Joanna Elverson43. Developing compassionate communities, Joe Sawyer and Libby Sallnow44. Bereavement, Charlotte Chamberlain and Lucy Selman7. Legal considerations45. A desire for hastened death, Becky Payne and Sam Lund46. Treatment escalation plans and CPR decisions, Gemma Lewis-Williams and Mark Taubert47. Withdrawal of treatment, Simeon Senders Galloway and Anna Gorringe48. Autonomy in children, Marie Claire Rooney and Jo Laddie