The magic of our mind(fulness)

 

irene-photoIrene Campagnolo Maschio, Physiotherapist, Princess Alice Hospice, Esher, Surrey, UK, explains the background to her longer article published in the current edition of the European Journal of Palliative Care.

I’ve always been fascinated by the potential the mind has to influence our perception and reaction to physical, emotional and mental stimuli.

I still remember how, as an experiment, I decided not to take any painkillers after surgery that left my mouth with two painful wounds. Being used to meditation, I just created a quiet space and focused on my breath and body, thus making the pain bearable. What decreased the pain by another good 50 per cent was my husband coming back home; feeling safer with someone around in case of a bleed did make an immediate difference to my perception of the pain.

The many patients I met in my career displayed the same connection between pain and state of mind. At the extremes, they could either be in minor discomfort despite severe injuries or in excruciating pain without physical stimulation; between these, they showed me the many ways of coping with pain that may hinder or promote quality of life throughout difficult times.

Sometimes in palliative care, where people are faced with a life-threatening diagnosis, fear of what the future holds can be overwhelming and create a feeling of detachment from a failing body. As a consequence, emotions and thoughts can become disconnected from what is actually happening to the body, losing objectivity and the possibility to recognise and profit from inner and outer resources; that is, to live fully even within the limits given by the disease.

Mindfulness meditation can help to reconnect body and mind. It is a simple intervention that can be tailored to the abilities of that unique person and, by including body, emotions and mind, is an ideal holistic approach bridging all domains of human experience.

Although I used the word ‘simple’, I do think that good training, together with professional and life experience, is mandatory to be able to safely guide the person through this process. Even if it is all about being in the present moment, this is difficult for everyone, and in terminal illnesses it could carry all the weight of the emotional and spiritual pain the person was trying to hide.

Mindfulness meditation can promote a sense of control and acceptance over pain and life events; if this is an outcome that would be generally good for every human being, it is even more welcomed when illnesses strip people of abilities we all take for granted.
I hope this brief post has tickled your curiosity. I have left the scientific review on mindfulness meditation and pain management for you to read in my longer article in the journal.

I’d love to hear of any thoughts, experiences, and ways of delivering and results of mindfulness meditations or other similar approaches in your practice. If you’d like to comment please email me, or leave a comment below.

Sharing is caring! 

4_cover_2-jpgRead the full article in the European Journal of Palliative Care
This post relates to a longer article, Mindfulness meditation by Irene Campagnolo Maschio, published in the November/December 2016 edition of the European Journal of Palliative Care (vol. 23.6). If you have a web-based subscription to the journal you’ll be able to download this issue, plus all articles in the journal archive.

You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.

Read more posts relating to articles published in the European Journal of Palliative Care on the EAPC Blog including one on the subject of mindfulness

 

ejpclinkedinEJPC Palliative Care Development Award 2017 – nominations form now online.

Do you know someone who has made a major contribution to palliative care policy development? Why not nominate them for the EJPC Palliative Care Policy Development Award? Click here to nominate. Launched by the European Journal of Palliative Care in collaboration with the European Association for Palliative Care, the award is aimed at professionals working in palliative care worldwide who have made a substantial contribution to policy development through research, clinical practice or as policy activists. The 2017 Award will be presented at the 15th World Congress of the EAPC  in Madrid, Spain (18–20 May 2017). Deadline for applications: 31 March 2017.

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Palliative care in respiratory disease

Professor David C Currow, Palliative and Supportive Services, Flinders University, Adelaide, Australia and Professor Claudia Bausewein Director of the Department for Palliative Medicine at Munich University Hospital and Chair in Palliative Medicine at Munich University, Germany, and Professor Miriam J Johnson, Professor of Palliative Medicine, Supportive care, Early Diagnosis and Advanced disease (SEDA) Research Group, Hull York Medical School, University of Hull, UK, explain the background to a new monograph focusing on the role that palliative care can (and should) play in optimising outcomes for patients with respiratory disease.

Professor David Currow

Professor David Currow

We’ve all sat at the bedside of someone who was short of breath. We’ve witnessed the palpable distress of relatives as they watch, helplessly, someone they love struggling with breathlessness day after day. Exhausting for the person concerned and devastating to see, severe breathlessness at rest or on minimal exertion – bathing, dressing or preparing a cup of tea – remains poorly managed.

A new monograph from the European Respiratory Society (ERS) has been released – ‘Palliative Care in Respiratory Disease’.

Professor Claudia Bausewein

Professor Claudia Bausewein

Firstly, this book deals explicitly with respiratory diseases that require palliation and the key issues in addressing each of these conditions. A major focus of the book is the role that palliative care can (and should) play in optimising outcomes for such patients. Many palliative care services have side-stepped people with respiratory diseases – assuming it must be some other clinical team’s problem – and respiratory teams have struggled to identify who and when should be referred for specialist palliative support. This is despite more than 20 years of evidence that the needs of people with end-stage respiratory diseases such as chronic obstructive pulmonary disease, interstitial lung disease or cystic fibrosis are the same or greater than they are for many other diseases, including cancer.

Prof. Miriam J Johnson

Prof. Miriam J Johnson

Secondly, the book is a great primer on better understanding breathlessness, its underlying pathophysiology, treatments that can predictably and safely reduce its intensity, and on its impact on patients and their families. So much is being discovered about the central pathways modulating the sensation of breathlessness, opening up new avenues of research to help this disabling symptom. Health services data about the difference that a structured approach to the assessment and symptomatic treatment of breathlessness is outlined. The real challenge is to answer the question of how we take new clinical information and new models of care and deliver this to the patients that we see in daily practice?

Arguably, breathlessness is still where pain was 20 years ago but we can close that gap quickly by applying the evidence available today into practice and, importantly, into our referral pathways in order to ensure that the needs of people with respiratory disease are better met.

9781849840729This book is an opportunity to start to change our current paradigms – to look at respiratory disease and respiratory symptoms through new eyes, focusing on the rapidly developing evidence base for all aspects related both to respiratory disease and to breathlessness.

Our patients deserve the highest quality and most current evidence to inform their care.

 

Links

  • Bausewein C, Currow DC and Johnson MJ (Eds). (2016). Palliative care in respiratory disease. European Respiratory Society (ERS). The ERS Monograph is available to access online. Individuals can purchase an eBook version, or full online access is available to ERS members or people at subscribing institutions.
  • Print copies of the ERS Monographs are available at the ERS bookshop. Discounts are available for ERS members.
  • For more information about the ERS Monograph, please email Eddy Baker, Editorial & Library Services Coordinator, European Respiratory Society.
  • ERS International Congress 9 to 13 September 2017, Milan, Italy – Abstract submission now open! Please visit our website for details.
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When children are dying – the distance between closeness and professional distance in paediatric palliative care

regula2Regula Buder, Nurse Practitioner, MAS FHO, Palliative Care, Geschäftsleitung Stv. Kinderspitex Nordewestschweiz, Switzerland, explains the background to her longer article that is published in the November/December issue of the European Journal of Palliative Care. 

As a professional in paediatric palliative care, you often get the same reaction as when someone asks you about your profession: People look at you with a respectful gaze, and often there is a moment of silence, mirroring the unspeakable nature of the fact that children are dying. And this is followed by sentences such as: “That must be a hard job” or, even more often, “I could never do that work”. Entering Canada for a Palliative Care Congress, a customs officer said to me when I explained about my job: “You must have a big heart.” Yes, indeed, working in paediatric palliative care and being there with the families when the children are dying, does need a big heart. But there’s much more to it than that.

Researching meaning for professional caregivers when children are dying, we realised that it is not only within the private social context where it is difficult to communicate. Professionals may also find it difficult. They talk about symptom management and about what they can do. Yet, they hardly ever talk about how they feel in these situations, and what it means to them, both as a professional and as a human being.

Addressing ‘paediatric palliative care’ among healthcare professionals of various disciplines is necessary to raise the awareness of its particularity and its rich spectrum. Talking positively about this challenging work, which never becomes routine, creates an understanding of the nurse’s personal vulnerability and opens a space for it. And raising awareness of the expertise, knowledge and personal involvement against the background of all four palliative care dimensions (physical, mental, social and spiritual), allows us to offer paediatric palliative care in an authentic and vivid way, while taking into account the lifeworld of the affected persons.

The closeness of nurses to the child is the main characteristic of paediatric palliative care. Nurses dedicate themselves to closeness – it brings to life the very essence of their profession. However, death and dying of children raises issues of deep involvement in societies of Western culture. Therefore we have to ask: How can nurses in their professional role cope with the tension between personal closeness and professional distance? It is important to focus on what supports the nurse in her daily work in paediatric palliative care. Being aware of these aspects as relationship and vulnerability, as well as the nurse’s role, enhances the ability to find the balance between closeness and professional distance.

And this enables the nurse to do this work, with expertise and professionalism, as well as with a big heart.

4_cover_2-jpgRead the full article in the European Journal of Palliative Care
This post relates to a longer article, Nursing paediatric palliative care patients, by Regula Buder and Prof. Dr. André Fringer, published in the November/December 2016 edition of the European Journal of Palliative Care (vol. 23.6). If you have a web-based subscription to the journal you’ll be able to download this issue, plus all articles in the journal archive.

You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.

Read more posts relating to articles published in the European Journal of Palliative Care on the EAPC Blog. You may also be interested in the recent series on children’s palliative care also published on the blog in partnership with the EAPC Taskforce on Paediatric Palliative Care.

 

ejpclinkedinEJPC Palliative Care Development Award 2017 – nominations form now online.

Do you know someone who has made a major contribution to palliative care policy development? Why not nominate them for the EJPC Palliative Care Policy Development Award? Click here to nominate. Launched by the European Journal of Palliative Care in collaboration with the European Association for Palliative Care, the award is aimed at professionals working in palliative care worldwide who have made a substantial contribution to policy development through research, clinical practice or as policy activists. The 2017 Award will be presented at the 15th World Congress of the EAPC in Madrid, Spain (18–20 May 2017). Deadline for applications: 31 March 2017.

 

 

 

 

 

 

 

 

 

 

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Management of malignant bowel obstruction with Lanreotide for a community palliative care patient

Dr Kate Markham, Dr Shan Shan Vijeratnam and Dr Pia Amsler, Isabel Hospice, Welwyn Garden City, UK, explain the background to their longer article published in the November/December edition of the European Journal of Palliative Care.

Dr Kate Markham

Dr Kate Markham

We are doctors from Isabel Hospice, providing specialist palliative care in the community in southern England. We see many patients with malignant bowel obstruction and would like to present two case reports outlining the potential for treatment with three to four weekly depot injections of Lanreotide. This method of slow-release injections could be used for patients who are mobile, in order to allow freedom from having one or more syringe drivers, and potentially higher quality of life.

Malignant bowel obstruction is a common distressing complication in patients with advanced abdominal or pelvic carcinoma.(1) In most patients with advanced disease, surgical options such as a colostomy or venting gastrostomy may not be feasible due to peritoneal carcinomatosis, ascites, multiple co-morbidities and poor performance status.(2) This can pose a challenge in such cases with advanced disease to healthcare professionals. The medical management of bowel obstruction is complex. There is limited data to support Lanreotide, a long-acting somatostatin analogue, in this situation.(3) In our two case reports, we found that Lanreotide can significantly improve the symptoms and quality of life of the patients who were both ambulatory with an undetermined prognosis despite advanced intra-abdominal disease. We believe that Lanreotide can be an effective treatment in the community in this particular group of patients.

We would advise consideration of the use of somatostatin analogues for patients in the community with malignant bowel obstruction if other medical treatments fail. We recommend that a trial of Octreotide be given via a syringe driver for one week in order to assess whether a patient would respond to somatostatin analogues. Once proven to be effective, the drug can be switched to the longer-acting Lanreotide, which can then be administered every three to four weeks via depot injection (slow release muscular injection), depending on the clinical picture.

However, the expense of somatostatin analogues remains an issue. An injection of Octreotide acetate of 200microgram/ml costs GB£70 (79 Euros). A depot injection of Lanreotide 30mg costs around GB£320 (359 Euros), 60mg costs around £550 (618 Euros) and 90mg costs over £730 (820 Euros).(4) Depending on the Octreotide dose required, a single monthly Lanreotide injection can therefore be more cost-effective, both in terms of nursing time to attend to the syringe driver daily and for the medication itself.

We believe that Lanreotide can be an effective treatment in the community in this particular group of patients. Once-monthly injections of Lanreotide can offer patients more freedom with their activities of daily living, and improve quality of life, without having to use syringe drivers at all times. Wider use of such treatment may reduce the need for admission to hospice or hospitals for symptom management and should be tailored to patients’ individual needs and wishes.

Lanreotide has proven to be a viable alternative to Octreotide in both our patients. Although expensive, the use of Lanreotide should be considered in ambulatory patients with advanced disease who are not expected to die within a few weeks.

References

  1. Mercadante S. Assessment and management of mechanical bowel obstruction. In: Portenoy RK, Bruera E, eds, Topics in Palliative Care. Vol 1. New York, NY, Oxford University Press; 1997: 113-130
  2. NHS palliative care guidelines, 2015. Accessed March 2016
  3. Marini P, Blumbery J, Landau Q, et al. Symptomatic treatment with lanreotide microparticles in inoperable bowel obstruction due to peritoneal carcinomatosis, a randomized, double-blind, placebo-controlled phase 3 study. J Clin Oncology 2012: 30; 4337-4343.
  4. Twycross R, Wilcock A, Howard P. Palliative Care Formulary. 5th ed. Nottingham: Palliativedrugs.com Ltd, 2014.

4_cover_2-jpgRead the full article in the European Journal of Palliative Care
This post relates to a longer article, Managing malignant bowel obstruction with lanreotide by K Markham, S Shan Vijeratnam and P Amsler, published in the November/December 2016 edition of the European Journal of Palliative Care (vol. 23.6). If you have a web-based subscription to the journal you’ll be able to download this issue, plus all articles in the journal archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.

Read more posts relating to articles published in the European Journal of Palliative Care on the EAPC Blog

ejpclinkedinEJPC Palliative Care Development Award 2017 – nominations form now online.

Do you know someone who has made a major contribution to palliative care policy development? Why not nominate them for the EJPC Palliative Care Policy Development Award? Click here to nominate. Launched by the European Journal of Palliative Care in collaboration with the European Association for Palliative Care, the award is aimed at professionals working in palliative care worldwide who have made a substantial contribution to policy development through research, clinical practice or as policy activists. The 2017 Award will be presented at the 15th World Congress of the EAPC in Madrid, Spain (18–20 May 2017). Deadline for applications: 31 March 2017.

Posted in EAPC-LINKED JOURNALS, European Journal of Palliative Care, Medicine, SYMPTOM CONTROL | Tagged | Leave a comment

Caring for patients’ rooms and souls: How cleaning staff communicate and cope with seriously ill and dying patients

Professor Gerhild Becker, Chair of the Department of Palliative Care, University Medical Center Freiburg, Germany, explains the background to the longer article selected as ‘Editor’s choice’ in the January issue 2017 of Palliative Medicine.

gb-photo

Professor Gerhild Becker

The impulse for our study was a conversation between a patient and a cleaning woman. It’s a pleasure to talk to this lady, the patient told us during the ward round. She knows about life and she understands about listening.

Thus, the idea for a study arose.

Caring for seriously ill patients and especially those receiving palliative care advocates a multidisciplinary team approach. Not only are physicians and nursing staff confronted with the challenge of caring for dying patients, other hospital staff members also have frequent patient contact and feel a commitment to care for and comfort dying patients and their families.

But, what is the role of cleaning staff on a hospital ward apart from cleaning rooms? Research on this topic is lacking. How may cleaning stuff help to improve the overall care of patients? Are they providing something like ‘low-threshold soul care’ as a side effect of their job? And, if so, how do they manage it? How do they cope? Are they aware of their role?

To answer these questions we chose a sequential mixed methods design. At our University Medical Center in Southern Germany, we recruited cleaning staff and also cleaning management staff for interviews and focus group discussions. Interviews and focus group discussions were content analyzed and results were used to create a questionnaire which was given to all cleaning staff (n=240) working at our clinic.

In interviews and focus group discussions, cleaning staff described interactions with patients as an important and fulfilling aspect of their work. In total, 124 questionnaires were returned. About half of participants indicated that patients talk with them every day, on average for one to three minutes. Although the most common topics of conversation include small talk such as weather and family, patients also discussed their illness and, occasionally, thoughts regarding death. When patients addressed illness and death, cleaning staff often felt uncomfortable and helpless.

Results of our study showed that cleaning staff perceive that they have an important role in the clinic – not only to clean but also to support patients. Serious illness frightens patients and isolates them from their support communities when they need them most. Likewise, patients seem to appreciate being able to speak openly with cleaning staff. Yet, it appears that cleaning staff may benefit from additional training in how to communicate with patients about sensitive issues such as illness.

We hope that this research may help to make us all more aware that caring for seriously ill and dying patients is a challenge for various occupational groups within the hospital setting, who come into contact with dying patients during their day-to-day work.

pmja_31_1-coverRead the full article in Palliative Medicine

This blog post relates to the longer article, Tidying Rooms and Tending Hearts: An Explorative, Mixed-Methods Study of Hospital Cleaning Staff’s Experiences with Seriously Ill and Dying Patients’ by Karin Jors, Svenja Tietgen, Carola Xander, Felix Momm and Gerhild Becker, published in Palliative Medicine 2017, Vol. 31(1) 63–71. First published online: May 9, 2016. Article first published online: May 9, 2016; DOI: 10.1177/0269216316648071.

Download your free copy of this month’s Editor’s Choice article from the EAPC website.

How to download previously published ‘Editor’s choice’ articles
EAPC members and registered users of the EAPC website can download all ‘Editor’s choice’ papers free of charge from the EAPC website but you will need to register or login first. Please follow the instructions in the top right-hand corner of the EAPC home page and scroll down to the article. Click here to view other EAPC-originated papers.

Read earlier Editor’s Choice posts on the EAPC Blog

Posted in EAPC-LINKED JOURNALS, Palliative Medicine: Editor's Choice, RESEARCH | Tagged | 1 Comment

Use of antibiotics in Singapore

mugshot-eng-koonDr Eng Koon, Division of Palliative Medicine, National Cancer Centre Singapore, explains the background to his longer article, published in the current edition of the European Journal of Palliative Care – a reminder that even common (and seemingly uncomplicated) treatments need to be carefully considered in palliative care.

Imagine yourself having the flu. You speak to your colleagues and all of them swear by having antibiotics as essential. Instinctively, (and with less than subtle probing by your anxious spouse), you ask your doctor for antibiotics although he says it is likely that it’s a viral infection. You recover within a week (albeit with some loose stools), and obviously you are glad that you asked for antibiotics in the first place.

Now imagine instead that you developed massive diarrhoea from your antibiotics requiring hospital admission and parenteral hydration. As you are discharged three days later you comfort yourself that the antibiotics may have aided your recovery from flu. But as you are walking out of the hospital your doctor tells you:

“You know, I wouldn’t recommend you take the same antibiotics again as they caused such a bad side effect. And to be honest, I think your flu might have resolved earlier if you hadn’t been so dehydrated.”

As your heart sinks, along with a part of your self-esteem, try to answer this question: “Would you want to take antibiotics for yourself (or your family) if someone develops flu again?”

It is common for patients and caregivers to struggle to understand exactly what medical intervention is being offered. For example, to ‘simplify’ matters, Cardiopulmonary Resuscitation (CPR) is commonly prescribed simply to facilitate chest compressions or endotracheal intubation – a tube in the windpipe to help one breathe. In contrast, the option of giving antibiotics is something I find relatively easy to offer and which is then usually accepted. I can almost imagine patients and family members having a thought bubble immediately after they hear the word ‘antibiotic’, containing phrases like “Ah yes, for infection,” and “Of course I would take it and kill the darn bacteria.”

As you attempt to answer the question above, imagine that now you are a hospice patient with a prognosis of less than three months. Your swallowing function is deteriorating and you will likely require intravenous antibiotics the next time you develop a fever. Your veins are burnt out from chemotherapy and you hate venepuncture. Would your answer differ?

The offer of antibiotics for hospice patients is thus not as straightforward as it seems, especially when the evidence supporting antibiotic use for hospice patients remains elusive with regards to mortality benefits, and at best weak for symptom alleviation. At the end of the day, clinical practice will have to be guided by the goals of care of the patient, balanced by the burdens of treatment.

Physicians should continue to be cognizant of their prescribing patterns and recognize the limitations of this powerful tool that was first presented to us more than 50 years ago.

4_cover_2-jpgRead the full article in the European Journal of Palliative Care
This post relates to a longer article, Use of antibiotics in Singapore by Ong Eng Koon and Chong Poh Heng, published in the November/December 2016 edition of the European Journal of Palliative Care (vol. 23.6).

If you have a web-based subscription to the journal you’ll be able to download this issue, plus all articles in the journal archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.

Read more posts relating to articles published in the European Journal of Palliative Care on the EAPC Blog

 

ejpclinkedinEJPC Palliative Care Development Award 2017 – nominations form now online.

Do you know someone who has made a major contribution to palliative care policy development? Why not nominate them for the EJPC Palliative Care Policy Development Award? Click here to nominate. Launched by the European Journal of Palliative Care in collaboration with the European Association for Palliative Care, the award is aimed at professionals working in palliative care worldwide who have made a substantial contribution to policy development through research, clinical practice or as policy activists.

The 2017 Award will be presented at the 15th World Congress of the EAPC  in Madrid, Spain (18–20 May 2017). Deadline for applications: 31 March 2017.

 

Posted in EAPC-LINKED JOURNALS, European Journal of Palliative Care, SYMPTOM CONTROL | Tagged | Leave a comment

EJPC Palliative Care Policy Development Award welcomes nominations

Professor Julia Riley, Editor of the European Journal of Palliative Care, encourages nominations for this year’s EJPC Award. Professor Riley is also Clinical Lead, Coordinate My Care; Palliative Care Consultant, Royal Marsden and Royal Brompton Palliative Care Service, The Royal Marsden NHS Foundation Trust, London, UK.

Professor Julia Riley

Professor Julia Riley

The 15th World Congress of the European Association for Palliative Care in Madrid will mark the fourth time that the prestigious EJPC Palliative Care Policy Development Award acknowledges another champion in the field.

These champions have made substantial contributions to policy development through their research or clinical practice or as policy activists.

Now is your time to make a nomination for 2017’s award. In previous years it has been both humbling and exciting to read of the achievements of many of our colleagues all over the world, some of whom we knew and others who had quietly worked in the background, achieving great things. By making a nomination, you will highlight exemplars from whom we can all learn. Each nominee will be informed, which in itself is an acknowledgement and a way of raising the profile of those who are mentors, masters, teachers and gurus in palliative care. A winner will then be selected.

The winner will join a group of esteemed award recipients:

Dr Olga Usenko

Olga Usenko

2014 Dr Olga Usenko – Transformation of pain and palliative care in Russia. (You can read an interview with Olga here as well as her post on the EAPC Blog).

 

 

 

Dr Emilio Herrera

Emilio Herrera

2015 Dr Emilio Herrera – New models of care in Spain and Columbia. (Read Emilio’s post on the EAPC Blog about the work that led to his award).

 

 

 

dublincherny

Nathan Cherny

2016 Prof Nathan Cherny – A pioneer in the integration of oncology and palliative care. (Read an interview with Nathan here.)

Please make your nominations now
We all need to hear about these remarkable people and discover what work they are doing globally to enable more patients to die with dignity.

How to write a nomination
Try to convey in your nomination the passion that the person you are nominating has demonstrated for their cause. I hope to be awarding the prize to your colleague at the closing ceremony of the 15th World Congress of the EAPC in Madrid next May. But most of all I look forward to being inspired by the work of the nominees.

ejpclinkedinHow to apply for the EJPC Palliative Care Policy Development Award
Visit the nominations website and complete your nomination online. Deadline for nominations: 31 March 2017.

 

new-new-eapc17_header_960x211The EAPC wishes all our readers a very happy New Year . . .

We hope to see you at the 15th EAPC World Congress – Progressing Palliative Care – in Madrid. Take advantage of the Early Bird Registration rate offering significant savings for delegates. But hurry, Early Bird Registration closes on 15 February 2017. You can still register after this date on the congress website but at higher rates. You can also book your accommodation via the congress website.

 

 

 

Posted in EAPC-LINKED JOURNALS, European Journal of Palliative Care | Leave a comment