Palliative care in bilateral malignant ureteric obstruction.

Bilateral ureteric obstruction is an uncommon complication arising from malignancy and its treatment. There are several effective methods of overcoming the obstruction but the choice of option requires careful consideration of various factors pertaining to each individual. These factors include the patient's age, premorbid health and lifestyle, and the extent and rate of disease. Patient and family expectations, goals and priorities need careful consideration in the context of the patient's prognosis. If measures to relieve the obstruction are not to be undertaken, symptom control then becomes paramount. This paper explores the various options and decision making by focusing on representative patients encountered in the practice of the Central Sydney Area Health Palliative Care Service.

Central Sydney Palliative Care Service: potential and limitations of an integrated palliative care service based in a metropolitan teaching hospital.

Palliative care needs to be available wherever needed, in hospital and home, and should be part of mainstream health care. Palliative care should be concurrent with anti-disease therapy, and includes but goes beyond "terminal care". The World Health Organization (WHO) encourages such development. Palliative care in Australia takes on many forms. Central Sydney Palliative Care Service based in Royal Prince Alfred Hospital (RPAH), Camperdown, is an example of mainstream palliative care integrating home and hospital care. Almost all units of RPAH refer patients to the palliative care service. Approximately 1000 new patients are referred annually by doctors (specialists or general practitioners) for medical consultation. Registrar (fellow) training in palliative medicine is a feature of the service. Palliative care in a hospital or community-based service is an issue of justice and equity, and gives structure to compassion.