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We have much to learn about the contribution of palliative medicine to undergraduate teaching. When should it be introduced and where should it be taught? Who should teach it and what methods should be used? How can the various practical skills be demonstrated? There is a need for an increased awareness of palliative medicine in those involved in undergraduate education. [ABSTRACT FROM PUBLISHER]

Presents a community-based prospective study of patients dying from lung cancer or heart failure and their caregivers. Evolving experiences from diagnosis of life-threatening illness to death and bereavement; Patient/carer-centered account of their changing and evolving needs; Patterns of existing service provisions.

Background: We set out to explore whether patients with life-threatening illnesses and their informal carers consider they experience significant spiritual needs, in the context of their overall needs, how spiritual concerns might vary by illness group and over the course of the illness, and how patients and their carers think they might be supported in addressing spiritual issues., Methods: Three-monthly qualitative interviews for up to one year with 20 patients with inoperable lung cancer and 20 patients with end-stage heart failure and their informal carers., Results: We conducted 149 in-depth interviews. Spiritual concerns were important for many patients in both groups, both early and later in the illness progression. Whether or not patients and carers held religious beliefs, they expressed needs for love, meaning, purpose and sometimes transcendence. The different experiences of lung cancer and heart failure raised contrasting patterns of spiritual issues and needs. Carers voiced their own spiritual needs. Patients and carers were generally reluctant to raise spiritual issues, but many, in the context of a developing relationship with the researcher, were able to talk about such needs., Conclusions: Spiritual issues were significant for many patients in their last year of life and their carers. Many health professionals lack the necessary time and skills to uncover and address such issues. Creating the opportunity for patients and carers to discuss spiritual issues, if they wish, requires highly developed communication skills and adequate time.

We interviewed the general practitioners (GPs) of 40 patients with life-threatening illnesses over the course of the last year of life. We asked them to identify their patients' holistic needs, and to discuss whether they considered that they had a role in providing 'spiritual care'. The GPs varied greatly in their understanding of their patients' experiences and needs. Most said that they had a role in providing spiritual care, but hesitated to raise spiritual issues with patients, mentioning lack of time, a feeling that they should wait for a cue, or being unprepared or unskilled.

Twenty-six patients with proven craniopharyngioma were treated between 1954 and 1977. Total surgical removal was achieved in three patients (11.5%). Tumour recurrence was inevitable following incomplete surgical removal alone. Fifteen patients received post-operative radiotherapy following incomplete surgical removal of the tumour and eight patients (54%) survived, recurrence-free, for 5 years or more. Post-operative radiotherapy, delivering a central target absorbed dose of 4500 cGy in 20 fractions over 28 days (1520 rets) or more, significantly improved the recurrence-free survival (P = 0.019) with minimal morbidity. Partial resection of recurrent tumour carried a high mortality rate. Minimal salvage surgery in the form of cyst aspiration sometimes resulted in worthwhile palliation.