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The article discusses a study exploring junior doctors experiences in foundation year 1 (F1) palliative medicine posts. The results revealed that F1 doctors were satisfied with the learning opportunities provided by the palliative medicine posts. The junior doctors felt the post helped them to develop generic skills and provided them with the opportunities for independent working and taking responsibility for patients.

Context It is well recognised that teaching about palliative care, death and dying should begin at undergraduate level. The General Medical Council in the UK has issued clear recommendations for core teaching on the relieving of pain and distress, and care for the terminally ill. However, whereas some medical schools have incorporated comprehensive teaching programmes, others provide very little. The reasons underpinning such variability are unknown. Objectives The aim of this study was to explore the factors that help or hinder the incorporation of palliative care teaching at undergraduate level in the UK. Methods Semi-structured interviews were carried out with a purposive sample of coordinators of palliative care teaching in 14 medical schools in the UK. Transcribed interviews were analysed using principles of grounded theory and respondent validation. Results There are several factors promoting or inhibiting palliative care teaching at undergraduate level that are common to the development of teaching about any specialty. However, this study also revealed several factors that are distinctive to palliative care. Emergent themes were ‘need for an individual lead or champion’, ‘the curriculum’, ‘patient characteristics and exposure’, ‘local colleagues and set-up of service’, ‘university support’ and ‘the influence of students’. Conclusions The incorporation of palliative care into the medical undergraduate curriculum involves a complex process of individual, institutional, clinical, patient and curricular factors. These new findings could help medical schools to incorporate or improve such teaching. [ABSTRACT FROM AUTHOR]

An obituary to professor Geoffrey Warren Hanks is presented.

The authors weigh the implications of the interim guidance on prosecution policy in cases of assisted suicide in Great Britain. They argue that the policy raises some serious concerns for medical professionals trying to navigate a course within the boundaries of responsible and lawful practice. The difference of the policy from proposals for legalizing assisted suicide is also pointed out by the authors. The authors ponder whether the policy directs the right course between prohibition and permission of assisted suicide. INSET: Factors affecting the decision over prosecution with potential....

The authors reflect on the doctrine of double effect in relation to end of life decisions (ELD) made by medical practitioners in Great Britain. Data used in studies of ELD are explored including an article featured in "Palliative Medicine" by C. Seale and another by J. Bilsen and colleagues on the use of opioids to hasten death. It has been sought that there are three groups of doctors practicing various types of methods in hastening death. In addition, the reasons for the apparently high levels of deaths involving ELD are cited.

Purpose: Malignant pleural mesothelioma (MPM) has a high symptom burden and poor survival. Evidence from other cancer types suggests some benefit in health-related quality of life (HRQoL) with early specialist palliative care (SPC) integrated with oncological services, but the certainty of evidence is low., Methods: We performed a multicentre, randomised, parallel group controlled trial comparing early referral to SPC versus standard care across 19 hospital sites in the UK and one large site in Western Australia. Participants had newly diagnosed MPM; main carers were additionally recruited., Intervention: review by SPC within 3 weeks of allocation and every 4 weeks throughout the study. HRQoL was assessed at baseline and every 4 weeks with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30., Primary Outcome: change in EORTC C30 Global Health Status 12 weeks after randomisation., Results: Between April 2014 and October 2016, 174 participants were randomised. There was no significant between group difference in HRQoL score at 12 weeks (mean difference 1.8 (95% CI -4.9 to 8.5; p=0.59)). HRQoL did not differ at 24 weeks (mean difference -2.0 (95% CI -8.6 to 4.6; p=0.54)). There was no difference in depression/anxiety scores at 12 weeks or 24 weeks. In carers, there was no difference in HRQoL or mood at 12 weeks or 24 weeks, although there was a consistent preference for care, favouring the intervention arm., Conclusion: There is no role for routine referral to SPC soon after diagnosis of MPM for patients who are cared for in centres with good access to SPC when required., Trial Registration Number: ISRCTN18955704., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Malignant pleural mesothelioma is an incurable cancer caused by exposure to asbestos. The United Kingdom has the highest death rate from mesothelioma in the world and this figure is increasing. Median survival is 8 to 12 months, and most patients have symptoms at diagnosis. The fittest patients may be offered chemotherapy with palliative intent. For patients not fit for systemic anticancer treatment, best supportive care remains the mainstay of management. A study from the United States examining advanced lung cancer showed that early specialist palliative care input improved patient health related quality of life and depression symptoms 12 weeks after diagnosis. While mesothelioma and advanced lung cancer share many symptoms and have a poor prognosis, oncology and palliative care services in the United Kingdom, and many other countries, vary considerably compared to the United States. The aim of this trial is to assess whether regular early symptom control treatment provided by palliative care specialists can improve health related quality of life in patients newly diagnosed with mesothelioma., Methods: This multicentre study is an non-blinded, randomised controlled, parallel group trial. A total of 174 patients with a new diagnosis of malignant pleural mesothelioma will be minimised with a random element in a 1:1 ratio to receive either 4 weekly regular early specialist symptom control care, or standard care. The primary outcome is health related quality of life for patients at 12 weeks. Secondary outcomes include health related quality of life for patients at 24 weeks, carer health related quality of life at 12 and 24 weeks, patient and carer mood at 12 and 24 weeks, overall survival and analysis of healthcare utilisation and cost., Discussion: Current practice in the United Kingdom is to involve specialist palliative care towards the final weeks or months of a life-limiting illness. This study aims to investigate whether early, regular specialist care input can result in significant health related quality of life gains for patients with mesothelioma and if this change in treatment model is cost-effective. The results will be widely applicable to many institutions and patients both in the United Kingdom and internationally., Trial Registration: Current controlled trials ISRCTN18955704. Date ISRCTN assigned: 31 January 2014.