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A survey at a large tertiary referral hospital showed that patients with cancer and HIV disease had poorly controlled symptoms. A palliative care service was introduced, employing a doctor and part-time pharmacist. The doctor was available to see and advise about terminally ill patients. With the pharmacists, an educational programme of meetings, teaching sessions and information leaflets was developed. One year after the introduction of the service a repeat survey all patients with cancer or HIV disease was carried out. Problems on admission were similar in both surveys, but fewer patients' symptom scores deteriorated during their hospital stay. There was a significantly increased use of appropriate opioid analgesics and NSAIDs. Staff were satisfied with the service.

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No abstract

Patients suffering from cancer and human immunodeficiency virus (HIV) disease at a teaching hospital were found to have poorly controlled pain. Many were prescribed inappropriate analgesia. A palliative care service was established to provide symptom control for patients and education for staff. Educational materials were developed, didactic teaching organized, and one-to-one education by case discussion provided to improve patient management. A repeat survey to evaluate the service showed an increase in the use of appropriate opioids, such as morphine and diamorphine, and a decrease in the use of buprenorphine and papaveretum, which are less suitable for use in chronic cancer pain. The acceptability of the guidelines and rapid availability of a palliative care opinion has improved analgesic prescribing.