Robert Twycross obituary
Robert Twycross, who has died aged 83, was a pioneering doctor in the field of palliative care. He has helped build the specialty both in Britain and internationally, not only as a practitioner but also as a teacher and author. His contribution to improving care for the dying and people at the bedside is enormous.
Robert first met Dame Cicely Saunders, the founder of the modern hospice movement, while he was still a medical student at Oxford. Inspired by her work, he joined her in 1971 at St. Christopher’s hospice in Sydenham, south-east London, as a research associate. There he began trials of the medications used to manage pain.
Since the late 19th century, most physicians used a mixture of medications later known as the “Brompton cocktail”as prescribed at Brompton Hospital in London for pain relief in the dying patient. This contained morphine with cocaine and alcohol and was also intended to sedate the patient.
Robert found that oral morphine alone, rather than cocaine, was equally effective for the relief of cancer pain. Morphine had to be administered regularly and sedation had to be prescribed separately if necessary. Subsequently, in 1986, his research was included in the World Health Organization (WHO) guidelines on the treatment of cancer pain.
Hospice care, later called palliative care, was still in its infancy at the time and was surrounded by skepticism about its potential to contribute to healthcare. Robert was determined that end-of-life patients and their families should receive better care, and became an outspoken advocate in the medical community.
In 1976 he developed one of the first NHS palliative care services at the Sir Michael Sobell House hospice, at Churchill Hospital in Oxford.
Teaching medical students at Sobell House began in the early 1980s, and in 1985 there was an innovative five-day course for the clinical medical students at the University of Oxford – long before any other medical school. Importantly, it included not only physical care of the patient, but also emotional, social and spiritual care, and also included communication skills and ethics. Robert learned that palliative care is a partnership between the patient, their loved ones and the healthcare team. He recognized and encouraged the development of non-drug therapies such as music and art.
In 1987, the Royal College of Physicians recognized palliative medicine as a medical specialty. The Sobell House hospice became a WHO Collaborating Center for Palliative Care (1988-2005) and attracted doctors, nurses and psychologists eager to learn.
In 1988, Robert established an annual two-day program to discuss complex issues and share new research in pain and symptom management. It continues to be held in Oxford and Newcastle, and is attended by hundreds of senior palliative care workers from Britain and abroad.
After writing a number of standard books on the management of pain and other symptoms in the 1980s, he published Introducing Palliative Care in 1995, which remains essential reading for healthcare professionals.
Born in West Bridgford, Nottinghamshire, Robert was the son of Jervis Twycross, an Anglican minister, and Irene (née Dell). He attended St John’s school in Leatherhead, Surrey, then studied medicine at St Peter’s College, Oxford, graduating in 1965.
Robert has influenced a generation of palliative care physicians and nurses around the world, including myself. He taught in more than 50 countries and was instrumental in establishing services in several countries, notably Poland, Hungary, Argentina, India and Russia. Recognizing the need for a comprehensive guide to describing the use of medications in palliative care, he developed the Palliative Care Formulary (1998), which is now an established text.
He was a founding member of the Association for Palliative Medicine (Great Britain and Ireland, 1985), and also of the European Association of Palliative Care (1988).
In 1985 Robert also co-founded the British Lymphology Society. After identifying patients suffering from lymphedema (swollen limbs), which can often occur with advanced cancer and sometimes after radical cancer surgery, he set up the first dedicated hospice clinic to treat and investigate the chronic condition symptomatically.
Robert has always argued against the legalization of assisted dying and it is no surprise that his latest article, published this year, explored the challenging issues that a change in the law could bring, both for society and for doctors, nurses and hospices in palliative care. He worried whether an assisted dying law could weigh the benefits for a few against the broader societal implications.
Robert remained active after retiring from the NHS in 2001. He continued to lecture and write around the world, but only recently slowed down as ill health took its toll.
He remained a lifelong Christian and a democratic socialist, and these values guided his principles.
Robert married Deirdre Campbell, a nurse, in 1964. She survives him, along with their five children, Alison, Judith, Fiona, John and David, and nine grandchildren, and his two sisters and a brother.