Robert Twycross, who has died aged 83, was a pioneering doctor in the field of palliative care. He helped build the specialty both in the UK and internationally, not only as a practitioner, but also as a teacher and author. His contribution to improving the care of the dying and those at the bedside is immense.
Robert first met Dame Cicely Saunders, the founder of the modern hospice movement, while still a medical student in Oxford. Inspired by her work, he joined her at St Christopher’s hospice, in Sydenham, south-east London, as a research fellow in 1971. There, he began trials into the drugs being used to manage pain.
Since the end of the 19th century, most physicians had been using a mixture of drugs known latterly as the “Brompton cocktail”, as prescribed at the Brompton hospital in London for pain relief in the dying patient. This contained morphine with cocaine and alcohol and was intended also to sedate the patient.
Robert established that oral morphine alone, rather than with cocaine, was equally effective for cancer pain relief. Morphine needed to be administered regularly, and sedation, if required, should be prescribed separately. Subsequently his research was incorporated into the World Health Organisation (WHO) guidance on the management of cancer pain, in 1986.
Hospice care, later to be called palliative care, at that time was in its infancy and surrounded by scepticism regarding its potential to contribute to healthcare. Robert was determined that patients at the end of life and their families should receive better care, and became a vocal advocate in the medical community.
In 1976 he developed one of the first NHS palliative care services at Sir Michael Sobell House hospice, at the Churchill hospital in Oxford.
Medical-student teaching at Sobell House started in the early 1980s, and by 1985 there was an innovative five-day course for the clinical medical students at Oxford University – long before any other medical school. Importantly, it did not only address the physical care of the patient, but equally the emotional, social and spiritual care, and included communication skills and ethics. Robert taught that palliative care was a partnership between the patient, their loved ones and the caring team. He recognised and encouraged the development of non-drug therapies such as music and art.
In 1987 the Royal College of Physicians recognised palliative medicine as a medical specialty. Sobell House hospice became a WHO collaborating centre for palliative care (1988-2005), attracting doctors, nurses and psychologists eager to learn.
In 1988 Robert established an annual two-day programme to discuss complex issues and share new research in pain and symptom management. This continues to run in Oxford and Newcastle, attended by hundreds of senior palliative care staff from the UK and abroad.
Having written some of the standard textbooks on the control of pain and other symptoms in the 1980s, in 1995 he published Introducing Palliative Care, which remains essential reading for healthcare professionals.
Born in West Bridgford, Nottinghamshire, Robert was the son of Jervis Twycross, an Anglican vicar, and Irene (nee Dell). He went to St John’s school, in Leatherhead, Surrey, then studied medicine at St Peter’s College, Oxford, graduating in 1965.
Robert influenced a whole generation of palliative care doctors and nurses around the world, including myself. He taught in more than 50 countries and was instrumental in helping establish services in several countries, particularly Poland, Hungary, Argentina, India and Russia. He recognised the need for a comprehensive guide to describe the use of medicines in palliative care, and developed the Palliative Care Formulary (1998), which is now an established text.
He was a founder member of the Association for Palliative Medicine (Great Britain and Ireland, 1985), and similarly the European Association of Palliative Care (1988).
In 1985 Robert was also a co-founder of the British Lymphology Society. Having identified that there were patients suffering with lymphoedema (swollen limbs), which can occur frequently with advanced cancer and sometimes after radical cancer surgery, he set up the first dedicated hospice clinic to symptomatically treat and research the chronic condition.
Robert had always argued against the legalisation of assisted dying and it is no surprise that his last paper, published this year, explored the challenging issues that a change in the law might bring, to society as well as palliative care doctors, nurses and hospices. He was concerned whether an assisted dying law could balance the benefit to a few against the wider societal implications.
Robert remained active after retiring from the NHS in 2001. He continued lecturing around the world and writing, only recently slowing down as ill health took its toll.
He remained a lifelong Christian and a democratic socialist, and these values guided him in 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.
