Abstract
By Steven R. Connor. New York: Taylor and Francis, 2009. 262 pp., $31.45.
In Hospice and Palliative Care: The Essential Guide, Steven R. Connor provides an orientation to the world of hospice that serves as an indispensable resource for both readers familiar with hospice practice and newcomers. This 262-page work is accessible to all interested professionals but especially relevant to new hospice providers. As a senior hospice worker, researcher, and international consultant to the NHPCO, Connor is uniquely positioned to offer historical perspective and a current update on issues facing the field.
The book's 14 chapters are divided into three sections. In the first part, Connor explores the care provided by hospice teams, and how care is delivered. The next section addresses challenges facing the hospice community, from the mechanics of management to the role of the field in the U.S. health care system. The final section examines strengths of the hospice model, its place in global health care, and its future. Most chapters are anchored with case illustrations, humanizing the relevant topics. The book concludes with two appendixes, the first composed of discussion questions and activities and the last a list of organizational resources.
The first and most practical section, composed of six chapters, explores the content and mechanics of hospice. Chapter 1, “What Are Hospice and Palliative Care?” provides historical perspective, defines terms, explores philosophical underpinnings, and lists characteristics common to all hospices. Chapter 2, “The Interdisciplinary Team,” explores the team structure of hospices and palliative care teams, differentiating these models from traditional ones. Chapter 3, “Symptom Management and Physical Care,” does not offer nuts and bolts of patient care—no medication dose are listed—but rather shows the general way symptom management is viewed through the lens of hospice workers. In chapter 4, “Psychosocial and Spiritual Care,” Connor reviews stage theories of death and their limitations, as well as the International Work Group principles for the psychosocial care of dying people (1993). While this and other excerpts may have been more accessible as an appendix, rather than embedded in the text, it is a useful reference. Chapter 5, “Grief and Bereavement,” offers a wonderful description of hospice's approach, covering bereavement services provided and theories of care. Chapter 6, “Community and Public Engagement,” explores hospice's role in the community through outreach and education.
The second section of the book begins with chapter 7, “Managing Hospice and Palliative Care.” In it, Connor delves into the mechanics of running a hospice, including addressing financial challenges, fostering a successful working climate, and meeting national standards. Chapter 8, “Hospice and Palliative Care in the U.S. Health System,” outlines topics including the Medicare Hospice Benefit, eligibility, and prognosis, and challenges in research. Additionally, Connor provides an insightful discussion of both “the arrogance of hospice” and the danger of hospice workers “needing” praise from their patients. Chapter 9, “Society and Denial,” explores the U.S. health care system's “unwillingness to acknowledge the likelihood of death” and the repercussions on patient care. Chapter 10, “A Right to Die?” examines the unique role hospice can play providing a middle ground in the often polarizing debate about assisted suicide.
The final section provides a broad perspective of the field, exploring unique strengths of hospice and palliative care and future directions. Chapter 11, “How Palliative Care is Unique in the Health Care System,” highlights the field's strengths, including its tendency to attract uniquely dedicated practitioners, the teamwork fostered by the interdisciplinary approach, and the emphasis on opportunity for growth at end of life. The chapter contains a masterful section on hospice providers' need for “accurate empathy,” the ability to empathize with patients effectively and passionately without becoming overly involved or burning out. Chapter 12, “How Good are Hospice and Palliative Care?” summarizes seminal evaluations of hospice outcomes. There is, however, little discussion about the impact and outcomes of non-hospice palliative care, including inpatient palliative care consult services. Chapter 13, “Hospice and Palliative Care around the World,” examines hospice's changing roles in the global health care system. In chapter 14, “The Future of Hospice and Palliative Care” Connor addresses important questions about the future of the field and makes recommendations for improvement.
Connor succeeds in providing the reader with an excellent overview of hospice. He also succeeds in presenting an analytical view of challenges in the field, rather than a cloying “pro-hospice” manual. Considering his background, he is surprisingly unbiased and critical, offering many astute insights. Importantly, however, this book is fundamentally about hospice, with only occasional paragraphs touching on the challenges and strengths unique to palliative care when distinct from hospice practice. Additionally, some practical aspects of hospice management could have been more thoroughly addressed. While Connor stresses the non-hierarchical structure of hospice teams, he brushes over practical, role-specific considerations, such as professional and legal culpability, that can interfere with fully realizing the interdisciplinary ideal.
The book will serve as a useful tool for hospice provider training or self-education. The discussion questions in appendix A are practical tools for self-study, and the index is helpful and detailed. The work is not a palliative medicine or hospice textbook, nor is it meant to be. Those looking for detailed guidelines on medical practice should look elsewhere. However, the book offers a strong introduction to practice concepts.
In summary, this book serves as an excellent introductory resource to the growing area of hospice practice. Accessible to all interested readers, it is perhaps most useful to those entering hospice training or work. It is a thoughtfully written, broad, and insightful look at the history and current practice of hospice.