Abstract
By Sara Booth, Polly Edmonds, and Margaret Kendall. New York: Oxford University Press, 2010, 173 pages, $59.95.
Palliative Care in the Acute Hospital Setting: A Practical Guide aims to support palliative care clinicians in establishing, developing, and maintaining palliative care services in acute care hospitals. Written by three palliative care clinicians from the United Kingdom, the book can be read from cover to cover or more selectively according to the needs of the reader. It is geared toward clinicians with management roles, and uses case-based vignettes to discuss common problems in the development of palliative care programs. However, the book is also useful for clinicians making the transition from a hospice to a hospital setting, or for any clinician working in the acute hospital environment.
The book starts by comparing palliative care in acute hospitals and in hospices. It highlights the need for increased resilience and perseverance when working as a hospital consultant in a new field that colleagues may not fully understand or value. One author comments that if you “have the need to be endlessly loved” the acute hospital setting may be a challenging environment.
After exploring the difficulties posed by the acute care setting, the book focuses on how to develop an inpatient consultation service, with chapters on the structure and function of an inpatient team, the organization of clinical care, and strategies for incorporating palliative care into the broader hospital culture. The chapter addressing practice within a multidisciplinary team, for example, includes practical advice on negotiating with team members, other medical services, and nursing colleagues.
Since the primary intended audience for this book is clinicians practicing in the U.K. health care system, some of the chapters have a strong U.K. focus. For example, the chapters on bureaucracy and finance, research, and education and training contain references and acronyms that may be unfamiliar to American readers. I would encourage readers to explore these sections, however, as they contain important and useful concepts that transcend specific health care systems and can help clinicians face the inevitable challenges in their own facilities and countries. One example is that these chapters showed me how helpful it could be for clinicians to have formal training in management, business, or public relations when facing the challenges inherent in developing a palliative care program.
The final chapter of the book includes a thoughtful discussion of burnout and self-care and includes helpful sections on dealing with difficult colleagues, frustration, paranoia, and competitiveness. I found this chapter engaging, powerful and highly activating. (I was personally motivated to infuse more dance in my life and actually signed up for a belly-dancing class.)
Overall Palliative Care in the Acute Hospital Setting: A Practical Guide is concise and balances the presentation of factual information with thoughtful discussion and illustrative vignettes. My biggest critique is that I found the book to be poorly edited with some awkward sentences that could be distracting. Nevertheless, the book is inspiring and leaves the reader excited about the possibilities of inpatient palliative care. With the current trend of rapid expansion of hospital-based palliative care services many clinicians are being asked to develop programs from the ground up. I recommend this book as one resource in an armamentarium to help support those missions.