Abstract
By Richard D.W. Hain and Satbir Singh Jassal. New York: Oxford University Press, 2010, 306 pages, $69.95.
Paediatric Palliative Care by authors Hain and Jassal is an important reference handbook that covers the basic principles of pediatric palliative care. The handbook is geared both for general and subspecialty pediatric teams whose patients have palliative care needs, and for adult palliative care providers delving into the world of pediatrics. Such a mission is broad, but overall the information within this lightweight handbook serves both groups.
The handbook includes 25 chapters, a formulary, and an index. The chapters fit into three categories: principles of pediatric palliative care, symptom management and disease processes, and end-of-life considerations.
Chapters 1–4 offer background in pediatric palliative care, including the definitions and structure of pediatric palliative care, the categories of life-limiting conditions in childhood, and ethical principles encountered in palliative care.
Chapters 5–7 focus on recognizing and treating pain in the pediatric population. The overview of pediatric pain scales may be especially helpful to those new to pediatrics. The pain treatments are introduced within the framework of the World Health Organization Pain Ladder, and the authors outline advantages and disadvantages for commonly used pain medications. Chapter 8 rounds out the discussion of pain with a look at diagnosis and adjuvant treatments for neuropathic pain, bone pain, muscle spasm, and cerebral irritation.
Chapters 9–16 cover non-pain symptom management. Specific topics addressed include nausea and vomiting, constipation, anorexia, hiccups, diarrhea, sialorrhea, dyspnea, seizures, spasticity, myoclonus, dystonia, depression, anxiety, insomnia, delirium, pruitus, and pressure sores. Chapter 16 is reserved for “palliative care emergencies” such as cord compression, hemorrhage, severe uncontrolled pain, superior vena cava syndromes, and intestinal obstruction.
Chapter 17 discusses palliative care issues specific to pediatric oncology, including the symptoms common for patients with cancer, and the role of chemotherapy when cure is no longer expected. Chapter 18 introduces clinical features of the “common enough” genetic and neurologic conditions that palliative care can be especially helpful such as Trisomy 18 and spinal muscular atrophy.
Chapters 19–21 address end-of-life considerations. Chapter 19 outlines the practicalities around the time of death, some of which (the authors acknowledge) are specific to United Kingdom laws where both authors practice. Chapter 20 provides an overview of religions and rituals, with special focus on the time of death. And Chapter 21 outlines bereavement theory, as well as issues specific to children, siblings, and parents.
Chapters 22–25 return to principles of palliative care. Chapters 22 and 23 discuss communication skills, both with families and among professionals. The communication with families focuses on establishing rapport for a “breaking bad news” communication scenario. Chapter 24 touches on “coping” (burnout prevention) for the palliative care providers. And Chapter 25 briefly talks about training curriculum for pediatric palliative care.
The handbook finishes off with a 28-page formulary of medications common to pediatric palliative care. For each medication, the authors provide helpful information on the use, dosing, and route of administration (the subcutaneous dosing is uniquely helpful), and notes specific to use in pediatrics. A note of caution to U.S. providers is warranted as many of the drugs (and their names) are geared toward the U.K. readership.
While Hain and Jassal's handbook contains a great deal of useful information, the handbook could improve by addressing some design and editing flaws. On a thorough reading of the handbook, one finds important advice is often buried in the text of the book and information gets lost for the reader. Without consistent layout (use of introductions and summaries varies between chapters), at times the book becomes more difficult to navigate.
Paediatric Palliative Medicine is an easy-to-carry source of information, covering a great deal of pediatric palliative care and is a good resource for novice learners—the pediatric providers unfamiliar with palliative care and hoping to help patients with palliative care needs. However, the handbook is not so quick-to-use in the United States and Canada because it is geared toward a U.K. readership. We look forward to a second edition with a more international focus.