Abstract
Edited by Jane E. Loitman, Christian T. Sinclair, and Michael J. Fisch. New York: Humana Press, a division of Springer Science+Business Media, 2010, 83 pages, $59.95. Amazon Kindle edition available.
Many clinicians, regardless of specialty, care for patients approaching end of life. Although some encounters are fairly routine and supportive, others require more time and focus, as well as an interdisciplinary approach to care. Palliative Care: A Case-based Guide, steers the clinician through practical case-based scenarios and offers novice and advanced palliative care practitioners a stepwise approach to the practice of palliative medicine. Despite not being the first case-based text available, it is convenient and easy to read, a guide worthy of the busiest of practitioners.
Palliative Care: A Case-based Guide is divided into 10 Care Issues, topics that range from Communication to Symptom and System Management. Each Care Issue is written by different authors with backgrounds in pain and palliative care, oncology, and nursing. Two of the editors, J. E. Loitman and C. T. Sinclair, also contribute to the text. Each Care Issue begins with an abstract with general information followed by a brief description of the patient to be discussed. “Consider” questions or statements follow the brief patient description, and a “Key Points” section takes the abstract apart into bullet points. Although this redundancy can be distracting at times, this careful introduction helps prepare the reader for the complexity of the case and contributes to the richness of the accompanying discussion. The final section, “Further Reading,” offers sentinel articles to supplement the topics.
The first two Care Issues of this guide define the basic concepts of palliative care. Although too simplistic for an active palliative care practitioner, these topics are useful for new learners; these topics define the elements of the multidisciplinary team, basic approaches to grief and bereavement, and important communication skills. The reference to the “S-P-I-K-E-S strategy” brings the fundamental principle of discussing serious prognostic information to the Communication Care Issue.
The middle section of the guide contains several useful systems-based Care Issues such as Cardiology, Pulmonary, and Gastroenterology. Each section provides actual case scenarios. Imbedded within the text, answering each case scenario, are tables that include methods to ascertain functional status, interventions, and treatment options. Among the many topics covered are pain in congestive heart failure, deactivation of devices, secretions at the end of life, and the palliation of inoperable bowel obstructions. There are even scripted questions for clinicians to ask patients in order to help direct conversation when discussing options for medical treatment.
The final section of the guide offers more detailed strategies for the management of psychiatric issues, nutrition, pain, and wounds. These Care Issues also contain useful tables of medication options and dosing, narcotic conversions, and treatment strategies. A table on wound care options is particularly useful, providing a quick reference guide to the majority of wound care products available and giving the clinician more confidence in knowing how to palliate wounds and decubiti.
In summary, Palliative Care: A Case-based Guide is an effective tool for dealing with the challenges of severe disease and the progression of the morbid state. Each case scenario provides a step-by-step method for approaching the complex care of terminally ill patients. Additionally, the continuum of care is addressed in the course of each Care Issue; as the burden of symptoms and disease progress, the goals of care are reexamined. Systematic, brief, and easy to maneuver, this guide is an essential primer for the palliative care novice.