Abstract
Edited by Doreen Oneschuk, Neil Hagen, and Neil Macdonald. Oxford, UK: Oxford University Press, 2012, 411 pages, $59.99.
On January 20, 2005, Dr. Derek Doyle received the Lifetime Achievement Award from the American Academy of Hospice and Palliative Medicine. In his elegant acceptance speech to the academy he said, “Palliative medicine should be an exercise in befriending and sharing as much as an exercise in therapeutics or clinical pharmacology.…We owe it to the world to share all we know and all we love about palliative care.” More apropos words could not be spoken to describe the third edition of this fun to read, interactive, informative, and well-written manual of palliative medicine. This third edition is revised to reflect the clinical developments in palliative care and brings a wealth of knowledge and perspective to the teaching and practice of palliative care. It is an excellent introductory text for medical students, nurses, and fellows coming to palliative care from other disciplines and is very useful for practicing clinicians.
The case-based format of each of the 31 chapters in this book allows for easy reading and application of palliative care principles. At the beginning of each chapter, the objectives are clearly outlined in the format of Attitude/Skill/Knowledge. This succinct style allows the reader to anticipate what will be learned in each chapter. Clinical vignettes are presented throughout each chapter and the question/answer format is utilized to highlight important issues.
This third edition of Palliative Medicine includes new chapters on the topics of neurological disorders, evaluation of a person's last days, and palliative sedation. Other important topics updated in this book include communication, interprofessional care, pain, anorexia-cachexia-rehabilitation-fatigue, respiratory problems, mouth care, gastrointestinal problems, ethical issues, psychosocial and spiritual issues, sleep disorders, palliative care in cardiac disease, end-stage renal disease (ESRD) and HIV/AIDS, pediatric palliative care, lymphedema, wounds in advanced illness, genitourinary symptoms, delirium, palliative care in the intensive-care unit, and complementary and alternative therapies in cancer. The book provides an overview of many palliative care issues using multiple clinical scenarios.
As an adult oncologist and palliative care physician, I found the section on palliative care in nonmalignant disorders to be well written, practical, and instructive. These are not areas of which I have particular expertise, so as a practicing clinician in palliative care I found theses chapters to be informative. Chapter 19 focuses on the trajectories of heart disease, symptom management of heart failure, and patients potentially eligible for cardiac transplantation. The chapter on ESRD outlines causes, etiologies of pain, and medication dosing in ESRD. The authors discuss the importance of communicating prognosis and establishing goals of care early in the trajectory of illness to help patient and families anticipate the inevitable future question of “When is it appropriate to discontinue dialysis?” Chapter 21 focuses on palliative care in the neurologic diagnoses of stroke and ALS. The challenging topics of nutritional support and longterm care along with symptom management in these patients are thoroughly addressed. The need for early integrated advanced care planning is emphasized, as this patient population often develops impaired cognition with disease progression and as a result, impaired decision making capacity.
Another particularly challenging area for me is when palliative care involves children. Caring for dying parents who are leaving young children is emotionally distressing for me both as a physician and as a parent. Through case-based teaching, this chapter enables the health care provider to have critical end-of-life conversations with parents about children in all stages of development. This section addresses important questions such as, “What do we know about supporting a child's involvement at the time of death?” “What about children's guilt and imagination?” “Do you think that children should attend a funeral?” This chapter presents a scenario of a child with a malignant brain tumor and outlines how to perform good symptom management and end-of-life care.
This book also tackles the ethically and emotionally challenging topic of palliative sedation. Again in a question/answer format the authors define palliative sedation, the prerequisites of its initiation, and under what circumstances palliative sedation is indicated. The meticulous adherence to guidelines is stressed throughout this chapter along with the need for active involvement by a palliative care specialist team. References are provided to guidelines by individuals as well as the Regional Canadian/National and International Guidelines. The ethical considerations of decreasing consciousness and the possibility of shortening life are discussed as potential “side effects” of the intent to alleviate the refractory symptoms being treated.
While reading this textbook it is important to remember that this is an introduction to palliative care. While the book gives a panoramic view of the field, it is not intended to be an in-depth evaluation and assessment of all possible palliative care scenarios. The up-to-date and comprehensive references provided at the end of each chapter guide the reader to further explore topics of interest.
The preface of this book states, “The other feature of the book that has not changed in this third edition is its Canadian perspective, as all of the authors who contributed their outstanding professional knowledge and skills to its production are based in Canada.” Thank you to our Canadian colleagues; this is an excellent book and one all students and teachers of palliative care should have on our bookshelves.