Abstract
As the need for palliative care (PC) providers continues to surpass the number of specialists in the field, there is an increasing recognition that all clinicians need to learn basic PC principles. Palliative Skills for Frontline Physicians offers a palliative toolbox and reminds readers that it is their duty to use it.
The book is divided into four sections: emergency medicine, inpatient medicine, surgery, and specialty medicine. There are 31 case vignettes representing some of the most common, yet challenging, dilemmas in inpatient medicine—a question of artificial nutrition for a patient with dementia, a morally distressed medical team delivering what they believe is “futile care,” a hospice patient who presents to the emergency room, and consideration of surgery for a dying patient, to name a few. The cases are intentionally authored by a variety of specialists, each with PC training, demonstrating that these skills are applicable, useful, and necessary to all fields.
After each case introduction, the authors present two methods in parallel: the “usual approach” and the “palliative approach.” The “usual” approach can be somewhat oversimplified, highlighting algorithms and poor language choice that often exist to some degree, but may strike some as not representative of their care. Yet, the contrast demonstrated between the two methods communicates clearly the positive impact that a palliative mindset can have on the patient and family, as well as the provider.
The chapters are short but dense with PC instruction. This ensures that even reading a single chapter can provide a new way of thinking immediately applicable to one's own patients. The authors do an excellent job of not only highlighting the key aspects of each case (through call-out boxes, graphs, and tables), but also weaving themes across chapters, to enhance retention for case-based learning.
The content is focused on communication. The reader is presented with some of the most well-known PC communication techniques—including conversation frameworks with specific words and phrases, the use and misuse of metaphors, and approaches to common challenges such as balancing hope and realism, expectations for miracles, and others. The book is not as focused on symptom management. The authors do highlight some essential symptom management concepts, although they are comparatively less nuanced. This focus on communication is appropriate for the scope of this work, since most readers will have greater baseline skills in treatment than communication and the stated goal of the book is to “realign” providers with patients.
Aside from communication and symptom management, this book unpacks many of the questions that are asked during a PC curbside, including order of surrogate decision makers, hospice qualification for dementia, the ever confusing peri-op do not attempt resuscitation (DNAR), and prognostication for some of the most common chronic illnesses. Moreover, this book encourages thoughts and behaviors central to PC practice that may be overlooked in other specialties. It encourages readers to reflect on their own values, seek support from colleagues, and always provide a goal-concordant recommendation to a patient.
This is a thoughtfully composed resource for anyone interested in advancing their PC communication skills, while offering tips and pointers for management of symptoms along the way. As a case-based learning tool, it is not intended to be an exhaustive review for the principles and practices of palliative medicine. However, it meets the goal to effectively provide the reader with a toolbox of primary PC skills that can improve the care of vulnerable patients with serious illnesses and their families. This book would be a useful addition to a PC or hospice program's bookcase to be shared with rotating learners from all disciplines and will help non-PC clinicians enhance patient care through daily use of a palliative lens.
—Reviewed by:
Teresa (Tess) Hanson, MD
Palliative Care Program
Department of Medicine
Duke University School of Medicine
Durham, NC
USA
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