End-of-Life Care for the Critically Ill

Abstract

For the novice or expert nurse, nurse practitioner, physician or social worker in the hospice, palliative care, or critical care specialty, this book provides an excellent and concise overview of end-of-life care for the critically ill patient and family. The book is an important addition to the library of both critical care and palliative medicine. The contributing authors are multidisciplinary experts from across the globe. There are 15 chapters, with numerous sections under each chapter. The chapters are as follows: Introduction, Improving palliative and end-of-life care in the intensive care unit, Symptom management, Caring for families in the critical care setting, Cultural issues and spiritual issues, Teamwork relationship and moral distress, Legal issues and conflict resolution, Cardiopulmonary resuscitation, Withholding and withdrawal of life support, Lessons learnt, Personal reflections, Special situations, Organ and tissue donation, Research issues, and Web-based resources. Easy to read and compact in size, the book can be accessed by clinicians on daily rounds. The authors nicely detail topics important for practice. These clinically relevant topics include an overview of barriers to end-of-life care, prognostication, common disease states, sample order sheets, and common medical abbreviations used in critical care. The book does not discuss the source of complicated palliative medical management. Instead, it provides concise evidence-based symptom management and practical information based on contributors’ experience. At the end of most chapters, references for additional reading are provided. The web-based resource chapter highlights links to intensive care information from a global perspective. For clinicians involved in research, two valuable chapters review the current state of end-of-life literature. In Chapter 4, several charts review the literature on observational, interventional, and qualitative studies of medical care for critically ill patients and their families. Chapter 14 covers research issues, such as barriers faced by clinical researchers of end-of-life care, and important ethical concerns surrounding randomized control trials at the end of life. Also of interest to the clinician is Chapter 2, which provides information on measuring the quality of care at the end of life. Key terminology for quality measurement is provided, along with specific examples of quality improvement activities. As an experienced clinician in both critical care and palliative care, I found the chapters on special situations, personal reflections, and lessons learned most interesting. These chapters provide a novel approach to guidance on complicated clinical situations that I have not seen in similar books. This is a must-read for clinicians in practice. The section entitled, “How to educate trainees in the ICU: The value of death rounds,” is well organized and will serve as an excellent resource for the clinician involved in teaching. My only criticism of this book is that professional degrees are not listed after the contributing authors’ names. The listing of clinical discipline may be helpful for the reader in terms of understanding how a topic is being examined. On balance, this is a worthwhile book for a wide variety of palliative care professionals at different levels of experience. Marlene E. McHugh, DNP, FNP-BC, RN, is Associate Director, Palliative Care Service, Montefiore Medical Center, Bronx, NY, and Assistant Professor of Clinical Nursing, Columbia University School of Nursing, New York, NY, USA.