Palliative Care: A Case-based Guide.

Abstract

Northwestern Memorial Hospital, Chicago, Illinois. aogunsei@nmh.orgEdited by Jane E. Loitman, M.D., M.S., Christian T. Sinclair, M.D., Michael J. Fisch, M.D., M.P.H. New York, Humana Press, 2010. Price: $59.95.In the summer of 2009, as the healthcare debate heated up, a new phrase was thrust into the American lexicon: death panels .Credited to the former governor of Alaska, Sarah Palin, the term was used to describe a section in the healthcare reform bill that would have funded doctors to have discussions about end-of-life planning with patients. To the horror of many practitioners, this was for many Americans, the first introduction to the concept of palliative care. The falsehoods and misconceptions that began circulating at that time were regarded to have set back the cause of palliative care at least a decade.Another year, another summer, and this time the practice of palliative care has cause to hope that it is no longer associated with “rationing” of care and administrative judgments of life versus death. The reasons for this change are two-fold. First was the publication in The New Yorker of Atul Gawande's1thoughtful treatise on end-of-life care in the United States and the struggles of patients, families, and healthcare providers faced with incurable illnesses in a system that can always offer one more intervention aimed solely at staving off the inevitable. In the article, Gawande1narrates his own journey of discovery that hospice and palliative care help patients “live their fullest lives now.”This essay was followed by the publication of a study a few weeks later in the New England Journal of Medicine 2that showed lung cancer patients receiving traditional curative care and early palliative care had a better quality of life and outlived patients that received standard care alone.These two publications—more than any others in recent memory—have helped shift the perception of palliative care from that of Grim Reaper to life-affirming holistic medicine that should be standard practice for people with advanced illness.It is into this new, nurturing climate that the book Palliative Care : A Case -based Guide is delivered. The book is a slim volume in a glossy, everglade green that is small enough to fit into a laboratory coat pocket. Palliative Care is aimed at general clinicians who are caring for patients with life-threatening or life-limiting illness.There are 10 chapters, spanning topics that range from global palliative issues to issues in the last hours of life. Each chapter is written by experts in the field and is presented as case-based problems realistic enough to be encountered in any medical practice. The cases work through scenarios from initial presentation and diagnosis to management, follow up, and handling of complications. In addition, Palliative Care provides a framework for dealing with the many associated psychosocial challenges that arise for patients and their families.Palliative care is a relatively young field with a budding evidence base and growing research to support many of its practices. The authors provide literature references at the end of each chapter for people inclined to seek out the data behind the recommendations.Overall the book is well written and edited, with scant editorial glitches. Included are the expected topics, such as communication; symptom management, including pain, dyspnea, nausea, vomiting, diarrhea, and constipation; as well as caring for patients and families when death is imminent.The chapters on nutrition and psychiatric palliative issues stand out for their insightful, thorough, yet concise handling of topics that are frequently challenging for patients, families, and healthcare providers. Also welcome are the chapters on cardiac issues and palliative skin and wound care.Because the book is aimed at general clinicians, an introductory chapter that defines palliative care and hospice, why this approach is important, who provides it, and where it is provided (inpatient, ambulatory, home) would have been beneficial. Also missing is a chapter on pediatric palliative care, as well as discussion of the challenges faced by families with young children when a sibling or parent is dealing with a life-threatening illness. However, these omissions do not take away from the value and utility of this book. It is a book that belongs on the desk, if not in the pocket, of every physician.Northwestern Memorial Hospital, Chicago, Illinois. aogunsei@nmh.org