The field of palliative care is changing. Behind us now are those pioneering days of Balfour Mount and Dame Cicely Saunders; they are a distant memory for some and more a thing of legend for others. Over the past 50 years, the hospice and palliative medicine movement has evolved from its humble, but essential, nursing and spiritual beginnings to a vast and multidisciplinary model of care aimed at the relief of suffering in whatever way, shape, or form it may appear.
And it is a uniquely philosophical field. Palliative care sits at the intersection of medicine and humanity and serves as an advocate for the patient as a person—a person with goals and values, fears, and expectations. There is an art to it, but there is also a science. With modern advances in interventional techniques, the discovery of novel drugs and the shifting healthcare environment, it has become imperative that our understanding of palliative care adapt and change with the field.
It is fortunate, then, that at such a critical time in the evolution of palliative medicine, the book Essentials of Palliative Care has been published. It is a book designed for all clinicians, regardless of specialty, and its aim is to discuss the many tools and techniques needed to provide high-quality palliative care in today’s world. Although some chapters are broad and general, others are very detailed and specific. Nonetheless, as a whole it strikes a comfortable balance and is a great addition to the palliative care library.
The book is divided into 28 chapters, with topics ranging from communication skills and symptom management to interventional techniques and vascular issues in palliative care. Each chapter is followed by 5–10 review questions that touch on key points from the chapter, along with answers to the questions and a full list of references. The review questions are, in general, quite good, although not all of the chapters contain explanations for the answers, which would have been helpful.
Each chapter is written by one or more experts in the field, which is one of the greatest strengths of the book; it is a truly multidisciplinary collaboration among nurses, social workers, anesthesiologists, internists, and more. Taken as a whole, the book is a wonderful reflection of how palliative care should operate on a daily basis, through teamwork and collaboration. There are only one or two instances in which a different perspective might have been interesting; for example, a nutritionist’s insight in the chapter on nutrition or those of a child life specialist in the chapter on pediatric palliative care might have been helpful.
The expertise of each author is evident as the chapters are well written and very informative. The chapters on psychological distress, communication skills, and symptom management are phenomenal, as are some of the later chapters, including Endoscopic Therapies for Palliation of GI Malignancies, Management of Advanced Heart Failure Patients, and Palliation in Respiratory Disease.
Several of the chapters, however, are a little too specific for a general clinician; for example, the chapter on interventional techniques seems geared to an interventional anesthesiologist, with detailed descriptions on technique, drug doses, and various equipments used. Other chapters are a little too general and not specific enough to the palliative care setting; for example, the chapter on headaches discusses the diagnosis and treatment of migraines and cluster headaches, but not specifically in a palliative context (as it might relate to primary or metastatic cancer, radiation therapy, or end-of-life prognosis). There are also several notable topic omissions: there is very little mention of dementia, wound care, or amyotrophic lateral sclerosis (ALS)—all of which are large topics in hospice and palliative medicine. A chapter on spirituality and cultural issues in palliative care might also have been helpful.
The book is well edited, with only a handful of grammatical and spelling errors. Chapter 1 Introduction and Education is identical to the Preface, which seems odd. There are several confusing or incorrect tables and figures: the FAST staging in table 4.2, for example, is incorrect, and figure 15.1 detailing the Seldinger technique is confusing. There are also a few font or layout irregularities throughout the book. However, these inconsistencies are greatly outnumbered by the many helpful diagrams, images, and tables as well as the logical chapter progression and incredibly detailed text.
Thus, the above points aside, Essentials of Palliative Care as a whole is an extremely well-written and very informative book. It is a book that should sit on the shelves of all physicians—from palliative care specialists to internists and anesthesiologists alike. It is a true multidisciplinary effort, and another step forward for the field of palliative care.
