This book provides a comprehensive overview of the principles and practices of palliative care as they apply to end-of-life care, for doctors and other health care professionals who are called
on occasionally to manage the physical and psychosocial distress of patients near the end of life and their families. This book is divided into four sections: Preparing Patients for End-of-Life
Care, Common Symptoms at the End-of-Life, Ethical Issues and Controversies near the End-of-Life, and Special Groups (AIDS, Children).
The first section deals with prognosis, communication and interdisciplinary teams. The presentation of guidelines for estimating prognosis in non-malignant conditions (necessitated by the <6
months life expectancy rule for hospice care in the USA) is an attempt to find signposts in a clinical minefield. The many factors listed for the different diseases may help the clinician but
do not replace clinical judgment and one wonders whether they have been validated in large numbers of patients. In the section on palliative care teams, I was surprised that occupational therapists
were barely mentioned; elsewhere, the occupational therapist is a key member of the team, responsible for assessing and modifying patients’ homes so that they may be discharged with maximal function,
independence and safety.
The second section reviews common clinical problems. These chapters provide clear explanation and recommendations but would be improved if they were referenced. The chapter on psychosocial
concerns is based on "opportunities", "opportunities" that the patient and family have during a terminal illness - from fear to peace, from confusion to meaning, etc. But
it is written as though the patients will percieve and pursue these "opportunities" themselves, rather than providing some guidelines about how we may go about helping our patients
with this important aspect of suffering.
The third section is on ethical issues and provides clear discussions about the benefits and burdens of interventions such as hydration and CPR; knowing what the patient wants is mentioned
frequently. The last chapter in this section is on physician-assisted suicide that, in an attempt to be "even-handed", has turned out lame: the Dutch have provided extensive documentation
of what they do.
My quibbles aside, this is a very good book that should be available to doctors and other health professionals who do not work in palliative care full time. It is well presented and the many
tables are useful. It provides a lot of information and is at the same time readable. Hopefully, this book will be widely available in health care libraries where it will provide a valuable resource
for health care workers on those occasions when they are called on to manage patients near the end-of-life.
Roger Woodruff
Past Chairman, International Association for Hospice and Palliative Care (IAHPC)
Director of Palliative Care, Austin & Repatriation Medical Centre, Melbourne, Australia
AUTHOR INFORMATION
Barry Kinzbrunne is Vice President/National Medical Director, Vitas Heath Care Corporation, Miami, Florida, USA
Neil Weinreb is Medical Director, Vitas Health Care Corporation-Broward, Ft. Lauderdale, Florida, USA
Joel Policzer is Medical Director, Vitas Health Care Corporation-Dade, Miramar, Florida, USA.
TABLE OF CONTENTS
Part 1. Preparing Patients for End of Life Care
Predicting Prognosis: How to Decide When End of Life Care is Needed
How to Help Patients Access End of Life Care
How to Inform the Patient: Conveying Bad News
How to Work with an Interdisciplinary Team
Measuring Outcomes and Quality of Life
Part 2. Common Symptoms at the End of Life
Pain Management
Dyspnea and other Respiratory Symptoms
Gastrointestinal Symptoms
Neurological Symptoms
Dermatological Problems
Depression and Other common Symptoms
The Last Days: The Actively Dying Patient
Psychosocial and Spiritual Concerns
Bereavement
Part 3. Ethical Issues and Controversies Near the End of Life
Advance Directives and CPR
Nutritional Support and Parenteral Hydration
Diagnostic Studies and Invasive Procedures
Physician Assisted Suicide and Euthanasia
Part 4. Special Groups
End of Life Care for Patients with HIV
Care of Children Near the End of Life
Index
