END-OF-LIFE-CARE Clinical Practice Guidelines
Kim Kuebler, Patricia Berry, Deborah Heidrich (Eds)
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| W.B. Saunders, 2002
ISBN 0-7216-8452-1
492 pp
RRP $US49.95 £31.95 
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The purpose of this book is to provide advanced practice nurses (APNs) in the United States with the guidelines and tools to provide comprehensive end-of-life care. Its goal is to encourage
a scientific approach to the understanding and assessment of symptoms and to use evidence-based therapies.
Part I provides a general description of palliative care, the role of APNs and the use of Clinical Practice Guidelines.
Part II is about holistic care. There is a chapter on grief and bereavement, followed by chapters on complementary therapies and psychosocial care. A curious order, given that the adequacy
of psychosocial care given before death often determines the need for therapy in bereavement.
Part III comprises seven chapters summarizing advanced/end-stage disease processes. The inclusion of these chapters on end-stage non-malignant disease is welcome, but they are perhaps too superficial
to provide an in-depth understanding of the pathophysiology. Twelve pages cannot do justice to advanced cancer, or seven pages to AIDS.
Part IV presents the clinical practice guidelines for 23 different clinical syndromes from ascites to ulcerative lesions. These are well set out - definitions, etiology and pathophysiology,
assessment and measurement, history and physical examination, diagnostics, intervention and treatment, patient and family education, and evaluation and plan for follow-up - and they are mostly
well referenced.
The treatment sections of some of these Guidelines lack depth and one is left asking whether the literature was critically reviewed. The Guideline on the management of pain is pharmacologically
satisfactory but there is no mention that the best way to treat cancer-related pain is often to treat the cancer itself. The Guideline on dehydration seems to favour artificial hydration, but
doesn’t mention the study that reported no relationship between hydration and the level of consciousness in terminally ill patients. The reference to the use of high dose dexamethasone in spinal
cord compression is to another book, which refers to the trial of high dose dexamethasone versus no dexamethasone; the sequential study showing no significant difference in ambulatory outcomes
of standard and high dose dexamethasone is not referenced.
Taken overall, the Guidelines are impressive. Using it as a day-to-day handbook it would provide a valuable and very practical guide to assessing patients and the approach to palliative medical
therapy. But if APNs are to work alongside MDs and provide equivalent medical care (as distinct from psychosocial and spiritual care), then the coverage of the pathophysiology of end-stage disease
needs to be more detailed and the assessment of treatment options reviewed more critically.
Roger Woodruff
Past Chairman, International Association for Hospice and Palliative Care (IAHPC)
Director of Palliative Care, Austin & Repatriation Medical Centre, Melbourne, Australia
AUTHOR INFORMATION
Kim Kuebler, Primary/Oncology/Palliative Care Private Practice, Michigan, USA
Patricia Berry, Assistant Professor, University of Utah, College of Nursing, Salt Lake City, Utah, USA
Deborah Heidrich, Nursing Consultant, West Chester, Ohio, USA
TABLE OF CONTENTS
Part I General Principles of End-of-Life Care
1. The Advanced Practice Nurse in end-of-life Care 3
Berry, Kuebler
2. Clinical Practice Guidelines for Advanced Practical Nursing 15
Kuebler, Berry
3. End-of-Life Care 23
Keubler, Berry
4. The Dying Process 39
Berry, Griffie, Heidrich
Part II Holistic Care at the End-of-Life
5. Grief and Bereavement 53
Roberts, Berry
6. Complementary Therapies 65
English
7. Psychosocial and Spiritual Care 97
Loseth
Part III Advanced/End-Stage Disease Process
8. Cardiovascular Disease 127
Scot
9. Pulmonary Disease 137
Berry
10. Gastrointestinal Disease 143
Spencer
11. Renal Disease 147
Keubler
12. Neurological Disease 157
Heidrich
13. Malignancies 165
Heidrich
14. HIV- and AIDS-Related Disease 181
Deshotels, Keubler
Part IV Clinical Practice Guidelines
15. Ascites 189
Heidrich
16. Anxiety 199
Keubler, Heidrich
17. Cachexia and Anorexia 213
McKinnon, Keubler
18. Constipation 221
Heidrich
19. Cough 235
Berry
20. Dehydration 243
Keubler, McKinnon
21. Delirium/Acute Confusion 253
Keubler, Heidrich
22. Depression 269
Keubler
23. Diarrhea 281
Heidrich
24. Dyspnea 301
Keubler
25. Fatigue 317
McKinnon
26. Hiccup 327
Berry
27. Nausea and Vomiting 333
Griffie, McKinnon
28. Pain 345
Griffie, McKinnon, Berry, Heidrich
29. Palliative Care Emergencies 383
Heidrich, McKinnon
30. Pruritus 409
Scot
31. Ulcerative Lesions 419
Heidrich
Prognostic Guidelines for non-cancer diagnoses 435
Internet resources 449
Index 457
