2013; Volume 14, No 9, September
IAHPC book reviews
By Dr. Roger Woodruff
Palliative Care Book of the Month
DIGNITY THERAPY
Final Words for Final Days
Harvey Max Chochinov
Oxford University Press, 2012
199 pp
ISBN 978-0-19-517621-6
RRP $US44.65 £32.50
Dignity Therapy is an individualised psychotherapeutic intervention designed to help terminally ill patients navigate the psychological, spiritual and existential problems that arise at the end of life, developed by Harvey Max Chochinov and his team. Evolving from their Model of Dignity in the Terminally Ill, it addresses issues most frequently associated with loss of dignity, as well as those where intervention has been shown to improve dignity. It has been demonstrated to be of benefit not only to patients, but their families as well. It should be noted that the general ideas underpinning Dignity Therapy are not new and go back as far as recorded history, but Chochinov has provided a framework and structure that any of us should be able to grasp and apply.
The book provides a detailed account of the foundations and development of Dignity Therapy. There is also a step-by-step description of how to do it, although I felt it would take more than a few goes to achieve any sort of proficiency.
I was left in no doubt that this would be a most worthwhile way to help many of our terminally ill patients and their families. But in practical terms, I was concerned that it was time consuming for the therapists and transcriptionists and that introducing it to a busy palliative care program would have significant staffing implications. But here is a most meaningful way of helping some of our dying patients and their families—adding meaning at the end of life, easing existential concerns, and improving the bereavement process for their families.
Other Reviews
HANDBOOK OF PALLIATIVE CARE 3e
Christina Faull, Sharon de Caestecker, Alex Nicholson and Fraser Black (Eds)
Wiley-Blackwell, 2012
374 pp
ISBN 978-1-118-06559-4
RRP £40.50 $US51.99
The opening chapters provide an overview of what has happened in palliative care in the United Kingdom over the last ten or fifteen years. It reflects the progression from specialised units and palliative care in general hospitals, to the more widespread application of the principles of palliative care in the wider community. It’s about the involvement of community, patients, carers and the public; how it has expanded to meet needs—access, choices, equality and diversity. I liked the chapters on Advanced Care Planning and Adapting to Death, Dying and Bereavement.
The second half of the book deals with clinical matters. There are chapters on pain and cancer, but also renal, cardiac and pulmonary failure, chronic neurodegenerative disease, HIV infection and AIDS, and separate chapters on palliative care for children and for adolescents and young adults. There is a new chapter on palliative care for people with advanced dementia.
The information in this book is very accessible due to a good system of headings and the use of lots and lots of boxes with lists and decision algorithms. This book provides an excellent overview of palliative care in its broader context, embracing the whole community.
GRIEF AND BEREAVEMENT IN THE ADULT PALLIATIVE CARE SETTING
E. Alessandra Strada
Oxford University Press, 2013 (Oxford American Palliative Care Library, OAPCL)
118 pp
ISBN 978-0-19-976892-9
RRP $US34.99 £19.77
I was pleasantly surprised by this little book. It is a very practical and clearly set-out handbook about grief and bereavement. I thought the information was set out in a manner that would be accessible and useful to any member of the palliative care team. And it’s short.
The first part of the book is about definitions and models with clear descriptions of normal, anticipatory, and complicated grief. I was pleased to see the emphasis given to the (normal) anticipatory grieving that so many of our patients have. The importance of cultural, spiritual and developmental aspects of grief reactions is also stressed. The second half of the book is more practical from a clinical point of view and deals with assessment and treatment: what’s normal and what you can do; what’s not normal, what the treatment options are, and when you need to involve the mental health and bereavement specialists. Again, I was pleased to see the discussion about patients’ grieving as well as that of the families. There is good use of tables and bullet-point lists. I thought this would be a good primer for a palliative care nurse or a less experienced doctor (or any other member of the palliative care team). It will also be useful for anyone faced with a worrying clinical problem, to brush-up and organise his or her thoughts about grief and bereavement. There needs to be a similarly straight-forward handbook about dealing with children—the children of dying young adults, or grandchildren old enough to be very attached to the dying person—as I feel that it is an area of continuing need where many of us could do with a little help.
THE PALLIATIVE APPROACH
A Resource for Healthcare Workers
Erica Cameron-Taylor
M&K Publishing, 2012
114 pp
ISBN 978-1-905539-67-3
RRP £19.00 $US27.48
As the title suggests, this book is about the palliative approach, what can and should be done to improve the holistic medical care and quality of life for the masses of people with life-limiting illness, not just those already under the banner of palliative care. The author says it is not a medical or nursing textbook but...‘It is intended instead to provide a simple and common sense introduction to the care of patients in the generalist setting for whom a palliative approach is deemed appropriate.’
The introductory chapters are about palliative care and the palliative approach, old age, and the meaning of death and dying. There are chapters on malignancy, organ failure and neurodegenerative disorders. How to recognise and treat the dying patient, difficult conversations, and comparing comfort-focused care with (some times futile) curative treatment are all dealt with. Caring for the carer, as well as grief and loss, are discussed.
I agree with the author that this is not a textbook of palliative care. But I think it will be a valuable resource to introduce medical students and undergraduate nurses to the concepts of palliative care. It’s short, to the point, and in no way dogmatic or challenging. It could sew seeds in fertile young minds that might reap benefits in the future. Whether you can get more than a few family physicians or general practitioners to read it is a different matter.
Something Special
I WASN’T STRONG LIKE THIS WHEN I STARTED OUT
True Stories of Becoming a Nurse
Lee Gutkind (Ed)
InFact Books, Pittsburgh, 2013
271pp
ISBN 978-1-937163-12-9
RRP $US15.95 £10.30
This book was a pleasure. Twenty-one stories, written in the creative or literate non-fiction vogue, about nursing. But I don’t think that the title does justice to what is in the book. Whilst a number of stories refer back to the ungainly days of training to be a nurse, this book is more about what it means to be a nurse. On the one hand, there are the hassles, the long shifts, dealing with difficult patients and their families, and caring for the disadvantaged and poor. On the other, there is the professional camaraderie and satisfaction.
I was surprised and pleased at how many of the stories directly related to palliative care. There are the stories of ER and ICU nurses who moved to palliative care and what it meant to them, which underline some of the most important principles in what we do in palliative care. There is the nurse who created a ‘safe haven’ for men with AIDS at the beginning of the epidemic, when homophobia reigned and funeral homes refused to collect the bodies; his goal was to ensure that they were all allowed to die with dignity. There are stories dealing with dying infants, just a few hours or weeks old, and their distraught parents; there’s some raw palliative care philosophy in there. I think my favorite was The Nurses Whispered, a woman’s story about the deaths of her mother and father and all the whispered support she received from nurses. The stories have a serious side as well: the observation that grief, sorrow and helplessness are not objective and so are not charted is salutatory; the ethical dilemmas we face each week are discussed, as is the difference between empathy and sympathy.
I thoroughly enjoyed these stories. The stories are real; there is no drama added for effect. Doctors do not come out with flying colors, but I respect the fact that I spend minutes with patients, where nurses look after them for eight hours (or longer). I recommend this book to all you palliative care nurses out there—you will probably relate to the stories more strongly than I did. I think this book is an important step in telling the world what nursing, palliative care nursing in particular, is all about. The cover tells me that the New York Times described it as ‘Beautifully wrought’.
Roger Woodruff, MD (Australia)
August 2013
Dr. Woodruff is a Lifetime Member of the IAHPC Board and Past Chair. His bio may be found here.
Note for authors and publishers: If you wish to have your book reviewed, please send to:
Dr Roger Woodruff
IAHPC Bookshop Editor
210 Burgundy St, Suite 9
Heidelberg, Victoria 3084
AUSTRALIA
Note: Review copies become property of IAHPC and are not returned to the author. Only palliative care related books which are previously approved will be reviewed. Due to the large number of requests, we can't provide exact dates of when books will be reviewed.
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