2015; Volume 16, No 9, September

IAHPC Book Reviews

By Dr. Roger Woodruff

Palliative Care Book of the Month

Edited and written by three pharmacists, this book is primarily about the use of medications in the management of pain and symptoms in adult palliative care patients. It is a guide to palliative care that emphasizes pharmacological information and the pharmacist’s concerns where medications are used.

In the first section, there is an introduction to what palliative care is about, followed by a description of what constitutes unnecessary medications. The second section (190 pp) provides Guidelines for Effective Management of Symptoms (GEMS) for 23 different symptoms or symptom complexes from Agitation to Xerostomia. Each section includes information about prevalence, causes and risk factors, non-pharmacological treatment, and pharmacological management; the list of possible drug therapies includes comments about relative efficacy and side effects. The whole text consists of lists and tables, making the information very accessible. Each section wraps up with a list of clinical pearls, a treatment algorithm, and references. The third section (46 pp) is about Disease State Management and includes material on 10 of the conditions we see commonly, including cancer, AIDS, and neurodegenerative disease, as well as end stage chronic cardiac, pulmonary, renal and liver disease. It provides useful information about where the effects and side effects of the drugs used to treat the underlying condition intersect with the goals of palliation.

At the end are some useful appendices, including tables on benzodiazepine equivalence, glucocorticoid equivalence, an insulin comparison chart, and lists of drugs that may cause extrapyramidal side effects, anticholinergic symptoms, or prolongation of the QT interval, as well as a 38-page list detailing drug dose modifications required with liver or kidney impairment/failure.

Although written for the American system, the information it contains is relevant anywhere (a few drug names and variations in drug availability aside). I think this would be a useful reference to have on a palliative care ward. It provides a wealth of accessible information regarding medications that would be useful to both experienced practitioners and to the resident staff and nurses.

Other Reviews

This book is about starting a conversation regarding what it is that healthcare chaplains do – which is a good question. In six years of medical school, I cannot remember spirituality or chaplaincy ever being mentioned. Dame Cicely’s admonitions about treating the whole patient (including their spiritual concerns) and Balfour Mount’s nomenclature (palliative care/soins palliatifs) were yet to come. But working in medical oncology, and even more so in palliative care, one would have had to be blind not to see the benefits that some patients got from involvement with the chaplain or pastoral care worker.

But what do they do? There is apparently a dearth of published case studies to inform us. By case study, the editors mean an in-depth report of a chaplain’s care, including background information about the patient and family, the chaplain and the institution, details of what was done (with verbatim records of important conversations, where possible), and the chaplain’s critical reflection on that care. Their thesis is that only when there is a sufficient mass of such reports will it be possible to ask the bigger questions about what should be done and how it should be done.

This book presents nine such case studies, grouped under pediatric, psychiatric and palliative care. At the end of each section two independent experts review the reports. In the case of the palliative care reports, this is done by an experienced nurse and another chaplain. There is no claim that the case studies do it the ‘right way’, or that they represent the ‘normal’ work of a healthcare chaplain.

This book will be of interest to healthcare chaplains, pastoral care workers and their students. The palliative care case studies will be of interest to anybody who works in palliative care and has an interest in the broader aspects of care (including spirituality), and would be useful discussion-starters in any palliative care course for doctors, nurses or social workers.

George Fitchett, Ph.D., is Professor and Director of Research in the Department of Religion, Health and Human Values at Rush University Medical Center in Chicago, Illinois, US. Steve Nolan, Ph.D., is a palliative care chaplain at Princess Alice Hospice in Surrey, UK. His insightful book, Spiritual Care at the End of Life (Jessica Kingsley, 2012), was reviewed in this column in January 2013.

This is an impressive book. What I know about aromatherapy can probably be written on the back of a postage stamp. But here is a comprehensive handbook, written by a Dutch nurse who seems to have spent a large part of her life studying and promoting complementary care. It is written for nurses and other healthcare professionals, describing in detail the use of aromacare, massage, aquacare and relaxation therapy. At the outset, complementary care is distinguished from alternative therapies. Complementary care, in addition to ‘normal’ care, may be a step towards achieving holistic care – the treatment of the whole person – helping them to achieve and maintain a state of wellbeing.

The first four chapters are about care in general and aromacare in detail. There follow chapters on Massage, Aquacare, and Odours, as well as the treatment of respiratory, cutaneous, circulatory, gastrointestinal, urogenital symptoms and pain. The last few chapters deal with such matters as fatigue, emotion, sedation, spirituality, dying and mourning.

As with any material about complementary care, the question about the evidence base comes up. From what I could see, Kerkhof has referenced the available evidence and then drawn on experience, her own and that of others, to provide reasonable recommendations. There may be no randomized trials, but I have no problem believing that some of the things described in this book are of genuine benefit to some patients.

Translating this book from the Dutch, never mind writing it, would have been no mean feat. There were a few words that did not seem to have translated well (although it may be a reflection of my ignorance). There is repeated mention of the need to perform ‘anamnesis’ – which to me has a somewhat uncomfortable tone – when what we are talking about is a list of questions you should go through with the patient before embarking on complementary care. ‘Affusions’ was another term that I was not familiar with.

This book should be of great interest to any nurses, or any other health care professionals, with an interest in aromatherapy and other complementary care techniques.

This is a review and update (it was last covered in 2004) of those aspects of palliative care of interest and importance to geriatricians. This is welcome as the fields of geriatrics and palliative care frequently overlap. There is a good, succinct review of changes in pain and symptom management. This and a later chapter emphasize the differences between palliative care for someone with a life-limiting illness and normal geriatric practice, particularly to do with the use of opioids. In the chapter on complementary therapies, there is again a contrast between their use in a patient who is dying and trying to prevent harm in normal geriatric practice. There is a discussion about the role of the primary care physician in the provision of palliative care for older individuals, as well as chapters on communication, spiritual care and culturally appropriate care.

This volume is directed primarily at geriatricians and their trainees, and provides useful pointers as to when and how they should think palliative. It will also be useful to those who practice in palliative care, as it discusses the problems that our older patients bring, the issues at the interface of geriatrics and palliative care.

And I found an acronym (I think it belongs to the geriatricians) that I had never seen before: WDHDNTBD – the widespread and deeply held desire not to be dead.

Dr. Thomas Smith is Director of Palliative Medicine at the Johns Hopkins Medical Institutions. Dr. Madeline Leong is a Palliative Care Fellow at the Johns Hopkins Hospital in Baltimore.

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Roger Woodruff, MD (Australia)
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, and which have an ISBN, 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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