2019; Volume 20, No 5, May

IAHPC Book Reviews

By Dr. Roger Woodruff, IAHPC Reviews Editor

Note for authors and publishers
If you wish to have your book reviewed, please send it to:

Dr. Roger Woodruff
IAHPC Bookshop Editor
210 Burgundy St, Suite 9
Heidelberg, Victoria 3084
Australia

Palliative Care Book of the Month

The first thing that struck me about this book was that all three editors had been involved with books in the past that I had admired. Ann Berger was senior editor for the four editions of Principles and Practice of Palliative Care and Supportive Oncology (4^th ed., Lippincott Williams and Wilkins, 2013), which I particularly liked because supportive oncology and palliative care were discussed as part of the same deal. The Textbook of Interdisciplinary Pediatric Palliative Care (Saunders, 2011), edited by Hinds et al., expressed similar ideals. And I found Puchalski’s A Time for Listening and Caring—Spirituality and the Care of the Chronically Ill and Dying (OUP, 2006), which explored the practicalities of integrating spiritual care into palliative care, almost revelatory.

Some of the introductory remarks in this book were absolute music to my ears: ‘Palliative care begins at the time of diagnosis of any chronic and/or life-threatening disorder’ and ‘Palliative care is healthcare which focuses on all the aspects of the patient—emotional, social, and spiritual as well as physical issues.’

This palliative care is delivered concurrently with the treatment of the underlying cancer by the oncologists and their team. Whilst I absolutely agree with what they say, the administrative system and the attitudes of oncologists (and hematologists) make this difficult to achieve. My brother died of myeloma at one of America’s most prestigious cancer hospitals, but he received zero supportive or palliative care until I screamed at them. When a woman, whose mother was being treated for a lymphoma at another well-known American cancer hospital, asked for some supportive/palliative care, she was simply told her mother wasn’t terminally ill. I think the editors share some of my concerns about this integration, which they cite that as the raison d’être for this handbook.

The book is divided into three sections. The first is about the whole-person approach to supportive oncology and palliative care and contains chapters about adult and pediatric cancer patients, the principles of palliative care, the palliative care team, and the palliative care assessment. The second is about symptom management in advanced cancer, with chapters on neurological, cardiac, pulmonary, gastrointestinal, genitourinary, and psychiatric symptoms, as well as the management of cancer pain and psychosocial and spiritual distress. The last is about supportive oncology and quality-of-life considerations, which touches on a number of important topics, including intimacy and sexuality, grief and bereavement, caring for the caregiver, family meetings, and advance care planning.

The text contains lots of bullet-point lists and there are numerous tables and diagrams, all of which improves access to the information. The references at the end of each chapter seem focused on recent publications. The index looks reasonably comprehensive.

The book does not contain a chapter on how to deal with requests for euthanasia and physician-assisted suicide. Unfortunately, because of the ideals of some of our colleagues who know much better than the rest of us — those who would refer to me as ‘ill-informed, unreflective and opposed to euthanasia for out-dated ideological/religious reasons’ — discussion of these issues has become a necessity.

Purchase of the print edition includes online access to its contents.

This book is meant to be a practical handbook for oncologists, residents, fellows, nurse practitioners, nurses, psychosocial providers, and physician assistants so that they understand and will be able to provide palliative care for their patients with cancer. However, I am skeptical about how many oncologists (or hematologists) would deign to read it, given that they believe they are already providing comprehensive care that could not be improved upon, and because they find all this psychosocial and spiritual stuff a distraction from doing what is really important, which is treating cancer (c.f. treating persons with cancer). But younger doctors, allied health personnel, and nurses may find this book a godsend, allowing them to improve the whole-person care they deliver.

Very good.

Note: Australian and New Zealand readers are eligible for a 15% discount at the Footprint website using the discount voucher code BCLUB19.

(Roger Woodruff, April 2019)

---

Other Reviews

Katy Butler is the author of Knocking on Heaven’s Door: The Path to a Better Way of Death (see my review in the November 2013 edition of the newsletter).

This book is a step-by-step guide to dealing with the predictable health stages of later life, from vigorous old age to final breath. There is a chapter devoted to each stage — Resilience, Slowing Down, Adaptation, Awareness of Mortality, House of Cards, Preparing for a Good Death, and Active Dying. I was impressed by the amount of detail given and the clarity with which it is presented. There are a few references that relate specifically to the system in the USA, but most of the material is applicable to people in any developed country.

I must take issue with her discussion of physician-assisted suicide in Oregon: ‘This pathway to the end of life is heavily regulated wherever it is legal, and it is available only to people certified to be of sound mind and within six months of dying.’ The guidelines may say that, but there is no effort whatsoever made [in Oregon] to see that they are upheld. In every year except the first, some patients have outlived their six-month prognosis. There is a report that two doctors associated with Compassion in Dying approved a man’s request for a lethal prescription, having failed to elicit his long history of depression and multiple attempted suicides. And even if you are mentally competent and free of coercion when you obtain your prescription, there is no information that that is the case when you come to use it.

I thought Diane Meier’s review was appropriate: ‘In plain English and with plenty of true stories to illustrate her advice, Katy Butler provides a brilliant map for living well through old age and getting from the health system what you want and need, while avoiding what you don’t. Armed with this superb book, you can take back control of how you live before you die.’

I think this is a well-written and useful book that you could recommend to troubled patients and their carers.

(Roger Woodruff, April 2019)

I have always had a lot of respect for volunteers in the palliative care setting. At the conclusion of their training, I used to tell them how important they were to patients, who would see them as ‘normal people,’ in contrast to all the health care professionals. At the beginning, Mundle notes that surveys of palliative care volunteers indicated a desire for more training with regard to listening.

This book is about how to ask open-ended questions, how to use body language and nonverbal communication, and how to develop one’s emotional capacity for listening. And to take it one step further, he explores a spirituality of listening — one that is more about the human spirit in general than about religious beliefs in particular.

The book is set out in six chapters. The first is about cues patients may drop and how to respond to them. This is followed by chapters on what he calls his ‘creative approaches’ to listening, helpful things to say in conversations, the benefits and risks of volunteering in hospice and palliative care, and how to delve into your own stories to deepen your own self-awareness and understanding. The last is about feeling heard and understood. The text contains lots of concise, clearly written clinical vignettes, which serve to illustrate Mundle’s points and bring them to clinical life.

This book is written primarily for hospice palliative care volunteers, who should find it both enjoyable to read and informative. If you are responsible for training volunteers, you certainly need to know about this book. And if you are one of the health care professionals who work in palliative care and have an interest in communication and empathetic listening, this book will allow you to meditate further on the issues involved.

Robert Mundle is a palliative care chaplain and registered psychotherapist from Kingston, Ontario, Canada.

Note: Readers in Australia and New Zealand can receive a 15% discount at the Footprint website using code BCLUB19.

(Roger Woodruff, April 2019)

I have always been troubled with the concept of fostering or maintaining hope in the terminally ill, probably due to my training in the purely medical model, in which the dying do not have hope. But it depends on the definition of hope. Shay proposes that the ‘hope-that’ is the hope which is external, dependent on something outside of ourselves, e.g., hope that a cure will be found; and ‘hope-in’ is the hope that arises from developing a sense of inner peace.

There are four chapters. The first is a review of the literature on hope at the end of life and how it has been described and categorized over the years; Shay defines and describes four dimensions of hope and why such a classification is useful. The second is about the theology of hope and the role of theological reflection in spiritual care; it includes descriptions of the afterlife concepts of all the world’s major religions, but I did not see anything about how to deal with such issues with atheists or agnostics. The third explores ways to cultivate hope and the role of the chaplain. The last is about how the four dimensions of hope can be used as a framework for a spiritual assessment and for the development of a plan of care.

This book is written for chaplains, but I think it will be of interest to a broader spectrum of palliative care professionals who have an interest in the spiritual aspects of care. It is particularly useful in distinguishing the dimensions of hope in the terminally ill, in addition to the ‘hope-that’ treatment will work or a cure will be found.

Laura Shay was a nurse for 30 years and is now a board-certified chaplain. She currently works in end-of-life care as a hospice chaplain.

Note: Readers in Australia and New Zealand can receive a 15% discount at the Footprint website using code BCLUB19.

(Roger Woodruff, April 2019)

This book is (I think) a celebration of the achievements of social work in the field of palliative care, and an invitation for social workers in other areas to adopt the principles and practices developed in palliative care. I acknowledge the former, but applying the principles of palliative care in other situations has been talked about since (at least) the 1960s. And there was the bit about ‘we [social workers] are positioned, in numbers and across settings, to build a human-centered health care system…’

There are chapters about all aspects of care — physical, psychological, social, spiritual, cultural, legal, and ethical. There is also a discussion of special issues in children and older adults.

I found the book difficult to read, because of the language used. The editors state that the linguistic challenges they faced were ‘exhilarating.’ But the meaning of ‘…the concept and social frame of intersectionality explores social location and experience and its relationship to power and oppression’ was not obvious to me. Using an ecological lens was also new.

There is no doubt about the importance of social work in palliative care, and social work (amongst others) has played an important role in the development of palliative care. Whilst the importance of a multidisciplinary team (in palliative care) is acknowledged early on, little else is said. I believe in the overlapping of roles, rather than exclusivity, in the palliative care team. This book is written by social workers for social workers, but I think it would provide insights into the social work aspects of overall care for other members of the team, such as doctors and nurses.

The three editors and the other 19 contributors are all from the United States.

(Roger Woodruff, April 2019)

---

Roger Woodruff, MD (Australia)
Dr. Woodruff is a Lifetime Member of the IAHPC Board and Past Chair. His bio may be found here.

NB: Review copies become the property of IAHPC and are not returned to the author. Only books related to palliative care that have been approved and have an ISBN will be reviewed. Due to the large number of requests, we cannot provide exact dates of when books will be reviewed.

---

---

Previous Page News Index Next Page

This newsletter, including (but not limited to) all written material, images, photos are protected under international copyright laws and are property of the IAHPC. You may share the IAHPC newsletter preserving the original design, the IAHPC logo, and the link to the IAHPC website, but you are not allowed to reproduce, modify, or republish any material without prior written permission from the IAHPC.