2021; Volume 22, No 2, February

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

People most likely to suffer serious illness or death from COVID-19 infection are the elderly and those with existing underlying health conditions, which means there will be significant overlap with the group of patients in the community referred for palliative care. This book argues that specialist palliative care services are ideally placed to manage patients with palliative needs in the community who acquire COVID-19. It is focused on the care of community palliative care patients who have already stated that if they contract COVID-19, their preferred place of care is at home (including their care home); and if their condition deteriorates, their preferred place of death is home or the hospice.

The importance of advance care plans (ACPs) is stressed, setting a ceiling for care and avoiding unwanted hospitalisation. Palliative care patients who may already have ACPs may need to specify their wishes should they contract COVID-19. And there is an urgent need for older adults and other vulnerable groups (at risk of serious disease if they contract COVID-19) to have ACPs. They suggest that a Treatment Escalation Plan (TEP) may be better than the traditional Do Not Attempt Resuscitation (DNAR). They also discuss the WHO Performance Status Classification and the use of a Clinical Frailty Scale.

They present some data about COVID-19 deaths in Care and Nursing Homes, pointing to deficiencies in such things as holistic symptom control assessment, staff education, referral to palliative care, ACPs, spiritual care, and bereavement. In other words, they were not set up to deliver the complete palliative care package.

COVID-19 has changed the way we communicate with patients, with Personal Protective Equipment (PPE), remote communication, social distancing, and having difficult conversations “up front” rather than after a period of time getting to know the patient and building confidence. They offer talking maps of what to say and how to react, as well as ways of trying to get around any compromise in communication caused by PPE.

In the discussion of patient management, besides those who do not need hospitalisation or do not wish to be hospitalised, the point is made that patients in the last few days of life are unlikely to benefit from hospitalisation, providing they receive the appropriate support and medications. There is a section on physical symptoms, addressing both non-pharmacological and pharmacological management, and I thought it would have been appropriate for there to be a discussion of the other aspects of suffering—psychological, social, cultural and spiritual—that have been highlighted by COVID-19. When talking about bereavement, I liked the term “disenfranchised grief” for family members and friends unable to participate in the usual rituals associated with a death.

I thought this book gave a clear and useful picture of the interface between community palliative care and COVID-19. The authors are both experienced in palliative care and it shows.

Tania Blackmore is Senior Lecturer in Adult Nursing (Palliative and End of Life Care) at the University of Greenwich in London. Georgina Parker is Lead Consultant in Palliative Medicine at Heart of Kent Hospice.

(Roger Woodruff, January 2021)

Other Reviews

Rubin Battino, PhD, is Professor Emeritus of Chemistry at Wright State University in Ohio. He also has a MS degree in mental health counselling and is a Licensed Professional Clinical Counselor (LCCP). He has spent the last thirty-odd years, as both a paid practitioner and as a volunteer, helping people who had life-challenging diseases. His speciality is very brief therapy and he presents a model for effective single-session therapy.

The opening chapters outline and justify his therapeutic approach. I do not have the psychotherapeutic credentials to pass judgement, but it seemed unpretentious and straightforward. I read about things I had encountered before, like Ira Byock’s list of five things a person nearing death should communicate to significant people in their life, and things I was less familiar with, such as nocebo effects; the latter, which are the negative equivalent of placebo effects, were discussed both in terms of modern psychotherapy and as a custom of ancient cultures, such as the Australian aboriginal practice of “pointing the bone.”

There are 15 detailed Case Studies, complete with transcript and commentary, which serve to illustrate his messages. These are interspersed with interesting discussions on guided imagery for healing and psychotherapy, the importance of rapport in the therapeutic alliance, healing language, therapeutic chatting (which seems to be one of his favorites), and healing factors. Another is about how to survive in a hospital, dealing with helplessness, hopelessness and control.

There is a chapter devoted to the use of guided imagery, hypnosis, and other psychotherapeutic approaches in palliative care, including sample transcripts and commentary. He emphasises the importance of psychotherapy in coping. I liked his practice of giving the patient a reminder of their encounter. “I have here a jar that has a bunch of small polished stones in it. Please pick one to take with you to remember this session.”

His “Ruminations on Turning 88” reveals his age, and this is followed by an appendix outlining those issues a person should consider towards the end of their life, together with details of where information can be accessed. He refers to euthanasia and physician-assisted suicide, but does not commit to being for or against. He discusses suicide, but not the observation that the non-assisted suicide rate goes up where physician-assisted dying is legal.

I found this book both intriguing and enjoyable. As noted above, I may not be qualified to pass judgement on his psychotherapeutics, but it all seemed practical and down-to-earth to me. On more than one occasion, I felt as though I was in his consulting room, observing. It seemed well-referenced, but it was anything but dry and academic.

If you work in palliative care and have an interest in helping patients cope and their psychological well-being (as we all should have), this book will give you lots to think about.

(Roger Woodruff, December 2020)

This book seeks to share a Christian response to the challenges of ageing.

The book is in four parts. The first is about the practice of caring for the ageing and includes discussions of whether the current trend towards medicalization of ageing is associated with reductive approaches to the human person that undermines dignity, what standards and continuing professional development are appropriate for aged care chaplains as allied health professionals, and the role of spirituality in the provision of compassionate and respectful aged care.

Part 2 is about the theology of ageing and felt a little too deep for me. There are discussions of ageing as a creation or a curse, the need to focus on ageing as a distinct life stage with specific challenges and opportunities, and Barth’s “Dignity and Crown of Suffering.”

Part 3 is about holistic and spiritual care for the ageing, where I felt much more at home. The discussion of life review, as an avenue to finding personal meaning, includes an impressive collection of techniques to reveal the full picture, as if uncovering a hidden story. In the chapter on music and meaning in dementia and de-medicalising palliative care, it is argued that society has lost touch with the physical, psychosocial, and spiritual experience of dying well. Does palliative care, left to professionals and institutions, disconnect an individual “from the opportunity for prayer, reflection, reconciliation of relationships, pastoral support and intercession, seeking forgiveness, and sometimes causes resistance to a conscious and comfortable passing”? The third chapter is about spiritual care needs in illness, dying and end-of-life choices.

The last part is about ageing in literature from Biblical times to ancient monasteries to Simone de Beauvoir’s book Old Age.

If you work in palliative care, and particularly if you are interested in patients’ spirituality, this book will provide you with a lot to think about. It provides a Christian perspective of what we might do in palliative care to provide the best possible spiritual care. But as I read it, I realised that it was extraordinarily similar to what we should be doing for people of other faiths, and indeed for those who profess no religious belief.

Stephen Smith is the managing partner of the Colloquium Group and an Associate Professor in Pastoral Theology at SCD. Edwina Blair is the Graduate School Project Manager and Academic Coordinator at the Australian College of Ministries. Catherine Kleemann is Dean of the Graduate School of Leadership at the Australian College of Ministries.

(Roger Woodruff, January 2021)

“This book is the first to describe this evolving model of geriatric mental health (MH) practice within the patient’s home,” which is described as a “new and exciting frontier” in clinical care. The stated aim of the book is to spark the reader’s interest in this type of clinical work, to describe practical strategies for assessment and treatment, and to highlight the powerful impact that can be made when patients are met in their own homes.

The book is divided into three main parts. The first reviews models of MH home care for older adults, identifies the many roles and skills the MH provider brings to the relationship, and explores the MH provider’s role within the healthcare team. There is a chapter describing the process of developing a therapeutic relationship when providing home-based MH care.

The second focuses on the practical aspects of home care: how it differs from traditional clinic-based work and the various safety issues in providing home care. There is a chapter on the consequences, assessment and intervention strategies for late-life hoarding disorder. There are also chapters outlining special considerations for social workers and psychiatry providers who provide home care.

The last section is about assessment and interventions in the home: psychodiagnostic and cognitive assessments, evaluations of decision-making capacity, provision of evidence-based psychotherapy, and caregiver interventions that are critical in supporting the home care patient’s family and friends. The last chapter explores suicide prevention, behavioral medicine interventions, telehealth, and end-of-life care.

Despite the editors’ claims, I was not excited by idea of geriatric MH home care. But as we deal with an ageing population, I was impressed by the effort being made to keep older patients out of care and in their own homes, and at the same time provide them with excellent psychological care. If you work in adult palliative care, at least some of your patients will be elderly, bringing with them all their psychological co-morbidities, and you may find some of the material in this book useful.

Danielle Terry is a health psychologist and Director of Behavioral Science at the Guthrie Medical Center Family Medicine Residency in Sayre, Pennsylvania. Michelle Mlinac is a geropsychologist at VA Boston Healthcare System and assistant professor of psychology in the Department of Psychiatry at Harvard Medical School. Pamela Steadman-Wood is a geropsychologist at the Providence VA Medical Center and associate professor in the Department of Psychiatry and Human Behavior at Brown University in Providence, Rhode Island. The other 25 contributors are all from the USA and I noted many were affiliated with the VA healthcare system.

(Roger Woodruff, December 2020)

This volume was produced in 1999 to celebrate the 20th anniversary of The National Hospice Organization (NHO) and the 25th anniversary of the first hospices in the United States.

The opening chapter on Origins is by Dame Cicely Saunders. She reflects on her career from RN to Lady Almoner to Physician, from St Luke’s to St Joseph’s to St Christopher’s, and the importance of the words of the young David Tasma. And reminds us that hospice and palliative care were not new ideas, but “the beginnings of a skilled return to the old values of care and caring…” There are several chapters recounting various aspects of the development of hospice and palliative care in the USA, including one on the NHO itself; where institutional care preceded the development of home care in the UK, it seems the opposite may have occurred in America.

The chapter on symptom control describes the multidisciplinary management of 10 prevalent symptoms in hospice care and provides some interesting insights into what was cutting edge in the late 1990s. There is a discussion of spirituality, once the prerogative of chaplains and clergy, but now becoming increasingly distinct from organized religion; the term existential suffering is appearing and there is a reference to psychosociospiritual care.

The discussion on access to hospice care is interesting. The barriers to care include societal attitudes towards death, diversity issues, socioeconomic issues, and eligibility issues, and the point is made that in order to develop and serve more of the population, hospice agencies must be flexible, creative, and use ingenuity to bridge the gaps that occur for some terminally ill patients. This is most noticeable when it comes to the care of patients with non-malignant diagnoses, extending end-of-life care to all patients, regardless of diagnosis. Some of the barriers don’t seem to have changed much.

There is a chapter outlining the differences and distinctions between hospice and palliative care, and another one describing the coming together of hospice and palliative care at a New York hospital. I think this American distinction is organizational rather than to do with clinical practice.

And there’s more. End-of-life care and end-of-life decision making. The challenges of interdisciplinary care. Talking about quality of care and quality of life. Documenting the impact of hospice. There are several chapters of reflections and reminiscences by leading lights, including George Soros and Mary Vachon, to mention two.

Reading about what happened in the 20-25 years before 1999 brought back a lot of memories. And reflecting on where we are today compared with 20 years ago is instructive. Hospice and palliative care programs continue to demonstrate that enlightened and dedicated care can markedly reduce the suffering of terminally ill people and their families, but there is still an awful lot that needs to be done.

Inge Corless, RN, PhD, was Professor and Director of the HIV/AIDS Specialization MGH Institute of Health Professions at the Massachusetts General Hospital in Boston. Zelda Foster, MSW, was the former Chief of Social Work Services at the Brooklyn Department of Veteran Affairs Medical Center in New York.

(Roger Woodruff, December 2020)

I found this book extraordinarily difficult.

I was told “this book offers a rounded and comprehensive view of how religion, belief and spirituality (including nonreligion and nonbelief) are associated aspects of hospice care. The book decompartmentalises hospice care in three areas – space, professionals, and organisation; it examines how religion, belief and spirituality are present in or absent from these areas.” It goes on to analyse how religion, belief and spirituality are dealt with in the key policy documents regarding hospice care. There were several chapters detailing the results of the author’s studies of how religion, belief and spirituality are present in or absent from hospice care.

All this material is then distilled into his Religious Literacy model for Hospice Care (RLHC). “The RLHC model's purpose is twofold: first, to offer practitioners, and hospice practise generally, a tool by which to measure necessary qualities when working with people for whom religion, belief and spirituality are important aspects. The second is to offer hospice care and policy-makers in EOL care a tool to set standards for practise. Also, the model helps distinguish between culture and religion, two concepts that may not be connected but have often been used interchangeably.”

I found this book almost impossible to read and it seemed to be written in an unnecessarily convoluted and obfuscatory manner. If you have an intense interest in the sociological aspects of religion and spirituality in hospice care, and a lot of time on your hands…

This book claims to offer a “comprehensive view of how religion, belief and spirituality (including nonreligion and nonbelief) are associated aspects of hospice care”, but I could find no discussion of euthanasia or physician-assisted suicide, which for some of us are rapidly becoming one of the most difficult hurdles in clinical practice.

And my O.E.D. indicates “practise” is a verb; the noun is “practice.” So, where practice is mentioned repeatedly in the context of religious practice or spiritual practice or professional practice, to have it spelt -ise became a source of intense irritation. Whoever wrote the back cover blurb that appears as the general description on Amazon got it right, with “practice” every time.

Panagiotis Pentaris is a thanatologist and qualified social worker who is a Senior Lecturer in the Department of Psychology, Social Work and Counselling at the University of Greenwich in London.

(Roger Woodruff, December 2020)

Something Different

Ferencz’s lessons are on Dreams, Education, Circumstances, Life, Principles, Truth, Love, Stamina, and the Future.

This book came to me as a gift. The name Ferencz didn’t ring any bells. He was born in Transylvania in 1920, and taken as an infant by his penniless refugee parents to New York. The recollections of his childhood circumstances and schooling are mind-boggling and I thought anyone reading this book, be they a patient or a palliative care professional, would find themselves thinking about some of the ups and downs of their own lives.

But Benny made it through, all the way to a law degree from Harvard. He then describes what he saw in the just-liberated Nazi concentration camps, how they uncovered the deeds of the SS extermination squads, and what it was like being a prosecutor at Nuremberg. Interesting, if not my cup of tea.

The last bit is about his lawyer’s passions regarding human rights. Having repeatedly warned the reader not to believe everything they hear, particularly from politicians, it is apparent this does not apply to his opinions.

I was quite moved that he was able to overcome a terrible start in life. And, that, “with the right level of faith and commitment, you can achieve anything you want to.” Very life-affirming.

(Roger Woodruff, January 2021)

---

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.