2022; Volume 23, Number 1, January

Reviewed by Lisa Potter, MD
Department of Palliative Care, Oncology Day Centre, The Sutherland Hospital, Caringbah, Australia

Palliative Care in Lung Disease aims to inspire clinicians who may have previously felt “there is little I can do” for patients with advanced lung disease to feel empowered by the skills and management strategies offered by the integration of early palliative care into traditional respiratory medical models. The book comprises 18 chapters, each devoted to a particular topic authored by one or more experts. The topics range from the general (i.e., Inadequate Palliative Care in Lung Disease) to the specific (i.e., Palliative Care in Pulmonary Arterial Hypertension). Much of the content is relevant globally: authors are from Australia, Canada, Europe, and the USA. However, the unique perspective of authors from less well-resourced settings or culturally and linguistically diverse backgrounds was lacking.

One of the strengths of this book is its acknowledgement in early chapters that prognostication in the diverse group of lung diseases is extremely challenging, and thus the role of palliative care is not simply to provide end-of-life care. Chapters on advance care planning and communication skills emphasize the expertise required to have thoughtful and nuanced future care planning discussions using a shared-decision-making model, and highlight common barriers to these discussions, such as clinician discomfort and inexperience, patient barriers, and social stigmas. The chapter on communication is full of practical tips and mnemonics to assist clinicians hoping to improve these skills.

Chapter 4 provides a highly detailed review of the research methodologies that can put patients’ voices—rather than the diseases—at the centre of care. It outlines various methods for assessing patient-reported outcomes. Some subsequent chapters make good reference to these tools, but I would have liked to see even more of this throughout the book, especially given its early emphasis in the text.

Chapters 5 through 9 review common patient/carer needs of this population in greater detail, starting with a thoughtful review of the profound impact that advanced lung diseases have on patients’ quality of life. These themes are expanded upon in the chapter on grief, anxiety, and depression that also helps clinicians to distinguish the difference between the natural distress of living with a progressive illness from clinical depression/anxiety. The chapter on breathlessness provides a thorough explanation of the current conceptual models for understanding the multidimensional nature of chronic dyspnea, including the interplay of lung-brain, behavioral-functional, and psychosocial factors. It also provides an example of how breathlessness can be assessed. The importance of nonpharmacological management is emphasized and there are a few helpful graphics on patient positioning for managing breathlessness. However, I would have liked even more detail in the section on nonpharmacological management. Clinicians new to this area will want to understand how to teach the techniques to patients but the authors seem to miss an opportunity to include more diagrams or “scripts” on the practicalities of using a hand-held fan or teaching types of breathing techniques. Similarly, self-management of breathlessness is mentioned as a key strategy for the nonpharmacological management of breathlessness, but there were no examples in this chapter of breathlessness management plans or crisis plans (although there are some in later chapters). There also could have been a deeper exploration of interventions targeting the lung-brain—or “thinking” factors—such as listing thoughts that are common to patents, and options for clinicians in how to respond in ways that may help patients reframe their thoughts.

The section on pharmacological management of chronic breathlessness briefly outlines the evidence for opioids and acknowledges some of the controversies surrounding their use. Given that opioids are currently the primary researched pharmacological intervention available, albeit with modest effects, the section could have been more detailed. I would have also liked some clinical “pearls” or case examples on how opioids may be used effectively (or not), and how to discuss their pros and cons with patients, including ways to address opioid fears.

Other common symptoms addressed include cough, pain, anxiety, depression, sleep, fatigue, delirium, and spiritual distress.

Chapters 10 through 15 review specific lung diseases (chronic obstructive pulmonary disease, interstitial lung disease, lung cancer, neuromuscular disease, pulmonary arterial hypertension, and children with lung diseases), one chapter for each. These chapters are particularly helpful for clinicians who do not have a background in respiratory medicine. Each one outlines the pathophysiology of the disease, its natural history, prognostication, common symptoms, and current available treatments. The COPD chapter also provides a review of models from around the globe for integrating palliative care into respiratory medicine. I found the chapter on pulmonary artery hypertension to be particularly successful; it presented a thorough review of the evidence for interventions that that may improve HRQoL (even when there is only a small amount of data), which was lacking in some of the other chapters.

Chapter 16 reviews one specific palliative care/respiratory program for patients with interstitial lung disease. The author’s insights are valuable for anyone hoping to build a new program. She explains how the team defined the roles of the various stakeholders, the aims of the program, patient selection, needs assessments, and the personalized symptom management offered. There are some particularly effective graphics to explain complex concepts.

Chapter 17 discusses the withdrawal of mechanical ventilation. Whilst it provides a thorough review of the issues in a US setting, I think this chapter was a missed opportunity to invite international authors to discuss their experiences. The laws, cultural preferences, and resources are so varied internationally, especially around withdrawal of care, it seems a missed opportunity to not reflect this.

The final chapter discusses the role of palliative care during a pandemic, with particular emphasis on COVID-19.

In summary, Palliative Care in Lung Disease provides a comprehensive review of the common advanced respiratory diseases and their symptoms, and the value of the early addition of integrated palliative care to improve the experience of patients, carers, and their clinicians.

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Note for authors and publishers
If you wish to have your book reviewed, please send an email with the book title, a brief description, and the ISBN to: Alison Ramsey. Do not ship hard copies to the IAHPC office.

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.

Note to app creators
If you would like your app reviewed, please contact Alison Ramsey with the app name, a link to the app, and a brief description.

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