Book Review

Volume 23, Number 2: February 2022
Palliative Medicine: A Case-Based Manual, 4th ed.

Susan MacDonald, Leonie M. Herx, and Anne B. Boyle (eds).
Oxford University Press
424 pp, softcover
Also available: eBook
ISBN: 978-0-01988-3700-8
$45.95 USD, £34.99

Review by Dr. Frank Brennan, MBBS, Dip Obs, DCH, FRACP, FAChPM, FACLM, LLB

From learning a new language to learning a musical instrument, there is no substitute for experience. The same could be said for clinicians and health care. When it comes to health care, however, there is a profound extra dimension to that process—the professional responsibility to act in the best interests of the patient and their family. Didactic lectures or textbooks may provide an introduction to an area: but they are only an introduction. The full experience of a skill or discipline comes with immersion at a deep, practical level.

In the discipline of palliative care, the true field of learning comes through sitting with patients and their families. The wise clinician is constantly learning, adapting, and reflecting. That is why case-based teaching is so valuable. The fourth edition of Palliative Medicine: A Case-Based Manual fulfills that promise. Figuratively, it places the reader in clinicians’ shoes. A decade on from the last edition, the book is divided into multiple chapters covering the physical, psychological, and spiritual dimensions of care of patients with life-limiting illnesses.

Each chapter of the book has an identical three-part introduction: Attitude, Skills, and Knowledge. Attitude refers to the recognition of the importance of each topic, skills to the understanding of the topic, and knowledge to the management and response by the clinician to each topic. The remainder of each chapter is a series of case studies revolving around the topic (e.g., delirium, nausea, anorexia, etc.) interspersed with a series of questions and answers. Those questions interrogate the readers’ understanding of the pathogenesis and mechanism of the topic, the approaches to management, and a short conclusion synthesizing the chapter. To illustrate points, diagrams and radiological imaging are used to good effect.

This manual reflects two modern developments in symptomatology in palliative care. The first is a growing sophistication in understanding of the mechanism of symptoms. Without that mechanistic understanding of, for example, neuropathic pain, nausea, or dyspnea, treatment remains empirical. The second development is the increasing number of well-conducted trials on medications for symptom management. That evidence base is tied, collectively, to many decades of clinical experience.

One of the challenges in any manual like this one is language. Language that is too simple can be trite; if too complex, it may be intimidating. The individual authors and editors achieve a good balance. A balance is also achieved in content. Necessarily, many chapters refer to cancer-related symptoms. It is good to see that, in addition, there are chapters dedicated to the multiple nonmalignant illnesses in which modern palliative care is now involved: including end-stage renal, cardiac, respiratory, hepatic, and neurological diseases. Indeed, any current palliative care textbook or manual needs to include these. Finally, it is pleasing to see separate chapters on palliative care in the pediatric, community, intensive care unit, and public health settings.

The manual is useful, readable, and accessible. It draws together the recent literature in this area and will be helpful for clinicians, both those who are new to, and those who are experienced in, this discipline.

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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