Monday, April 26, 2010

Palliative Care: Transforming the Care of Serious Illness – A Book Review

On my way out of the hospital this evening I ran into a soon-to-be palliative care fellow. Our conversation quickly turned the topic of what one should read prior to beginning a fellowship in order to hit the ground running. This used to be a tough question for me, considering the myriad of key journals, textbooks, and novels that have helped shape my understanding of the field. The answer, though, has become a lot easier after reading Diane Meier’s new book, Palliative Care: Transforming the Care of Serious Illness.

Palliative Care: Transforming the Care of Serious Illness is a whirlwind tour of the history of the hospice and palliative care movement and how it is reshaping the care given to those with serious illnesses. It is edited by Diane Meier, Stephen Isaacs, and Robert Hughes, and incorporates some of the very best works that the field has to offer.

The book begins with Dr. Meier's original article on the "Development, Status, and Future of Palliative Care". Dr. Meier gives her readers the grand picture of how a small movement focused on the care of the dying developed into what we now know as palliative care. From the early work of Elisabeth Kubler Ross and Cicely Saunders, to more recent works from the National Consensus Project for Quality Palliative Care, Dr. Meier creates a timeline revealing the influences behind the fields rapid growth. She further describes the current state of the field, both successes and failures, and how it can continue to move forward through her policy recommendations.

Dr. Meier's essay is followed by reprints of 25 influential works in the field of Hospice and Palliative Care, ranging from book chapters to journal articles. These seminal works cover a range of topics and serve as a nice complement to Dr. Meier’s overview. Here is a taste of the articles picked for the section titled "Efforts to cope with advanced illness":
  • Hope (by Elisabeth K├╝bler-Ross)
  • The Nature of Suffering and the Goals of Medicine (by Eric J. Cassell)
  • The Nature of Suffering and the Goals of Nursing (by Betty R. Ferrell and Nessa Coyle)
  • Death: “The Distinguished Thing” (by Daniel Callahan)
  • The Philosophy of Terminal Care (by Cicely Saunders)
  • Access to Hospice Care: Expanding Boundaries, Overcoming Barriers (by Bruce Jennings, True Ryndes, Carol D’Onofrio, and Mary Ann Baily)

It was great to read these articles over again, as well as to see works that I previously overlooked. Take, for instance, the inclusion of Timothy Quill and Ira Byock's article Responding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids. This work focused on the use of palliative sedation to treat intractable suffering. The editors, on a truly brilliant move, also added a letter to the editor from a group of prominent physicians and ethicists expressing strong disagreement with the premise of Quill and Byock's article.  This small addition stressed the importance of differing opinions, something that gets seemingly lost in many debates surrounding end-of-life care.

If I had one minor criticism of the book, it would be that I was eager to read more content in the editor’s introduction for the reprinted articles. These introductions were generally only a paragraph in length, which I’m guessing made it difficult to fully describe the articles impact. I would have loved to be able to catch a glimpse of the inner thoughts of someone like Dr. Meier and how she viewed the importance of each one of these articles. What made them stand out? How did it change the playing field?

Nevertheless, I remain thoroughly impressed by Palliative Care: Transforming the Care of Serious Illness. It makes a terrific read for those practicing in the field, and serves as a great resouce for trainees interested in Hospice and Palliative Medicine.  

2 comments:

Touching Souls International said...

It is very informative blog about paliative care

Alex Smith said...

A quick testimonial to say this is a fantastic book and resource. I would argue that the articles in this book are the best material for palliative care journal clubs - particularly for fellows - and time spent reviewing these is better spent then reviewing the newest and hotest papers. These articles are the core of our field, and address fundamental questions like: what is palliative care? How did we get here? Is what we do important?

I would also say that the introductory chapter, titled "the Development, Status, and Future of Palliative Care" should be required reading for new fellows. From Philippe Aries to Terri Schiavo, from Ivan Ilych to to Cicely Saunders, this is the most complete, concise, and throughtful framing of the field of palliative care I've encountered.