Palliative Care: An Oxford Core Text
By Christina Faull and Richard Woof
Published by Oxford University Press, Oxford, United Kingdom, 2002 112 pages, $22.50
Palliative Care is a practical manual specifically written for medical students and interns in the United Kingdom. Consisting of eight chapters, a reference list, and several appendices, the manual addresses major topics essential to palliative care: definitions, history taking, psychosocial care, end-of-life decision-making, and symptom management. The content is timely and highly relevant to the field of palliative care. The clear and conversational writing style presents an informal, yet supportive, approach to teaching content that frequently causes distress in new trainees who are often ill-prepared to care for the dying. The case histories, text boxes, and figures effectively illustrate key points and learning exercises provide opportunities for clinical application of the material. Each chapter begins with a list of key points and ends with a summary text box.
A very creative aspect of this book is the questionnaire that appears in Appendix 1. Students are instructed to imagine their performance on an exam (using a 5-point scale ranging from “awful” to “brilliant”) on 64 different items addressing various topics in palliative care. A scoring system allows the student to take their self-ratings, determine knowledge, skills and attitudes, and plot these to ascertain learning needs.
The authors' style is nurturing, allowing that communication can be difficult and sometimes overwhelming. The authors state clearly in the first chapter that palliative care should be an integrated part of all medical care. Their premise is that although professionally and personally challenging, competence in palliative care is not optional. They persuasively argue that all physicians will care for people affected by advanced disease. The excellent second chapter focuses on taking a palliative care history and handling difficult situations. While acknowledging that one short chapter cannot teach all aspects of effective communication, the content provides very useful strategies to effectively communicate. One text box lists quotes from other physicians about their own beliefs about breaking bad news. Another learning point suggests the student ask a patient who has been given bad news how it was done and what if felt like for them.
The first half of this book would apply to medical students, interns, nurses, and other staff around the world. The second half (chapters 5 through 8) is very specific to palliative care in the UK. Chapter 5 addresses symptom control and, although many of the interventions are universal, some of the drugs listed are not widely available in other countries. Chapter 6 is directed very specifically to the use of the syringe driver as a drug delivery system. Chapter 7 describes the regulations regarding controlled substances, unlicensed drug use, death certification, and other rules specific to palliative care in the UK. The final chapter provides an overview of specialized palliative care services very specific to the UK, identifying the wide range of available care, as well as defining the various levels of palliative care nursing services. Websites are listed as additional resources.
This book would be of great interest to readers of the Journal of Pain and Symptom Management, especially those who teach and practice in the United Kingdom or countries with similarly organized health systems. Additionally, anyone who is considering an externship or an observership within one of the hospices or palliative care centers in these countries should review this book prior to their experience. In considering the use of this manual in medical students or interns in the US, I am concerned they would find half of the book is not applicable to their practices. I strongly encourage the publishers to develop another manual to reflect the variances in drug use and regulations that affect hospice and palliative care in the US. Such a manual would be required reading for all of the medical students, residents, and fellows who rotate through our palliative care and home hospice service and, I suspect other programs would do the same. Discussion of the function of an interdisciplinary team would be another useful addition. And a final suggestion, when reprinting this book, reduce the size so that it would fit in a lab coat pocket, making it more user-friendly for the student.
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