Volume 23, Number 3: March 2022

Reviewed by Dr. Madonna R. Bacorro

Described by the publisher as “the first resource of its kind” and “a fundamental framework,” Palliative and Serious Illness Patient Management for Physician Assistants proposes many novel ideas that some might call ambitious. Yet these ideas remind everyone who is part of the palliative care team that there is always room for future improvement.

The book comprises contributions by 51 authors, all experts in their field, all but one based in the United States. The format is arranged logically, starting with the importance of the complexity of palliative cases. The book is a much-needed reference for knowledge-based and complementary skills. It discusses constitutional symptoms and symptom management of five major systems and physical aspects of care in a brief and practical way.

The book is divided into six sections: Essential Aspects of Serious Illness Patient Care: Structure and Processes; Spiritual, Religious, and Existential Aspects of Care; Illness Burden and Its Management: Physical Aspects of Care; Special Populations and Communities; Care Transitions Including End of Life; and Social, Cultural, and Legal Aspects of Care.

The first section focuses on large, overarching topics, such as the physician assistant’s role in palliative care, palliative models of care delivery, and a decision-making toolkit. The reach is global, including information and examples from low-, middle-, and high-resource countries. This section includes a notable chapter that describes the evolution of the palliative care team. After discussing the interdisciplinary roles of palliative care providers (nurses, pharmacists, social workers, chaplains, and other core members of the team—such as psychologists and therapists in the fields of art, music, speech and language, as well as physical and occupational therapists, and volunteers), it then discussed unique team dynamics. Collaborative plans-of-care are described as key, as is meeting the management challenge of transitioning from a multidisciplinary to an interdisciplinary team, seeing beyond the focus of each area of expertise. To be effective, the authors note, the team as a whole must approach care strategically by discussing underlying issues and developing a comprehensive plan together on how to address symptoms holistically. The authors warn readers that it is a challenge to set up a system so that each team member is involved in communication and continuing development of each person’s role, which has the potential to lead to conflict.

The third section is devoted to gastrointestinal symptoms, the cardiopulmonary system, genitourinary issues in palliative care, assessment and management of pain, and the psychological and psychiatric aspects of care.

Although not as extensive as major reference books for these topics, nor a pocketbook for at-the-bedside instruction or direct symptom management, it contains concise and up-to-date information and inspires the reader to enact more detailed practices involving newly-introduced ideas and concepts. Yet it is also a practical book for clinical and hospital duties, as it can remind readers of the specific management of particular symptoms. Furthermore, the fourth section tackles brief but high-yield information on the pediatric population, older adult population, LGBTQ community, patients with substance use disorder, veterans, and persons who are—or who have been—incarcerated.

The final two sections tackle practical details regarding withdrawal of life support, the last days and hours of life, and transitions in palliative and end-of-life care. Albeit a short section, social and legal aspects of care were substantially covered.

I should also mention that the book contains valuable examples of case studies, making it feel like an interactive experience. By the end, readers should feel confident and equipped, be inspired to seek more information, aspire to be the best they can be executing the ideals and principles, and even be prepared to face head-on potential challenges by using novel ideas to tackle difficult and complex case problems.

Dr. Nadya Dimitrov is a clinical associate professor at Stony Brook University (SBU) PA Program, NY, and an affiliate faculty member at Shiley CSU Institute for Palliative Care at San Marcos CA.

Ms. Kathy Kemle has been an assistant professor at the Mercer University School of Medicine Department of Family Medicine since 1994.

Madonna Bacorro, MD, DFM, FPAFP, FPSHPM, is head of the Palliative and Supportive Care Service, Tondo Medical Center, in the Philippines; a palliative care consultant for the Department of Family Medicine, University of Santo Tomas Hospital; and Chair of Mary Johnston Hospital.

Below is the entirety of Dr. Roger Woodruff’s review of the first edition of this book, published in 2003 and written by the same author, James L. Hallenbeck. For comparison, the first edition was 232 pages. This republished review, which appeared in the July 2004 issue of the IAHPC Newsletter (Vol. 5, No. 7), is followed by a brief description by the publisher of what is new in the second edition.

This is one palliative care physician’s synthesis of both the art and science of palliative care. It is distinguished by the use of clinical stories to introduce or illustrate clinical problems, and by the inclusion of boxed “Palliative Care Notes”, which are clinical pearls.

Chapters cover the history and philosophy of palliative care, pain and symptom management, ethical issues, psychosocial and spiritual aspects of care, communication, and how to manage the final 48 hours.

This is not a palliative care treatment manual, but a discussion of palliative care that is both insightful and clinically practical. It will be particularly useful as an introduction for doctors and nurses coming to the field of palliative care, but will also be valuable to more experienced practitioners to ponder and to use in their teaching.

(Reviewed by Dr. Roger Woodruff, 2004)

New to the second edition:

• Research and citations have been thoroughly updated.
• There is a new chapter on burnout, including compassion fatigue.
• The topic of intercultural communication has been significantly expanded

Biographical information on the author, supplied by Oxford University Press: Dr. James L. Hallenbeck, a nationally recognized pioneer in hospice and palliative medicine, is an Associate Professor of Medicine Emeritus at Stanford University in the Department of Medicine. His academic work has focused on medical education in palliative care, system change, and intercultural communication. He has also done work on burnout in health care, co-authoring a curriculum on burnout and compassion cultivation through the Compassion Institute.

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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