2019; Volume 20, No 3, March

IAHPC Book Reviews

By Dr. Roger Woodruff, IAHPC Reviews Editor

Note for authors and publishers
If you wish to have your book reviewed, please send it to:

Dr. Roger Woodruff
IAHPC Bookshop Editor
210 Burgundy St, Suite 9
Heidelberg, Victoria 3084
Australia

Palliative Care Book of the Month

The first thing that drew my attention was the manner in which Carranza talked about different aspects of hospice work. She is wary of ‘evidence-based practice,’ which she describes as the go-to safe path in the practice of Western medicine, but it is missing in what is as yet un-evidenced. She takes patient-centered care to an extra level ‘…to practice medicine that fits the patient, not fit the patient into the practice that we know in medicine.’ During the dying process, she says, ‘It is our job as medical professionals to allow the sick person to lead.’ She discusses what she feels is or is not appropriate, and ends, ‘Questions matter, answers may or may not come, being there is everything.’ And she says that whilst death may involve the loss of our earthly physical companions, the deepest connections of one to another remain forever.

Here are 250-odd little stories (or bedside portraits) — some as poetry, some as prose — to do with living and death and dying. Here and there are a few poems variously attributed to a pastoral care worker, a massage therapist, a social worker, and another nurse. I found the narratives a pleasure to read. They are about real people with real problems that you will recognize, together with Carranza’s assessment and her description of how the problems were addressed. Of the ones that I read, the stories of her father’s funeral and the one about the hospice nurse with terminal colon cancer stood out. Insightfully observed, beautifully expressed.

On a couple of occasions, she has to confirm the death of patients who have died as a result of Oregon’s legalized physician-assisted suicide, but there is no hint of admiration for the system. And that is consistent with the messages from her other narratives — that the dying process may have positive aspects.

The cover tells me that Janine Carranza was born in Mexico City in 1960. She grew up in rural Mexico, surrounded by much poverty; her father is described as a midwife, although the details of his training are not given. As a teenager, she moved to Vermont where she went to college and then trained as a nurse. She took leave during college to spend time with her father in Mexico: ‘When we were together, we nursed people who did not have or could not afford doctors.’ She now works with Lumina Hospice in Oregon and was awarded that state’s Hospice Nurse of the Year Award in 2017.

If you work in hospice or palliative care, I think you will be drawn to this book. To be able to read a few stories each night, something to mull over and think about, should be both enjoyable and help you reflect on your work.

(Roger Woodruff, February 2019)

Other Reviews

Anne Kenny is a geriatrician, palliative care physician, and emeritus professor at the University of Connecticut Health Center in Farmington.

The book is laid out as a guidebook for those who care for family and friends with dementia. ‘[It] is focused on care and decisions in the final stages of dementia. Specifically, it is meant to help you deal with the inevitable end-of-life problems, such as pain and difficulties with eating, and show you how to navigate the difficult decision-making challenges and communication needs among caregivers and health care providers in the final stages.’

The chapter headings give a good idea of the scope of the matters covered: Understanding the End and the Need for Letting Go, Preparing to Let Go: Emotions of Caring, Making Decisions for Others, Legal Aspects of Decisions, Complex Medical Decisions, Decisions about Places of Care, Changing Care Needs at the End of Life, Changing Needs for the Caregiver/Partner at the End of life, Active Dying, and After Loss and Adjustment.

The text is enriched with stories of Kenny’s own family (her mother died of dementia) and from numerous other patients and families, which brings what she has to say to life. She does not pull any punches about dying and death and all the problems they bring, but she does so in a kind and caring way. Except perhaps for some of the legal issues and matters to do with the organization of the health care system that may be USA-specific, what she has to say applies to dementia anywhere.

So, is this the book you recommend to those caring for somebody with dementia? Perhaps excluding those with a lower educational level, I think this book will be very helpful to many people. I might have considered listing the potential problems, with a list of possible solutions underneath, but the way she has done it with lots of illustrative clinical anecdotes is possibly better. If your work in palliative care involves significant numbers of patients with dementia, this book will give you plenty to reflect on.

(Roger Woodruff, February 2019)

The book is designed for primary care physicians and other doctors and nurses who should be aware of age-related changes in disease manifestations and in the approach to care.

The book is divided into three sections. Part I, General Considerations, includes chapters on the assessment of the geriatric patient, as well as what is appropriate therapy; there are chapters on end-of-life care and palliative care, although I doubt they contain anything new for someone who works in palliative care. Part II covers common disorders in older adults, by system (cardiac, renal, respiratory, etc.). Part III, Geriatric Syndromes and Related Problems, covers topics like malnutrition, gait disorders, delirium, cognitive decline and dementia. The material is presented in a clear and concise manner, which is appropriate for non-geriatricians. There is a reasonable use of tables and there are a number of very useful-looking clinical treatment algorithms. Each chapter finishes with a summary of clinically relevant points and there are two multiple-choice questions to check that you have paid attention.

I thought it curious, particularly in view of the heated debates going on in Australia, that there was no word about euthanasia or assisted dying.

This book is not an encyclopedia of geriatric care, but if your palliative care practice involves a significant proportion of very elderly folk, together with all their medical comorbidities, this may be a useful reference to have on the Palliative Care Unit bookshelf.

The three editors are physicians involved in Aged Care in Sydney, Australia.

(Roger Woodruff, February 2019)

Will Holsinger is a lawyer working in the San Francisco Bay area. He is a trained hospice volunteer, although he claims that some of the stories in this volume predate his hospice work. He says his association with death began with his own drowning at the age of five, complete with an out-of-body experience.

So what does he mean by ‘A life well lived and a death well met’? He explains, ‘Many of us hope to have lived well. And each of us hopes death will be gentle when it comes. I like to think that living well — in the sense of kindness, service, and generosity of spirit — prepares us for death, both ours and that of our loved ones. I also like to think that I will welcome the time of my passing if I have done my best to reconcile old wounds and conflicts.’

There are 90-odd pieces, a mixture of poetry with a little prose, reflecting on death, dying, and living. I would not presume to judge the quality of his poetry, but there is a warm sincerity to what he writes. The pieces I liked most were from his hospice work: describing being with a stranger, reflecting on the person who is the stranger, just being there, accompanying. ‘The man or woman destined to die tomorrow often finds more peace and joy in today than those of us who have a less definite expiration date.’

If you work in palliative care and like poetry, you will enjoy this book. And even if you’re not into poetry, this is a worthy collection of little stories and thoughts upon which to reflect.

(Roger Woodruff, February 2019)

This book sets out to provide intensive conversation analysis on patient-clinician interactions in the context of palliative medicine.

After the introductory part, the book is divided into three sections. The first, Presentations and Introductions, focuses on moments of introduction, presentation, and mutual recognition, in which clinicians and patients present themselves and their intentions to one another. The second, Dynamics of the Interaction, is focused on the rapport and irony in conversation, and the mutually reinforcing relation between them in the context of palliative care. The last, Some Components of the Consultation, deals with the three primary goals of the palliative care conversation from the clinician’s perspective: preparing for the consultation, how to discuss complex medical histories, and discussing the prognosis.

The transcriptions come complete with symbols for the speed, volume, emphasis and pitch of the speech, and a lot more. Whilst I understand the use (and importance) of such symbols, I found it difficult to read. Their interpretation of the conversations were, however, very clear. It deals with very practical palliative care situations where conversational interactions may be difficult or misunderstood, and the bottom line is about how communication in palliative care might be improved.

The book gives no information about the authors. A web search revealed that David Gramling is Director of Graduate Studies, Department of German Studies, at the University of Arizona, and Robert Gramling is Chair of Palliative Medicine at the University of Vermont Medical Center. On the ‘Acknowledgements’ page there is a dedication to ‘our family’ (singular), suggesting they may be closely related.

If you have an interest in communication in palliative care, this book will provide a lot for you to think about.

(Roger Woodruff, February 2019)

I am not sure how this book found its way onto my desk. It’s about the science of implementation, which I had not come across before. Effective interventions are of no benefit if they cannot be delivered. This book provides an overview of research that can improve the delivery of evidence-based interventions in cancer prevention, early detection, treatment, and survivorship.

Whilst many of the topics discussed were of interest to the medical oncologist in me, I thought they would be of very limited interest to the readers of a palliative care newsletter. However, there was one chapter — Integrating Concurrent Palliative Care into Cancer Care Delivery Settings — by Meagan Whisenant (University of Texas MD Anderson Cancer Center) and Kathi Mooney (University of Utah College of Nursing) that provided a succinct review of the barriers between palliative care and medical oncology. They discuss the key implementation factors under the headings of acceptability, adoption, appropriateness, costs, feasibility, fidelity, penetration, and sustainability. Despite the evidence for the need for concurrent palliative care and the randomized controlled trials that demonstrate the benefit, I couldn’t help but feel that it was the medical oncologist who remains the major problem. I didn’t understand the statement ‘palliative medicine is a relatively new subspeciality developed in 2006…’

If your work in palliative care involves trying to integrate palliative medicine into medical oncology and other specialities, the review noted above is worth knowing about.

The three editors are from the Implementation Science Team in the Division of Cancer Control and Population Science at the National Cancer Institute in Rockville, Maryland.

(Roger Woodruff, February 2019)

Roger Woodruff, MD (Australia)
Dr. Woodruff is a Lifetime Member of the IAHPC Board and Past Chair. His bio may be found here.

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.

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