Book and Multimedia Reviews: Media Review
Palliative Care, Volume 24, No. 1 of Anesthesiology Clinics
Gavrin J, ed. Philadelphia: Elsevier/ Saunders, 2006. ISSN 0889-8537. 234 pages. $180.00 annual subscription for four issues or $84.00 for a single issue.
When I was asked to review this volume on palliative care in the Anesthesiology Clinics series, my first thought was why would anesthesiologists need or want to know about palliative care? In the forward and preface to the book, Drs. Fleisher and Gavrin acknowledge that anesthesiologists are rarely involved in interdisciplinary management of patients with chronic advanced illness or those who are dying. However, they also note that half of all hospitals now have palliative care teams and correctly imply that anesthesiologists should contribute to the care of the dying as “a universal health professional obligation.”
Palliative care is perhaps best described according to the World Health Organization definition as “an approach which improves quality of life of patients and their families facing life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual”. There is now strong consensus in the United States that palliative care approaches should also be available to all patients with advanced chronic illness, even if not immediately life threatening. As such, fundamental principles of palliative medicine should be learned and by all physicians and incorporated into their repertoire of basic knowledge and skills—especially those working in hospital environments.
This remarkable volume is quite comprehensive in scope, and the contributors are among the most accomplished and well-know palliative care providers and opinion leaders in the country. The volume discusses palliative care issues throughout the age cycle from pediatrics through geriatrics. Further evidence of its comprehensive approach involves inclusion of subjects ranging from regional anesthetic techniques for pain management and palliative radiation oncology to spiritual care at the end of life. It is well referenced and contains much useful information for anesthesiologists as well as other specialists. Topics in palliative care assessment, pain management, spirituality, ethics, and complimentary medicine are discussed authoritatively and are balanced. The chapter on complimentary and alternative medicine is evidenced based and well referenced. The ethics chapter discusses very well issues related to perioperative considerations about resuscitation orders and withdrawal of ventilator support to hopelessly ill patients in intensive care units, which should be of particular interest to anesthesiologists. I was impressed with the emphasis on listening to the patient narrative as a key to understanding suffering and other important concerns, especially highlighted in the spirituality chapters.
The volume does suffer from an esoteric academic writing style in some sections, most notably in the spirituality chapter that discusses the concepts of “agency” and autonomy. This makes the discussion somewhat less useful than it otherwise could be.
Overall, this is a useful and comprehensive reference source for palliative care for anesthesiologists. I suspect that nonanesthesiologists will find this useful as well and convenient source for information relating to palliative care needs of patients with advanced illness. I will certainly keep it close by on my reference shelf.