Publications
APS Bulletin • Volume 9, Number 5, September/October 1999
Resource Reviews
John D. Loeser, MD, Department Editor
Topics in Palliative Care (Vol. 3)
Reviewed by Stuart Farber, MD
R.K. Portenoy & E. Bruera (Eds.), Oxford University Press, New York, 1998, 328 pages, $55 (hardcover), ISBN 0-19-510246-0
The books in this series explore important clinical topics in palliative care. Pediatric palliative care, the management of bone pain, psychopathology in patients with cancer, and skin disorders are covered in this volume. At its best, this series concisely covers what is known on the topic, but more importantly, it covers what is not known. The authors raise questions that challenge many accepted practices in providing palliative care and, at the same time, illuminate directions healthcare providers should explore to improve practice. The sections on pediatric palliative care and the management of bone pain meet the high standards set in the first two volumes. Although the section on skin disorders is less challenging, it is a good review of the current understanding and treatment of common skin problems, with its emphasis on pressure ulcers and lymphedema.
The section on psychopathology is the most problematic. Although the introduction to this section emphasizes that “what we are experiencing as a renaissance of spirituality in palliative care is in fact a backlash against the ‘over-medicalization of dying,’” the content goes on to do just that: Medicalize the topic. A more critical analysis of the appropriateness of describing human events at the end of life in a psychiatric context would be of great interest. For example, what are the limitations and benefits? Are there alternative approaches? Yet, the reviews of depression at the end of life and providing symptom management to patients with severe personality disorders are thoughtfully presented. Whether implicitly or explicitly, volume 3 challenges readers on essential topics in palliative care. This is a very useful book for healthcare providers who are beginning to focus on palliative care and end-of-life issues.
Stuart Farber is clinical assistant professor of family medicine at the University of Washington School of Medicine in Seattle.