HOSPICE AND PALLIATIVE CARE: QUESTIONS AND ANSWERS Virginia F. Sendor, MS, MPA and Patricia M. O'Connor, RN, MA, CNA. Lanham, MD: Scarecrow Press, 1997, 250pp., $39.50 (hardcover).
In recent years there has been growing interest in hospice and end-oflife care issues. For those who want to learn more about what a hospice is and how it functions, what is palliative care, and the history of the hospice movement, Hospice and Palliative Care: Questions and Answers provides an excellent introduction. The book addresses many of the questions and concerns of terminally ill patients and their families, as well as those of the healthcare provider who has little or no exposure to these issues. It is clearly written and provides a substantial list of references and resources which would be of help to patients, families, and healthcare providers. It is also one of the few books about end-of-life care which provides practical information that is important for physicians in order to be able to facilitate discussions with patients and their families. Therefore, those who have had little exposure to palliative or hospice care and who are wondering how to explain certain issues to patients and families will find this book most helpful.
The predecessor of the modernday hospice was first seen in Europe during the Middle Ages. The 20th century hospice movement was started by Dame Cicely Saunders in the 1960s and has been steadily growing ever since. It has been predominantly a nurse, patient, and family-based movement. Despite the lack of physician involvement in hospice care, it has become a factor in the Medicare budget. In 1994 Medicare spent $1.2 billion of its roughly $200 billion budget on hospice services (Field & Cassel, 1997).
Only in the past 10 years have physicians begun to address endof- life issues with the growth of the field of palliative medicine (American Board of Internal Medicine, 1996; Council on Scientific Affairs AMA, 1996; Field & Cassel, 1997). Recent research that documented poor pain and symptom management, as well as the need to provide improved care in response to the physician-assisted suicide movement, triggered an interest in end-of-life care among physicians (Lo, 1995). As a result, research about end-of-life care and the field of palliative medicine have seen dramatic growth in the past few years.
Both hospice and palliative care are based upon the principle that the goals of care should be determined by the patient and family's needs and wishes. The basic goal of care is to maximize patient autonomy and limit iatrogenic and noniatrogenic suffering, but not necessarily to cure patients of their underlying illness. Hospice has been defined historically, and more recently economically (Medicare reimbursement) as a service for patients who have a poor prognosis (less than 6 months). Medicare requires patients to accept the hospice benefit and relinquish curative treatment, (although they may later decide to switch from the hospice benefit to standard care reimbursement). Palliative care is more vaguely defined although it has embraced many of the principles and practices of hospice care and includes giving bad news; pain management; care of the family; nutritional support; spiritual care; assessment and clarification of the goals of care; withdrawal of lifesustaining care; addressing ethical issues at the end of life; advanced directives and do-not-resuscitate orders; other general communication skills; symptom management; team decision making and care.
READABLE AND USEFUL
Virginia Sender and Patricia O'Connor's thoughtful and creative approach to this field makes this book very readable and useful. One unique aspect of the book is how good a job it does in covering two fields that have not always seen eye to eye, namely, hospice and palliative medicine. The authors clearly and concisely explain how hospice and palliative medicine are similar and how they differ-philosophically, economically, and practically. …