Marie O'Riordan, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP
Oxford Textbook of Palliative Medicine (4th Edition)
The Oxford Textbook of Palliative Medicine aims to be a comprehensive guide to palliative care, presenting 'practical clinical advice backed up by the most up-to-date scientific data' and for the most part it fulfils this aim.
Layout And Organisation
At first glance the book is a rather intimidating tome with a fairly plain and simple front cover. The pages are generally quite text-heavy, with little space at the edges for writing notes. There are regular diagrams, tables and some medical images (such as x-rays) throughout, though diagrams are generally monochrome. The layout suggests that this is definitely a serious textbook, with none of the 'useful tips' or 'key points' type features that are so common in student medical textbooks. This therefore puts it firmly in the category of 'reference textbook' rather than a source for exam revision.
The textbook is divided into 20 well-thought-out sections covering the history and status of palliative care, specific ethical and communication challenges, medical management from a variety of angles, including a substantial chapter on the management of common symptoms, and special sections on paediatric and geriatric palliative care. It also covers palliative care at home and has an entire section devoted to the terminal phase alone. Within each section are between one and fourteen subsections, generally appropriately titled so that you can easily locate the information you are looking for. It is clear that the authors have designed the textbook in such a way, to be easily dipped into to find specific information, rather than as a text to be read as a whole, and this is evidenced by some repetition of key points between sections, for example between the 'communication skills' and 'truth-telling ethics' sections.
The sections (described above) cover their respective topics very well. The book begins with a history of palliative care and charts its progress as a specialty before considering the future of palliative care, such as its provision in resource-poor countries. This is useful for providing context, but I am not sure if the details are relevant to today's practice of palliative care. The next two chapters considers the challenges of palliative care, especially problems with predicting survival (and considers some of the epidemiology associated with this), barriers to provision and economic challenges; and the role of the interdisciplinary team, with comprehensive sections covering a wide range of disciplinary team members, including music and art therapy. Within the latter section are also some case studies and in the social work section, issues around the family and bereavement are also covered. In fact the patient's family are considered at various points in the textbook, recognising the importance of their care both before and after the death of their relative.
Ethics and communication skills are covered next – these cover the kind of issues you would expect, such as the issue of 'truth-telling', consent and withdrawal of treatment, and these chapters have made use of a number of studies to advise practitioners on what kind of information to give and how. However, at times this does get a little technical – for example, the chapter on truth telling and consent includes a table considering the usage of 'hope' as a verb and a noun. The communication skills section, covering similar ground, also includes good advice on avoiding some common pitfalls in communication – however, while there are insightful case studies elsewhere in the book, I feel that this chapter is somewhat lacking in practical examples – it would have been useful to include some dialogue giving examples of 'good' and 'bad' communication.
With these 'softer' chapters dealt with, the OTPM then launches into an in-depth coverage of the 'medical' side of palliative care – but not before an interesting chapter on research in palliative care, including a bit of revision of the types of clinical trial and a consideration of some more difficult areas specific to palliative care, such as research into the psychosocial side and the difficulty of measuring pain.
The coverage of medical aspects of palliative care in this textbook is wide-reaching. It considers malignant disease issues, non-malignant, the management of symptoms common to both, the specific side effects of different cancer treatments and so forth. Each section considers some of the basic science (which you would probably have forgotten by now!) and pathophysiology before describing the presentation and management options. For example, the pain section considers the pathophysiology of pain, including neural pathways and receptors, its assessment, different types of pain before finally considering the range of treatments – opioid therapy, non-opioid analgesics, adjuvants, more invasive methods, psychological interventions and even considers alternative therapies, such as acupuncture, which are rarely covered in general medical textbooks. Within the same chapter is also a section on the medical management of withdrawal of care, something unlikely to be covered in 'regular' medical textbooks.
- Very comprehensive
- Coverage of topics beyond the mere medical
- Extensively referenced
- At £70 for a paperback copy, not the cheapest textbook you can buy
- Not portable!
- Not very revision-friendly
As a medical student, this book will cover all the palliative care you could possibly need for finals (and more!) and would therefore be an excellent resource for writing a palliative care assignment. However, it is weighty, expensive and includes much information that is either covered in other standard textbooks or too detailed for revision. Therefore, it's definitely one to look at in the library, but probably won't be on the average medical student's wish list.