Ten Best Readings
Ten Best Readings in Palliative Care
Paul B. Jacobsen, PhD
Psychosocial Oncology Program
H. Lee Moffitt Cancer Center & Research Institute
Tampa, Florida
Breitbart W, Bruera E, Chochinov H, et al. Neuropsychiatric syndromes and psychological
symptoms in patients with advanced cancer. J Pain Symptom Manage. 1995;10:131-141.
This paper summarizes current knowledge regarding the prevalence, assessment, and
management of mood and cognitive disorders in patients with advanced cancer. The authors
also provide an agenda for future research designed to fill major gaps in the current
understanding of neuropsychiatric syndromes and symptoms in palliative care.
Cassell EJ. The Nature of Suffering. New York, NY: Oxford University Press;
1991.
The author describes how medicine is moving from a basic concern with disease to a
greater focus on the sick patient. The discussion is centered on the problem of suffering
since, in the author's view, its recognition and relief are tests of the adequacy of any
system of medicine. A failure by physicians to understand the nature of suffering is seen
as resulting in medical interventions that, although technically adequate, fail to relieve
suffering and may serve as additional sources of suffering.
Cella DF. Measuring quality of life in palliative care. Semin Oncol. 1995;
22(2 Suppl 3):73-81.
This article examines the concept of health-related quality of life and its application
as an outcome measure in palliative care. Psychometric and utility approaches to quality
of life measurement are described and evaluated.
Cherny NI, Coyle N, Foley KM. Suffering in the advanced cancer patient: a definition
and taxonomy. J Palliat Care 1994;10:57-70.
This paper provides a useful taxonomy of the factors that can contribute to suffering
in patients with advanced cancer. The authors illustrate how this taxonomy can be used as
a framework for diagnostic evaluation, selection of therapeutic interventions, and
scientific research in palliative care.
Doyle D, Hanks GWC, MacDonald N. Oxford Textbook of Palliative Medicine. New
York, NY: Oxford University Press; 1993.
This large volume is the "bible" of palliative care. The 73 chapters
summarize the history of palliative care, its current status and practice, and its future
directions. Topics covered include pain and symptom management, ethical, psychosocial, and
spiritual issues in palliative care, and education and training in palliative medicine.
Foley KM. Pain, physician-assisted suicide, and euthanasia. Pain Forum.
1995:4;163-178.
According to the author, pain, uncontrolled symptoms, and psychological distress are
among the many factors that may lead patients to request termination of life. Improvement
in physician-patient communications, a greater respect for patient-centered care, better
physician judgment on withdrawing and withholding care, and greater familiarity with
palliative care are identified as factors that would reduce the need to legalize
physician-assisted suicide and euthanasia.
Gavrin J, Chapman CR. Clinical management of dying patients. West J Med.
1995;163:268-277.
Knowledge about the natural events associated with dying and an informed approach to
medical and psychologic interventions are identified as key factors that contribute to
systematic and successful comfort care. The authors describe how pain, shortness of
breath, nausea and vomiting, and fear of abandonment contribute significantly to physical
and psychologic discomfort at the end of life.
Jacox A, Carr DB, Payne R, et al. Management of Cancer Pain: Clinical Practice
Guidelines. No 9. AHCPR Publication No. 94-0592. Rockville, Md: Agency for Health Care
Policy and Research, US Department of Health and Human Services, Public Health Service;
1994.
The guidelines set out in this volume, developed by an interdisciplinary panel of
clinicians, patients, and researchers, are based on expert judgment as well as a review of
scientific research. The volume outlines a multimodal approach to the management of cancer
pain and emphasizes the need for careful and continuous assessment in order to match
interventions to the sources of pain in individual patients.
Johnston G, Abraham C. The WHO objectives for palliative care: to what extent are we
achieving them? Palliat Med. 1995;9:123-127.
This article examines recent research in palliative care in the light of the guiding
principles set out by the World Health Organization. Some key methodologic problems in
palliative care research are discussed, such as making comparisons across settings,
identifying appropriate outcome measures, and combining different perspectives offered by
patients, lay caregivers, and professional caregivers. Gaps in the existing literature and
suggested priorities for future research also are identified.
Walsh D. Palliative care: management of the patient with advanced cancer. Semin
Oncol. 1994;21(4 Suppl 7):100-106.
This paper provides an excellent overview of current trends in the palliative
management of patients with advanced cancer. With increasing numbers of elderly
individuals expected to develop cancer in the 21st century, there is an urgent need to
find methods to provide adequate care that are compatible with cost-saving and
cost-effective strategies currently being used in the health care industry. Useful
insights into how to meet these challenges are offered.
Back to Cancer Control
Journal Volume 3 Number 3