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Helping the Patient with Advanced Disease: A Workbook
Interactive Helping the Patient with Advanced Disease: A Workbook Claude Regnard (Ed) Radcliffe Medical Press, 2004 £29·95 (US$54·66, €45·33), pp 248 ISBN 1 85775 964 8
Claud Regnard’s workbook for professional learners in palliative care uses a new and refreshing approach. Helping the Patient with Advanced Disease: A Workbook is a series of 57 worksheets that cover various physical and psychosocial features of patients who are in the late stages of life. The opening pages introduce an education model called CLIP (Current Learning in Palliative Care), which is the basis for a series of worksheets throughout the book. The extensive testing of this model before publication supports the use of this crisp educational format. Each CLIP worksheet begins with an assessment of the level of the activity (introductory, intermediate, or advanced), a statement of the objective of the worksheet, and instructions for use (which are clear but oversimplified). Repetition of instructions on every worksheet throughout the book is a double-edged sword. Although individual worksheets can be used independently, or in blocks over a period, redundancy could suggest to the reader, inappropriately, that blocks of material in the worksheet can be omitted without loss of content. Little would be lost by relocation of the identical instructions to the introduction of the Workbook. A case study that opens each educational activity is the most delightful feature of the workbook because it is the pivot point for the learning activity, providing immediate applicability and reinforcement of the educational material. An Information Page follows the case study, providing facts, tips, definitions, and graphic learning aids that are generally and specifically applicable to the case. A well-organised Work Page with suggestions for further activity and substantial reference material (eg, key documentation and interent sources) follows the Information Page. The workbook follows a logical progression with similar palliative topics grouped into sections. An introduction to palliative care section has three introductory worksheets: What is Palliative Care?, Meeting the Very Ill Adult for the First Time, and Making Sensible Decisions. A section on physical care of the dying patient covers pain, other symptoms, as well as assessment and management of psychological needs. However, rather than simply enumerating the vast psychological needs of dying patients, their families, and caregivers, the collaborators have chosen to develop several wonderfully creative worksheets on topics traditionally regarded as difficult to teach called Fostering Hope, Answering Difficult Questions, and Collusion and Denial. For example. the Fostering Hope worksheet, provides an innovative approach to the therapeutic features of hope by challenging the reader to
Oncology Vol 5 September 2004
think through the nuances of the meaning of hope from the viewpoint of the clinically inexperienced. The succinct discussion of how to use the notion of hope therapeutically could easily lead to less trial and error in the palliative care of patients. The sections on Communications, The Last Hours and Days, and Bereavement are especially noteworthy. The presence of these well written sections in a text that offers effective strategies for physical-symptom management is unusual. Again, Regnard avoids simple enumeration of communication barriers and instead uses a worksheet that identifies conditions that might have a negative effect on communication, followed by practical worksheets on managing communication with patients who are distressed or cognitively challenged. Bereavement, summarised to relevant points for clinicians who care for dying patients, gives good practical information. The text gives information in a crisp, patient-relevant format, and engages the learner right from the start. The varied learning activities of the Work Page, as well as creative use of fonts and page layout, convey a liveliness that maintains engagement. However, the strengths of the text are sometimes less than effective, and offer opportunities for further improvement. The clean style compromises some of the graphics, in which more information would be welcome. A similar lack of information is apparent in the worksheet on confusion, in which discussion of sedative use for abnormal or aggressive behavior does not indicate a route of administration for risperidone, and only some possible routes of administration for haloperidol are listed. The inexperienced reader is left to wonder if these routes are unavailable (physiologically or geographically), unacceptable, or somehow dangerous. The potential for error—apparently more of omission than commission— make the information less dependable than otherwise might be the case. Helping the Patient with Advanced Disease: A Workbook is fresh and exciting presentation of practical management skills for the care of patients in the late stages of life. However, the text is compromised by an ethnocentricity that is perhaps unavoidable. References such as Macmillian care or Graseby syringe driver diminish the adaptability of some of the worksheets to local context. After working through this text and reading the careful explanation of purpose, justification of method, and simple instructions, the reader gets the sense that the initially daunting task of caring for a distressed, dying patient and their family is actually possible. The overwhelming physical and psychosocial needs of patients at the end of life are broken down into more manageable, more approachable pieces. Regnard and his collaborators have given the appearance that this task was nearly effortless. They have succeeded in packing the text with wonderful clinical pearls and yet making it all seem so simple. Overall, the shortcomings of the Workbook are minor and should not discourage access to this wonderful new resource for learners of palliative care and educators alike. Linda Sutton
http://oncology.thelancet.com
579
Claud Regnard’s workbook for professional learners in palliative care uses a new and refreshing approach. Helping the Patient with Advanced Disease: A Workbook is a series of 57 worksheets that cover various physical and psychosocial features of patients who are in the late stages of life. The opening pages introduce an education model called CLIP (Current Learning in Palliative Care), which is the basis for a series of worksheets throughout the book. The extensive testing of this model before publication supports the use of this crisp educational format. Each CLIP worksheet begins with an assessment of the level of the activity (introductory, intermediate, or advanced), a statement of the objective of the worksheet, and instructions for use (which are clear but oversimplified). Repetition of instructions on every worksheet throughout the book is a double-edged sword. Although individual worksheets can be used independently, or in blocks over a period, redundancy could suggest to the reader, inappropriately, that blocks of material in the worksheet can be omitted without loss of content. Little would be lost by relocation of the identical instructions to the introduction of the Workbook. A case study that opens each educational activity is the most delightful feature of the workbook because it is the pivot point for the learning activity, providing immediate applicability and reinforcement of the educational material. An Information Page follows the case study, providing facts, tips, definitions, and graphic learning aids that are generally and specifically applicable to the case. A well-organised Work Page with suggestions for further activity and substantial reference material (eg, key documentation and interent sources) follows the Information Page. The workbook follows a logical progression with similar palliative topics grouped into sections. An introduction to palliative care section has three introductory worksheets: What is Palliative Care?, Meeting the Very Ill Adult for the First Time, and Making Sensible Decisions. A section on physical care of the dying patient covers pain, other symptoms, as well as assessment and management of psychological needs. However, rather than simply enumerating the vast psychological needs of dying patients, their families, and caregivers, the collaborators have chosen to develop several wonderfully creative worksheets on topics traditionally regarded as difficult to teach called Fostering Hope, Answering Difficult Questions, and Collusion and Denial. For example. the Fostering Hope worksheet, provides an innovative approach to the therapeutic features of hope by challenging the reader to
Oncology Vol 5 September 2004
think through the nuances of the meaning of hope from the viewpoint of the clinically inexperienced. The succinct discussion of how to use the notion of hope therapeutically could easily lead to less trial and error in the palliative care of patients. The sections on Communications, The Last Hours and Days, and Bereavement are especially noteworthy. The presence of these well written sections in a text that offers effective strategies for physical-symptom management is unusual. Again, Regnard avoids simple enumeration of communication barriers and instead uses a worksheet that identifies conditions that might have a negative effect on communication, followed by practical worksheets on managing communication with patients who are distressed or cognitively challenged. Bereavement, summarised to relevant points for clinicians who care for dying patients, gives good practical information. The text gives information in a crisp, patient-relevant format, and engages the learner right from the start. The varied learning activities of the Work Page, as well as creative use of fonts and page layout, convey a liveliness that maintains engagement. However, the strengths of the text are sometimes less than effective, and offer opportunities for further improvement. The clean style compromises some of the graphics, in which more information would be welcome. A similar lack of information is apparent in the worksheet on confusion, in which discussion of sedative use for abnormal or aggressive behavior does not indicate a route of administration for risperidone, and only some possible routes of administration for haloperidol are listed. The inexperienced reader is left to wonder if these routes are unavailable (physiologically or geographically), unacceptable, or somehow dangerous. The potential for error—apparently more of omission than commission— make the information less dependable than otherwise might be the case. Helping the Patient with Advanced Disease: A Workbook is fresh and exciting presentation of practical management skills for the care of patients in the late stages of life. However, the text is compromised by an ethnocentricity that is perhaps unavoidable. References such as Macmillian care or Graseby syringe driver diminish the adaptability of some of the worksheets to local context. After working through this text and reading the careful explanation of purpose, justification of method, and simple instructions, the reader gets the sense that the initially daunting task of caring for a distressed, dying patient and their family is actually possible. The overwhelming physical and psychosocial needs of patients at the end of life are broken down into more manageable, more approachable pieces. Regnard and his collaborators have given the appearance that this task was nearly effortless. They have succeeded in packing the text with wonderful clinical pearls and yet making it all seem so simple. Overall, the shortcomings of the Workbook are minor and should not discourage access to this wonderful new resource for learners of palliative care and educators alike. Linda Sutton
http://oncology.thelancet.com
579