Care at the Close of Life: Evidence and Experience / Edition 1

Care at the Close of Life: Evidence and Experience / Edition 1

by Stephen J. McPhee, Margaret A. Winker, Michael W. Rabow, Steven Z. Pantilat

ISBN-10: 0071637958

ISBN-13: 9780071637954

Pub. Date: 10/29/2010

Publisher: McGraw-Hill Professional Publishing

From one of the world’s leading medical journals comes the definitive evidence-based, full-color guide to end-of-life and palliative care

"...represents an important milestone in the evolution of care for people with advanced disease—-for which its editors and authors and JAMA should be rightly proud. It is wonderful that JAMA had the

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From one of the world’s leading medical journals comes the definitive evidence-based, full-color guide to end-of-life and palliative care

"...represents an important milestone in the evolution of care for people with advanced disease—-for which its editors and authors and JAMA should be rightly proud. It is wonderful that JAMA had the foresight to publish a series on this topic, which, as medicine has become more technologically advanced and subspecialized, is often overlooked and, sometimes worse, avoided....this book will be invaluable for front-line clinicians, and indeed all health care practitioners—as care at the close of life is a part of almost all of medicine’s specialties and settings."--Irene J. Higginson, BMBS, PhD, FPPHM, FRCP; Dept. of Palliative Care, Policy, & Rehabilitation; Cicely Saunders Institute; King's College London (from the foreword)

A new addition to the JAMAevidence series, Care at the Close of Life: Evidence and Experience offers evidence-based and clinical expert guidance on caring for patients with life-limiting illness, incorporating the words and perspectives of affected patients, their families, and treating clinicians.

Organized by these actual clinical cases, the book is based on the acclaimed 7-year series of 42 articles, originally published in JAMA as “Perspectives on Care at the Close of Life,” and now thoroughly updated as chapters and featuring extensive never-before-published material. Care at the Close of Life covers are a wide range of clinical syndromes, disease processes, communication challenges, health-care delivery settings, and issues faced by patients, including withdrawal of dialysis and other life-sustaining measures, cross-cultural approaches, and the role of chemotherapy. Throughout the book, emphasis is on the principles of palliative care, with the patient and family at the center of care, and with attention given to all problems—physical, psychological, social, and spiritual.

Reflecting this focus, each chapter begins with a patient case study to introduce the clinical problem, followed by “perspectives” that draw on extensive, real-world dialogue between clinicians, patients, and families. Internationally renowned authors then review the typical challenges illustrated by the case, offering state-of-the-art, evidence-based assessment and treatment approaches.


  • Fully revised and updated text with new evidence and references, including the search methodology for each chapter’s update
  • Evidence-based orientation presents the current state of knowledge in the care of terminally ill patients and support for their families and caregivers
  • Practical clinical guidance and approaches from international experts in palliative care
  • Self-assessment Q&A, for reinforcing your knowledge of each chapter’s content and for preparing for exams
  • A useful Glossary of acronyms, terms, and tests
  • Updated Resources for each chapter offer current, authoritative sources of diagnostic and treatment information that can help you optimize palliative care
  • Medline PubMed ID numbers facilitate quick, convenient access to references

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    McGraw-Hill Professional Publishing
    Publication date:
    Edition description:
    New Edition
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    Product dimensions:
    8.50(w) x 10.70(h) x 1.00(d)

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    Table of Contents


    Foreword, Irene J. Higginson, BMBS, PhD, FFPHM, FRCP




    1. Initiating End-of-Life Discussions with Seriously Ill Patients: Addressing the "Elephant in the Room," Timothy E. Quill, MD

    2. Beyond Advance Directives: Importance of
    Communication Skills for Care at the End of Life, James A. Tulsky, MD

    3. Decision Making at a Time of Crisis Near the End of Life, David E. Weissman, MD

    4. Dealing With Conflict in Caring for the Seriously Ill:
    “It Was Just Out of the Question,” Anthony L. Black, MD; and Robert M. Arnold, MD


    5. Managing an Acute Pain Crisis in a Patient With
    Advanced Cancer: “This Is as Much of a Crisis as a Code,” Natalie Moryl, MD; Nessa Coyle, NP, PhD; Kathleen M. Foley, MD

    6. Management of Dyspnea in Patients With
    Far-Advanced Lung Disease: “Once I Lose It, It’s
    Kind of Hard to Catch It…,” John M. Luce, MD; Judith A. Luce, MD

    7. Management of Intractable Nausea and Vomiting in Patients at the End of Life: “I Was Feeling
    Nauseous All of the Time…Nothing Was Working,” Gordon J. Wood, MD; Joseph W. Shega, MD; Beth Lynch, NP; Jamie H. von Roenn, MD

    8. Palliative Care for Frail Older Adults: “There Are
    Things I Can’t Do Anymore That I Wish I Could…,” Kenneth S. Boockvar, MD, MS; Diane E. Meier, MD

    9. Palliative Management of Fatigue at the Close of
    Life: “It Feels Like My Body Is Just Worn Out,” Sriram Yennurajalingam, MD; Eduardo Bruera, MD

    10. Spinal Cord Compression in Patients With Advanced
    Metastatic Cancer: “All I Care About Is Walking and
    Living My Life," Janet L. Abraham, MD; Michael B. Bannffy, MD; Mitchel B. Harris, MD

    11. Agitation and Delirium at the End of Life: “We
    Couldn’t Manage Him," William Breitbart, MD; Yesnea Alici, MD


    12. Alzheimer Disease: “It’s OK, Mama, If You Want to Go, It’s OK,” Ann C. Hurley, RN, DNSc; Ladislav Volicer, MD, PhD

    13. Practical Considerations in Dialysis Withdrawal:
    “To Have That Option Is a Blessing,” Lewis M. Cohen, MD; Michael J. Germain, MD; David M. Poppel, MD

    14. Overcoming the False Dichotomy of Curative vs
    Palliative Care for Late-Stage HIV/AIDS: “Let Me
    Live the Way I Want to Live, Until I Can’t,” Peter A. Selwyn, MD, MPH; Marshall Forstein, MD

    15. Palliative Care for Patients With Heart Failure, Steven Z. Pantilat, MD; Anthony E. Steimle, MD

    16. Integrating Palliative Care for Liver Transplant Candidates: “Too Well for Transplant, Too Sick for Life,” Anne M. Larson, MD; J. Randall Curtis, MD, MPH

    17. Palliative Care for Patients With Amyotrophic
    Lateral Sclerosis: “Prepare for the Worst and
    Hope for the Best,” Hiroshi Mitsumoto, MD, DSc; Judith G. Rabkin, PhD, MPH

    18. Palliative Care for Patients With Head and Neck
    Cancer: “I Would Like a Quick Return to a Normal
    Lifestyle," Nathan E. Goldstein, MD; Eric Genden, MD; R. Sean Morrison, MD


    19. Complexities in Prognostication in Advanced
    Cancer: “To Help Them Live Their Lives the Way
    They Want," Elizabeth B. Lamont, MD, MS; Nicholas A. Christakis, MD, PhD, MPH

    20. Caring for the Child With Cancer at the Close of
    Life: “There Are People Who Make It, and I’m
    Hoping I’m One of Them," Craig A. Hurwitz, MD; Janet Duncan, MSN, CPNP; Joanne Wolfe, MD, MPH

    21. Sudden Traumatic Death in Children: “We Did
    Everything, But Your Child Didn’t Survive," Robert D. Truog, MD; Grace Christ, DSW; David M. Browning, MSW; Elaine C. Meyer, PhD, RN

    22. The Role of Chemotherapy at the End of Life: “When Is
    Enough, Enough?" Sarah E. Harrington, MD; Thomas J. Smith, MD

    23. Palliative Care in the Final Days of Life: “They
    Were Expecting It at Any Time,” James Hallenbeck, MD


    24. Psychological Considerations, Growth, and
    Transcendence at the End of Life: The Art of the Possible, Susan D. Block, MD

    25. Caring for Bereaved Patients: “All the Doctors
    Just Suddenly Go,” Holly Gwen Prigerson, PhD; Selby C. Jacobs, MD, MPH

    26. Adolescent Grief: “It Never Really Hit Me…Until
    It Actually Happened,” Grace H. Christ, DSW; Karolynn Siegel, PhD; Adolph E. Christ, MD, DrMSc

    27. Dignity-Conserving Care—-A New Model for
    Palliative Care: Helping the Patient Feel Valued, Harvey Max Chochinov, MD, PhD, FRSC

    28. Physician Opportunities to Support Family
    Caregivers at the End of Life: “They Don’t
    Know What They Don’t Know,” Michael W. Rabow, MD; Joshua M. Hauser, MD; Jocelia Adams, MD

    29. Spiritual Issues in the Care of Dying Patients:
    “…It’s OK Between Me and God," Daniel P. Sulmasy, OFM, MD, PhD


    30. Responding to Requests for Physician-Assisted
    Suicide: “These Are Uncharted Waters for
    Both of Us…," Paul B. Bascom, MD; Susan W. Tolle, MD

    31. Palliative Sedation in Dying Patients: “We Turn to
    It When Everything Else Hasn’t Worked,” Bernard Lo, MD; Gordon Rubenfeld, MD, MSc


    32. Negotiating Cross-Cultural Issues at the End of
    Life: “You Got to Go Where He Lives,” Marjorie Kagawa-Singer, PhD, MA, MN, RN;Leslie J. Blackhall, MD, MTS

    33. Palliative Care for Latino Patients and Their Families:
    “Whenever We Prayed, She Wept," Alexander K. Smith, MD, MS, MPH; Rebecca L. Sudore, MD; Eliseo J. Pérez-Stable, MD

    34. End-of-Life Care for Homeless Patients: “She Says
    She Is There to Help Me in Any Situation,” Margot B. Kushel, MD; Christine Miaskowski, RN, PhD

    35. Palliative Care for Prison Inmates: “Don’t Let Me
    Die in Prison," John F. Linder, MSW, LCSW; Frederick J. Meyers, MD

    H: SETTINGS FOR CARE (Structural Issues)

    36. The Role of Hospice and Other Services: Serving
    Patients Who May Die Soon and Their Families, Joanne Lynn, MD, MS

    37. Secondary and Tertiary Palliative Care in Hospitals, Charles F. van Gunten, MD, PhD

    38. Withdrawal of Life Support: Intensive Caring at the
    End of Life, Thomas J. Prendergast, MD; Kathleen A. Puntillo, RN, DNSc

    39. Meeting Palliative Care Needs in Post–Acute Care
    Settings: “To Help Them Live Until They Die,” Laura C. Hanson, MD, MPH; Mary Ersek, PhD, RN

    40. Referring a Patient and Family to High-Quality
    Palliative Care at the Close of Life: “We Met a
    New Personality…With This Level of Compassion and Empathy," Joan M. Teno, MD, MS; Stephen R. Connor, PhD


    41. Care of the Dying Doctor: On the Other End of the Stethoscope, Erik Fromme, MD; J. Andrew Billings, MD

    42. Self-Care of Physicians Caring for Patients at the
    End of Life: “Being Connected…A Key to My Survival,” Michael K. Kearney, MD; Radhule B. Weininger,
    MD, PhD; Mary L. S. Vachon, RN, PhD; Richard L. Harrison, PhD; Balfour M. Mount, MD

    Answers to Chapter Questions



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