Book Review - Continuity in palliative care

Providing continuity of care is a complex issue, discovers Dr Kamilla Porter.

This book explores the complexity of providing continuity of care to terminally ill patients in the 21st century and raises several questions that do not have straightforward answers.

The introduction sets out the territory, highlighting the poignant statistic that, in one study, patients with advanced cancer saw an average of 28 doctors during the first year after diagnosis.

The succeeding 15 chapters address a good range of issues, from obstacles to good continuity - such as communication difficulties between primary, secondary and tertiary care, as well as with out-of-hours providers - to problems particular to elderly patients. Palliative care for non-cancer patients, patients' spiritual needs, the role of district nurses, and the pros and cons of patient-held records are also explored in detail.

The comprehensive discussion on organisational issues in primary care and end-of-life initiatives will be particularly helpful to registrars and newly-qualified GPs, with clear explanations about the Gold Standard Framework for palliative care, Preferred Place of Care Tool, Liverpool Care of the Dying Pathway and the NHS End-of-Life Care Programme.

There is also interesting discussion of the impact of payment by results and practice-based commissioning on the continuity of primary palliative care, and of the difficulties of precisely defining generalist palliative care. This makes it a complex service that can prove difficult for commissioners to assess.

The book's layout could have been more enticing and the early chapters did, at times, test my powers of motivation. It feels, in places, like a series of academic essays, disjointed and occasionally repetitive.

Ethical issues
However, the excellence of the content won me over, in particular the very last chapter on the ethical issues in providing continuity in palliative care, which included a discussion on the implications of the Mental Capacity Act and several engaging case histories to outline the ethical frameworks and arguments.

The summaries at the end of each chapter are helpful and the indexing quite thorough, so the book does not have to be read cover to cover.

Indeed, individual chapters might be useful material on which to base a registrar tutorial or nMRCGP study session.

The final chapter ably summarises the issues in light of recent healthcare reforms. Despite considerable changes in modern medicine and general practice, as the book states: 'People are designed to live at home, so the linchpin of continuity in care is general practice.'

This is not necessarily a publication to place at the top of a GP's reading list, but I would definitely recommend Continuity in Palliative Care as an addition to a well-stocked reference library, particularly valuable for GP registrars, out-of-hours doctors and all in the primary care team with an interest in palliative care.

Dr Porter is a sessional GP in Leigh-on-Sea, Essex.

Book giveaway
and the RCGP are giving away five copies of Continuity in Palliative Care by Dr Dan Munday and Dr Cathy Shipman, worth £24.95 each.

For a chance to win a copy, email by 7 November 2008.

If you are unlucky in the book draw, you can order a copy directly from the RCGP website at the price of £24.95:

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