Book Review of Final Acts: The End of Life,Hospice and Palliative Care

Reviewed by: Rebecca Wallace, Pathways Hospice & Palliative Care, St. Louis, MO, USA

Editors Gerry Cox and Robert Stevenson demonstrate their passion and commitment to quality end-of-life care by compiling a collection of important topics related to hospice and palliative care. The editors have achieved their goal of promoting the International Conference on Death, Grief, and Bereavement held annually in La Crosse, WI. The chapters of this book are drawn from the presentations at the 2012 event and clearly reveal the quality of presenters, the depth of research, and the comprehensive knowledge shared in the wide variety of issues covered. From cultural considerations and social networks to developmental tasks and psychospiritual aspects of care, it is only possible to highlight some of the important concerns presented in the 16 chapters written by 26 authors of this well-rounded book.

As a hospice professional, it is my view that end-of-life practitioners do not need another general book describing the basics of care and the typical issues associated with grief and death. Cox and Stevenson succeed in going far beyond the basics, delving deep into specific areas of research and practice that will help practitioners better serve their clients. We still live in a death-denying society, but end-of-life professionals are craving more substantive information on particular populations, approaches, and considerations as we move forward to provide compassionate, quality care. Research, literature, and training that is specific to hospice and palliative care builds professional confidence in clinicians, which in turn benefits the clients that we serve.

Section 1, “Professional Applications in End of Life Care,” details issues that hospice and palliative care professionals face as they work within the team model. Its six chapters contain excellent material for new staff training as well as continuing professional education which will assist all staff to see the importance of their role and how that function interfaces with other staff, caregivers, and patients. In Chapter 2, “Attachments and Losses: Individual and Global Perspectives,” Sir Colin Murray Parkes provides excellent coverage regarding attachment and loss issues and how these can affect the process of grieving and impair an entire family in the way that it functions and copes after the death of a loved one. In Chapter 3, “The Private Worlds of Professionals, Teams, and Organizations in Palliative Care,” Danai Papadatou addresses the relational approach and gives words and value to the care that we provide in the intersubjective space where caregiving interactions take place. Chapter 5, “Meeting the Stress Challenge,” by Neil Thompson and Denise Bevan, focuses on the considerable stress absorbed by the hospice and palliative care professionals. Other areas of interest in this section are pediatric palliative care, the death of an infant, and the importance of the social network, including religion and family influences.

In Section 2, “Facing End-of-Life and Its Care,” Cox and Stevenson have joined chapters on the suicide of hospice patients, the dying process in prison settings, and a variety of other important concerns. Richard Gilbert, in Chapter 7, “To Be is To Be, and the Do-ing Should Follow” teaches clinicians to recognize the invitation to deepen into the conversation with a patient or family member. Special attention is paid to how our own agendas affect our work, and how “doing our own work first” prepares us to be present for our patients. In Chapter 9, “The Psycho-Spiritual Side of Palliative Care: Two Stories and Ten Transformations Toward Healing,” Douglas Smith and Conley Potter provide their personal experiences with a loved one’s death and identify 10 transformational steps that can be taken by both the dying person and those who love them to achieve psychospiritual comfort (pp. 120–126). This, too, is excellent material to use for continuing education for all staff, especially chaplains and social workers who address the psychospiritual concerns of our patients. In Chapter 10, “And the Sun Refused to Shine,” Susan Adams applies the framework of Transactional Analysis, Kubler-Ross’ Five Stages, and Worden’s Four Tasks of Mourning (pp 132–135) to two case studies in order to review the coping skills and actions of patients and families. This material teaches us how to recognize the roles of the five Transactional Analysis ego states (Critical Parent, Nurturing Parent, Adult, Free Child, and Adapted Child), as they experience the emotional journey of dying and anticipatory grief (pp. 129–132). As we learn to identify these ego states and their effect on the family dynamic, we can adjust our professional interventions and better serve our clients. Adams also addresses compassion fatigue and the importance of self-care in this chapter. Her case examples are detailed and robust in their content.

Section 3, “Cultural Considerations,” provides an in-depth study of the lack of access to health care, palliative care, opioid pain control, and the trends emerging from all over the world regarding psychological, physical, and cultural obstacles to care. Chapter 15, “Spirituality in End-of-Life Care: A Roman Catholic Perspective,” jointly written by Gerry R. Cox and the Rev. Christopher W. Cox, is dedicated to understanding the spiritual and religious approaches and strengths that Roman Catholics receive from the church. In Chapter 16, “Grief and the American Indian,” editor Cox joins with Andrea R. Sullivan to outline the cultural differences and the belief systems of which we must be aware when interacting with the underserved American Indian population. In Chapter 17, “It Will Do When I Am Dying”: Navigating the Nuances of Fundamentalist Christianity’s Understandings of Death and Dying,” Harold Ivan Smith addresses the very important topic of patient and family members having differing theological beliefs, especially in regard to the belief of what a good death entails. This can affect treatment decisions, create conflict, and delay communication. He identifies several objectives and starting points for health-care professionals to utilize in assisting patients and families with Christian fundamentalist beliefs.

Hospice and palliative care professionals, students interested in end-of-life care careers, health-care policy makers and administrators, chaplains and religious leaders, social workers and other mental health professionals, nurses, and anyone interested in improving end-of-life care will find this book helpful. How refreshing to find a compilation of topics that will help practitioners provide care with renewed sensitivity and deeper awareness. This book breathes vitality into the industry and provides all of us with personal and professional growth. This book deserves a place on the desk of every end-of-life educator.