books

Providing a palliative care service

Towards an evidence base

Edited by Nick Bosanquet and Chris Salisbury Oxford University Press 276 pages£29.95

The publishers describe this book as written for palliative care physicians. It is, however, a valuable resource for all professionals working in specialist palliative care: those responsible for developing current service provision, commissioners of healthcare, providers applying the palliative care approach to all areas of healthcare, anyone undertaking further study in palliative care and researchers looking for new areas of palliative care to study.

This is a comprehensive book that looks at the key questions facing everyone involved in palliative care provision.

The authors supply an objective view of the research findings world-wide, though most are from the UK and the US. Two thousand documents were identified and, following clear criteria, 673 were systematically reviewed.

The areas covered include: patterns of use of palliative care services, the need for palliative care, models of services, costs and benefits, impact on quality of life and patient/carer satisfaction, and palliative care for cancer and non-cancer patients.

The editors, along with five other contributors, analyse the research available relating to a specific question in each chapter.

Some of the chapters list the review of papers in tabular format, which is easy to follow and shows the strengths and constraints of each study. This is particularly helpful for readers who wish to analyse the methods used and compare studies.

There is particularly helpful evidence for managers and commissioners who may only recently have become involved in the palliative care agenda.

The authors balance the evidence available with the questions yet unanswered, to give those among us, who are overwhelmed with research studies giving apparently conflicting results, some comprehension of the dilemmas we face.

The ethical and practical difficulties of conducting research involving palliative care patients are discussed realistically and sensitively. Although the attrition rate causes a challenge, the evidence produced by such studies is identified as valid and more reliable than retrospective studies.

Studies on models of service provision, cost-effectiveness and the areas for development are reviewed, the majority from the UK and the US.

The differences in the healthcare systems in these countries could potentially confuse the picture given by the studies. But the authors address the review of these issues with clarity.

The summary appears as the first chapter of the book. This outlines the areas covered, the method used for the review, the constraints of the review and the conclusions reached. It does, however, serve effectively as an aperitif, leaving the reader enthused to read on. Bon appetit.

Macmillan regional cancer service assessor (palliative care), North West NHS Executive regional cancer project team, and Royal College of Nursing palliative nursing group steering group member.