Palliative care: core skills and clinical competencies. Linda L Emanuel, S Lawrence Librach, editors. Philadelphia: Saunders, 2007 (xxi + 705 pp). ISBN 978 1 4160 2597 9.

What can we learn from Americans about palliative care? “Not much!” you might say, especially when this book’s foreword — by Balfour Mount — is largely devoted to the legacy left by British pioneers like Saunders and Kearney. But palliative care is rapidly taking off in the United States, as the many new textbooks from there attest. So is this one worth reading?

While some contributors are well known (Mount, Emanuel, Bruera, Buckman, Meier, Fainsinger), most will be unfamiliar to Australian readers. Pitched at the student/trainee level, or the non-specialist provider, it has a very practical orientation (eg, Buckman’s “SPIKES” protocol for breaking bad news, and a six-step protocol for eliciting the goals of therapy), providing insight into the emerging North American approach to palliative care. These methods might not go down well here, but they serve as a useful teaching resource.

Being a soft-covered handbook comprised of 40 short chapters, divided into four sections, Palliative care represents good value for money. Section one, “Core skills”, takes up the first half of the book, and a large part of that is on symptom control. All chapters are written to a template, making it reader-friendly, each one concluding with “Pearls”, “Pitfalls” and a short summary. References are limited to 20 per chapter, but there are also useful resources lists (Internet and non-Internet).

Symptom control chapters broadly cover their subjects and the therapeutics are up to date. For example, ketamine is mentioned in Fainsinger’s pain chapter, but dealt with in 35 words. Most common problems faced in modern palliative care practice are covered, including chapters on advanced care planning and handling euthanasia requests. But there is nothing on prognostication, an important omission.

While the North American focus can grate, the chapters giving the US perspectives on suffering, legal and ethical issues, the economic burden of illness, and reimbursement for physicians make for interesting reading for Australian palliative care practitioners interested in the future directions of their specialty.