Portenoy RK, Bruera E; eds. 316 pages. New York: Oxford Univ Pr; 1997. $46.95. ISBN 0195102444. Order phone 800-451-7556.

Field of medicine: Palliative medicine.

Format: Hardcover book.

Audience: Clinicians working in and those pursuing education and research in hospice and palliative medicine.

Purpose: To enhance communication among practitioners and academics working in palliative medicine, summarize state-of-the-art science and clinical care in this field, and frame directions for future research.

Content: This is the first book in a new series on selected clinical topics in the developing field of palliative medicine, which is devoted to the relief of suffering associated with advanced terminal illness. The book is composed of invited contributions from authors around the world and addresses delirium, gastrointestinal disorders (particularly constipation and obstruction), pain, and psychosocial adaptation to cancer.

Highlights: Most internists have never been exposed to the in-depth treatment of issues common in patients with advanced terminal illness. The extensive discussion of the medications used to treat constipation and the rationale for their use is particularly helpful. The chapters are written by experts, and the editors are of the highest caliber.

Limitations: As in all texts of this genre, there is some unevenness of style and treatment among chapters. The writing in a few chapters lacks clarity.

Context: The book is remarkable for its very existence and is a mark of the growing interest in palliative medicine. This new field of specialization in health care is developing as a response to unrelieved suffering (physical, psychological, social, and spiritual) in patients with advanced, progressive illness with limited prognosis. Books such as Twycross and Lack's Therapeutics in Terminal Cancer (Churchill Livingstone) and Saunders and Syke's The Management of Terminal Malignant Disease (Edward Arnold) are useful clinical references but focus primarily on cancer. The Oxford Textbook of Palliative Medicine is now in its second edition and is seen by many as the exhaustive reference text for the field. Several additional textbooks are nearing publication. Research in palliative medicine has been particularly difficult, given the often debilitated patients with multiple concurrent problems on whom the field focuses. Nevertheless, six journals are now in circulation to serve this field: Palliative Medicine, The Journal of Palliative Care, The European Journal of Palliative Care, The Journal of Pain and Symptom Management, The American Journal of Hospice and Palliative Medicine, and The Hospice Journal. The American Academy of Hospice and Palliative Medicine has been formed as the specialty society of physicians in the field. The American Board of Hospice and Palliative Medicine now offers certification to qualified physicians. Similar societies, scientific meetings, and certification examinations have developed in other countries.

Reviewers: Charles F. von Gunten, MD, PhD, Northwestern University Medical School, Chicago, Illinois.

Commentary: The skills necessary to appropriately care for patients with advanced progressive terminal illness and their families are essential and attainable, and physicians need training and educational resources in palliative medicine. To that end, there is now an academic enterprise in palliative medicine similar to that for other specialties: a specialty society, research journals, handbooks and textbooks, and certifying examinations. This series adds a new dimension to the available resources for those interested in this developing branch of medicine.