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Improving Palliative Care for Cancer
coverage…was scored as presenting useful information in only five of the nine domains.”
Overall scores ranged from 11 percent for The Washington Manual to 38 percent for Harrison’s Principles of Internal Medicine.
In contrast to the lack of coverage in medical textbooks, the Mayo Clinic Family Health Book contains a chapter on death and dying with a comprehensive discussion of “pain control in a terminal patient, the emotions of a dying patient, hospice care, funeral arrangements, when and how to tell the patient about a terminal diagnosis, and what the family should expect” (Carron et al., 1999).
Osler’s 1899 textbook was found to be more straightforward about the fact of death but generally not about how to help patients cope with dying. One exception is Osler’s admonition to use opiates for patients dying of hemorrhage into the lungs, to suppress terror and dyspnea. This information did not appear in any other text.
End-of-Life Content in 50 Medical Specialty Textbooks
The end-of-life content of 50 top-selling textbooks in a variety of specialties (Table 9-5) was the subject of the second major review (Rabow et al., 2000). The methodology followed closely the methods used by Carron and colleagues in their study of general medical textbooks, but the content domains were expanded and the medical conditions studied necessarily varied from book to book and were chosen to represent the common causes of death in each specialty. The authors also reviewed the tables of contents for chapters dealing specifically with end-of-life care and searched the indexes for 18 relevant key words. In scoring, rather than calculating an overall score for each book (as Carron and colleagues did), the results are presented as the percentage of instances of “absent,” “minimal,” and “helpful” information.
When the overall scores for each specialty were calculated (the average of the individual textbook scores in each specialty), there were some differences among specialties but a generalized pattern of 50–70 percent absent content and lower scores (i.e., poorer ratings) for minimal or helpful content (see Rabow et al., 2000, figure 1). Although the differences were not large, the authors noted that textbooks with the least end-of-life content were in the specialties of infectious diseases and AIDS, oncology and hematology, and surgery.
Information on how each domain was covered was presented for the six internal medicine textbooks. The 14 conditions analyzed in these texts included three cancers (breast, colon, and lung). The best-covered domains were epidemiology and natural history (i.e., consistent ratings of 2), and the