Contributors<br>Foreword, Irene J. Higginson, BMBS, PhD, FFPHM, FRCP<br>Preface<br>Acknowledgments<br>A. COMMUNICATION ISSUES<br>1. Initiating End-of-Life Discussions with Seriously Ill Patients: Addressing the "Elephant in the Room," Timothy E. Quill, MD<br>2. Beyond Advance Directives: Importance ofCommunication Skills for Care at the End of Life, James A. Tulsky, MD<br>3. Decision Making at a Time of Crisis Near the Endof Life, David E. Weissman, MD<br>4. Dealing With Conflict in Caring for the Seriously Ill:“It Was Just Out of the Question,” Anthony L. Black, MD; and Robert M. Arnold, MD<br>B. SYMPTOM MANAGEMENT<br>5. Managing an Acute Pain Crisis in a Patient WithAdvanced Cancer: “This Is as Much of a Crisis asa Code,” Natalie Moryl, MD; Nessa Coyle, NP, PhD; Kathleen M. Foley, MD<br>6. Management of Dyspnea in Patients WithFar-Advanced Lung Disease: “Once I Lose It, It’sKind of Hard to Catch It…,” John M. Luce, MD; Judith A. Luce, MD<br>7. Management of Intractable Nausea and Vomitingin Patients at the End of Life: “I Was FeelingNauseous All of the Time…Nothing Was Working,” Gordon J. Wood, MD; Joseph W. Shega, MD; Beth Lynch, NP; Jamie H. von Roenn, MD<br>8. Palliative Care for Frail Older Adults: “There AreThings I Can’t Do Anymore That I Wish I Could…,” Kenneth S. Boockvar, MD, MS; Diane E. Meier, MD<br>9. Palliative Management of Fatigue at the Close ofLife: “It Feels Like My Body Is Just Worn Out,” Sriram Yennurajalingam, MD; Eduardo Bruera, MD<br>10. Spinal Cord Compression in Patients With AdvancedMetastatic Cancer: “All I Care About Is Walking andLiving My Life," Janet L. Abraham, MD; Michael B. Bannffy, MD; Mitchel B. Harris, MD<br>11. Agitation and Delirium at the End of Life: “WeCouldn’t Manage Him," William Breitbart, MD; Yesnea Alici, MD<br>C. DISEASE MANAGEMENT<br>12. Alzheimer Disease: “It’s OK, Mama, If You Wantto Go, It’s OK,” Ann C. Hurley, RN, DNSc; Ladislav Volicer, MD, PhD<br>13. Practical Considerations in Dialysis Withdrawal:“To Have That Option Is a Blessing,” Lewis M. Cohen, MD; Michael J. Germain, MD; David M. Poppel, MD<br>14. Overcoming the False Dichotomy of Curative vsPalliative Care for Late-Stage HIV/AIDS: “Let MeLive the Way I Want to Live, Until I Can’t,” Peter A. Selwyn, MD, MPH; Marshall Forstein, MD<br>15. Palliative Care for Patients With Heart Failure, Steven Z. Pantilat, MD; Anthony E. Steimle, MD<br>16. Integrating Palliative Care for Liver Transplant Candidates: “Too Well for Transplant, Too Sick for Life,” Anne M. Larson, MD; J. Randall Curtis, MD, MPH<br>17. Palliative Care for Patients With AmyotrophicLateral Sclerosis: “Prepare for the Worst andHope for the Best,” Hiroshi Mitsumoto, MD, DSc; Judith G. Rabkin, PhD, MPH<br>18. Palliative Care for Patients With Head and NeckCancer: “I Would Like a Quick Return to a NormalLifestyle," Nathan E. Goldstein, MD; Eric Genden, MD; R. Sean Morrison, MD<br>D. OTHER PATIENT MANAGEMENT ISSUES<br>19. Complexities in Prognostication in AdvancedCancer: “To Help Them Live Their Lives the WayThey Want," Elizabeth B. Lamont, MD, MS; Nicholas A. Christakis, MD, PhD, MPH<br>20. Caring for the Child With Cancer at the Close ofLife: “There Are People Who Make It, and I’mHoping I’m One of Them," Craig A. Hurwitz, MD; Janet Duncan, MSN, CPNP; Joanne Wolfe, MD, MPH<br>21. Sudden Traumatic Death in Children: “We DidEverything, But Your Child Didn’t Survive," Robert D. Truog, MD; Grace Christ, DSW; David M. Browning, MSW; Elaine C. Meyer, PhD, RN<br>22. The Role of Chemotherapy at the End of Life: “When IsEnough, Enough?" Sarah E. Harrington, MD; Thomas J. Smith, MD<br>23. Palliative Care in the Final Days of Life: “TheyWere Expecting It at Any Time,” James Hallenbeck, MD<br>E. PSYCHOLOGICAL, SOCIAL, AND SPIRITUAL ISSUES<br>24. Psychological Considerations, Growth, andTranscendence at the End of Life: The Art ofthe Possible, Susan D. Block, MD<br>25. Caring for Bereaved Patients: “All the DoctorsJust Suddenly Go,” Holly Gwen Prigerson, PhD; Selby C. Jacobs, MD, MPH<br>26. Adolescent Grief: “It Never Really Hit Me…UntilIt Actually Happened,” Grace H. Christ, DSW; Karolynn Siegel, PhD; Adolph E. Christ, MD, DrMSc<br>27. Dignity-Conserving Care—-A New Model forPalliative Care: Helping the Patient Feel Valued, Harvey Max Chochinov, MD, PhD, FRSC<br>28. Physician Opportunities to Support FamilyCaregivers at the End of Life: “They Don’tKnow What They Don’t Know,” Michael W. Rabow, MD; Joshua M. Hauser, MD; Jocelia Adams, MD<br>29. Spiritual Issues in the Care of Dying Patients:“…It’s OK Between Me and God," Daniel P. Sulmasy, OFM, MD, PhD<br>F. ETHICAL ISSUES<br>30. Responding to Requests for Physician-AssistedSuicide: “These Are Uncharted Waters forBoth of Us…," Paul B. Bascom, MD; Susan W. Tolle, MD<br>31. Palliative Sedation in Dying Patients: “We Turn toIt When Everything Else Hasn’t Worked,” Bernard Lo, MD; Gordon Rubenfeld, MD, MSc<br>G: CROSS-CULTURAL AND SPECIAL POPULATIONS ISSUES<br>32. Negotiating Cross-Cultural Issues at the End ofLife: “You Got to Go Where He Lives,” Marjorie Kagawa-Singer, PhD, MA, MN, RN;Leslie J. Blackhall, MD, MTS<br>33. Palliative Care for Latino Patients and Their Families:“Whenever We Prayed, She Wept," Alexander K. Smith, MD, MS, MPH; Rebecca L. Sudore, MD; Eliseo J. Pérez-Stable, MD<br>34. End-of-Life Care for Homeless Patients: “She SaysShe Is There to Help Me in Any Situation,” Margot B. Kushel, MD; Christine Miaskowski, RN, PhD<br>35. Palliative Care for Prison Inmates: “Don’t Let MeDie in Prison," John F. Linder, MSW, LCSW; Frederick J. Meyers, MD<br>H: SETTINGS FOR CARE (Structural Issues)<br>36. The Role of Hospice and Other Services: ServingPatients Who May Die Soon and Their Families, Joanne Lynn, MD, MS<br>37. Secondary and Tertiary Palliative Care in Hospitals, Charles F. van Gunten, MD, PhD<br>38. Withdrawal of Life Support: Intensive Caring at theEnd of Life, Thomas J. Prendergast, MD; Kathleen A. Puntillo, RN, DNSc<br>39. Meeting Palliative Care Needs in Post–Acute CareSettings: “To Help Them Live Until They Die,” Laura C. Hanson, MD, MPH; Mary Ersek, PhD, RN<br>40. Referring a Patient and Family to High-QualityPalliative Care at the Close of Life: “We Met aNew Personality…With This Level of Compassionand Empathy," Joan M. Teno, MD, MS; Stephen R. Connor, PhD<br>I. CLINICIAN SELF-CARE<br>41. Care of the Dying Doctor: On the Other End ofthe Stethoscope, Erik Fromme, MD; J. Andrew Billings, MD<br>42. Self-Care of Physicians Caring for Patients at theEnd of Life: “Being Connected…A Key to My Survival,” Michael K. Kearney, MD; Radhule B. Weininger,MD, PhD; Mary L. S. Vachon, RN, PhD; Richard L. Harrison, PhD; Balfour M. Mount, MD<br>Answers to Chapter Questions<br>Glossary<br>Index