“‘Integrating Clinical Aromatherapy in Palliative Care’ is a welcome and timely publication, supporting the increased recognition of a need for further specialist aromatherapy, within the field of palliative care. This book is well referenced and presented, with readable chapters that link, and flow easily. It would be of great to use to those qualified in aromatherapy, health professionals who are qualified in essential oils, or indeed those who are dual trained.

The interface between palliative care and aromatherapy is explored from Rose’s different professional backgrounds. With over 20 years of nursing, and a further 20 years of clinical aromatherapy, her holistic perspectives allow for a deeper understanding of how aromatherapy can be used within palliative care; versus how aromatherapists can diversify their practice/confidence, to care for those with advanced symptoms, or who are dying.

In the true essence of aromatherapy, the chapters fuse evidence of aroma, intervention, and clinical effectiveness. Rose describes definitions of palliation, evidenced based practice, whilst contrasting alongside relatable case studies.

An important chapter is the useful summary ‘Tools of the Trade’, highlighting the merit of oil origin, efficacy, and safety. This aids the greater understanding of the therapeutic values of essential oils, when exploring their use to aid challenging palliative symptoms such as pain, fatigue, breathlessness and insomnia. There is a seemingly innate feel about how this chapter is written, and then moves into the next; ‘Practice and Application’. The science supporting clinical reasoning.

Throughout the chapters there is a clear focus upon how aromatherapy may enhance the holistic assessment needs of not just the patient, but their carer. Rose encourages depth of clinical refection upon the evolving physical, emotional and spiritual needs of both.

The book demonstrates the depth of Rose’s experience and practice (as a nurse, and aromatherapist), offering diverse treatment suggestions, and plans. Consultation skills are explored, encouraging both the novice and specialist to consider the complexity of this therapeutic relationship. The chapters central reflections encompass a multi-disciplinary approach, that recognise the strength of timely, collaborative interventions – thus protecting the wellbeing of the patient, in addition to the nurse/therapist.

Times and symptoms of particular difficulty are written well, and with compassion; such as addressing final wishes, and vigils, whilst supporting the whole family unit. As Rose quite rightly highlights ‘endings matter’.

The pathophysiology, and treatment options (conventional and aromatherapy) for specific symptoms, such as skin-related symptoms, are detailed, and offer a good review – these chapters consider the profound impact of distressing symptoms, and enable the reader to understand the specific causes of distress.

The final chapter evokes powerful reflexivity of practice. Although great strides have been made to integrate aromatherapy into the forum of palliative care, and the book reports some of that evidence build, more studies are required to further demonstrate its clinical effectiveness. If we are to offer truly diverse, inclusive patient care, aromatherapy should be part of those treatment options; in all health care settings. This book is a must read.”

Emma Vincent
Respiratory Nurse Specialist
Royal College of Nursing (RCN)
London, United Kingdom

“This much awaited book makes an extremely valuable addition to any clinician, whether aromatherapist or other health professional who is involved in palliative care. The book easily crosses the ground between a palliative care clinician with minimal knowledge of aromatherapy and an aromatherapist with little knowledge of palliative care. Carol writes from her extensive clinical experience both as a registered nurse and aromatherapist and uses language in a considered professional way. Evident through all the text is the profound desire to make this time of someone’s life as comfortable as possible, whilst upholding principles of safety and efficacy.

The 300+ page book is divided into 15 chapters, taking us on a journey from the background explanation of what palliative care is, through to evidence based practice then leading us into a detailed chapter on what exactly essential oils and associated aromatics are. The comprehensive table of key constituents, plants present in and possible functions, is an excellent resource for any aromatherapist. Again, the focus is very much on safety and quality.

Chapter three introduces us to the myriad of ways essential oils can be incorporated, again with safety at the forefront with a brief discussion of the types of medications and cautions needed (such as not using oils high in 1,8 cineole) which can increase dermal absorption of some drugs. Excellent consideration of techniques such as compresses, foot baths and stick inhalers rather than diffusers. Chapter four talks about resilience and the information in this chapter reaches far wider than aromatherapy and palliative care – we can all learn something to apply in our own lives. A case study provides a wonderful example.

The spiritual aspects are explored in chapter five and introduces the reader to the notion of spiritual distress felt by many undergoing palliative or end of life care. I especially liked the language around spiritual assessment, which is not religion dependent. Some aromatic suggestions are provided to help ease spiritual distress. These notions are anchored with some excellent case studies.

Chapters, six, seven, eight and nine all approach the specifics of cancer. Up to this point the term palliative care has been an inclusive term, as not all palliative patients have cancer and not all cancer patients need palliative care. Each chapter is anchored with at least one case study. Each chapter highlights cancer specific concerns such as pain relief, cancer fatigue and treatment issues and how aromatherapy can be integrated into management of these symptoms. There is a very helpful discussion in chapter 9 on the endocannabinoid system and a brief view of cannabinoid benefits for some of these symptoms.

Chapters ten, eleven, and twelve follow three key pathological sequelae of palliative and end of life care, regardless of the underlying disease. Chapter eleven explores breathlessness; chapter twelve looks at all the gastrointestinal effects (including oral care) and chapter thirteen is all related to the skin. Each chapter has a solid discussion of the underlying pathology (disease changes) and the current typical medical treatment. Then an exploration of the possible evidence-based aromatherapy benefits, again supported with a case study. Each of these chapters can be used across any number of clinical areas and while some of the language is technical, by its nature, the information contained is invaluable to ensure the best treatment is used to manage symptoms without adding any risk of harm to the patient.

Carol is careful not to exclude the burden on caregivers and family members with a loved one undergoing palliative or end of life care. In many countries palliative care is delivered in the home supported by expert clinicians reaching out from a hospice service. However, in some cases this is not so and the burden to provide care falls heavily on family members to navigate these difficult pathways for their loved ones. Chapter thirteen on resilience also has lessons which relate to wider life, with lots of handy strategies.

I must admit chapter fourteen had me in tears reading the case studies of the last moments of life and how aromatherapy can assist. Some of the content on grief was valuable, and my only suggestion here is I would have liked to have seen the seminal work by Dr Lois Tonkinson, about growing around grief, mentioned, which grew out of the recognition that grief doesn’t go through stages as initially posited by Kubler-Ross.

The final chapter is a short chapter with good suggestions for the way to move forward through more research, better quality research and early referral to integrated palliative service. Then follows the exceptionally strong reference list.

In conclusion:

Carol’s book makes a considered and valuable addition to aromatherapy and palliative care. It is not a book of recipes for problems, rather the approach is to provide detailed background to what the issues are, what can be done to help and comes from a position of the reader having some sort of baseline understanding of patient care and medical language. Whilst I would not consider this a book for beginning practitioners of aromatherapy, I do consider it an essential one for anyone who wishes to expand their knowledge. It should be available in every hospice as a reference book and used as a reference in any courses about palliative care. Congratulations Carol for bringing this book to life.”

Dr. Wendy Maddocks, RN, DHlthSci
Nurse Academic and aromatherapist