Community-State Partnership to Improve End-of-Life Care Program Curriculum

• Module 1: Advance Care Planning

— Define advance care planning and explain its importance.

— Describe the steps of the advance care planning process.

— Describe the role of patient, proxy, physician, and others.

— Distinguish between statutory and advisory documents.

— Identify pitfalls and limitations in advance care planning.

— Utilize planning to help the patient put affairs in order.

• Module 2: Communicating Bad News

— Know why communication of "bad" news is important.

— Understand a six-step protocol for delivering bad news.

— Know what to do at each step.

• Module 3: Whole Patient Assessment

— Describe elements of suffering (physical, psychological, social, and spiritual).

— Demonstrate ability to assess.

• Module 4: Pain Management

— Compare and contrast nociceptive and neuropathic pain.

— Know steps of analgesic management.

— Know use of adjuvant analgesic agents.

— Know use of nonpharmacological approaches.

— Know adverse effects of analgesics and their management.

• Module 5: Physician-Assisted Suicide (PAS)

— Identify root causes of suffering that prompt PAS or euthanasia requests.

— Define PAS and describe its current legal status.

— Explain key steps for responding to requests.

— Understand alternative strategies for addressing a patient’s suffering and fears.

• Module 6: Anxiety, Delirium, and Depression

— Identify major depression in patients facing the end of life.

— Distinguish major depression from normal reactions.

— Describe management plans for anxiety, delirium, and depression.

• Module 7: Goals of Care

— Name at least five potential goals of care that patients may have.

— Identify clinical junctures at which priorities should be clarified.

— Discuss how priorities should be determined.

— Know how to assist the patient to identify reasonable goals.

• Module 8: Sudden Illness

— Describe the features of sudden illness that require special skills.

— Know how to communicate effectively in the face of sudden illness.

— Know how to guide decision making in the face of sudden illness.

— Explain the benefits and risks of using a time-limited trial approach.

• Module 9: Medical Futility

— List factors that might lead to futility situations.

— Know how to assist in resolving each factor.

• Module 10: Common Physical Symptoms

— Describe general guidelines for managing nonpain symptoms.

— Explain the impact of symptom control.

— Assess and treat each nonpain symptom.

— Explain how the principle of double-effect applies to symptom management.

• Module 11: Withholding/Withdrawing Treatment

— List medical orders relevant for terminally ill patients.

— Apply this knowledge to clinical situations.

— Describe common misconceptions about withholding or withdrawing therapy.

• Module 12: Last Hours of Living

— Prepare and support the patient, family, and caregivers (professional and volunteer) through the dying process.

— Assess and manage the pathophysiological changes of dying.

— Identify and manage initial grief reactions.

• The Plenary Modules

I. Gaps in End-of-Life Care.

— Describe the current state of dying in America.

— Contrast this with the way people wish to die.

II. Legal Issues in End-of-Life Care.

— Describe legal consensus points.

— List common legal myths and pitfalls.

III. Elements of End-of-Life Care.

— Describe a conceptual framework for suffering.

— Describe the elements of end-of-life care.

— Define palliative care.

— Compare/contrast palliative care to hospice care.

IV. Next Steps.

— List the important themes from the conference.

— Identify barriers to good end-of-life care.

— Develop potential solutions.

Source: Robert Wood Johnson Foundation, Princeton, NJ.