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.
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