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Modules:

  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
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    Back to Introduction and Background
    Five Important Themes in End of Life Care

    Models for Care
    Five Important Themes in End of Life Care

    Barriers to Good End of Life Care

    Five Important Themes in End of Life Care

    1. Relief of Suffering is a Cornerstone Goal of Medical Care

    Advances in the Relief of Suffering

    • One of the most basic motivations for the profession of medicine, and the impetus for all of health care, is the relief of human suffering
    • It has only been in the past few decades that there has been a concerted effort to understand the nature of suffering and to develop the conceptual, technical, and practical frameworks to relieve it
    • In many ways, this has been made possible and necessary by the scientific advances in medicine
    • Now, in the late 20th century, we appreciate both the promise of understanding human biology, as well as its limits
    • Most of us will die after a long period of illness that will affect each of our dimensions of human experience:
      • Physical
      • Psychological
      • Social
      • Spiritual

    Meeting Patient Expectations

    • In the US, patients expect that the medical profession has a deep understanding of both the nature of suffering and how to relieve it
    • However, this expectation goes largely unmet in contemporary America
    • Some of the dissatisfaction with modern medical care may relate to this unmet need
    • It is one of the primary goals of the EPEC project to help the medical profession meet this public expectation

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    2. Palliative Care

    Is an extensive and complex area of expertise in medicine that has much to contribute to patients' comfort and quality of life

    • The skills that physicians use to relieve suffering and improve quality of life form a rapidly growing medical endeavor that has been termed palliative medicine
    • We have tried to correct the misperception that palliative care is the absence, or withdrawal of medical care. We hope that the word "only" will fall out of the statement, "he only wants comfort care"
    • Palliative care is a positive, humanistic, and technically powerful part of the general practice of medicine
      • In fact, never before in the history of medicine have we had the power and understanding to relieve suffering to the degree that is possible today

      • To realize the full potential requires an understanding of advanced pathophysiology in every area of medical specialization

      • It has a full complement of areas of special sophistication (e.g., pain and other symptom control), each with a growing literature

      • In addition, palliative care has its own demands for well-honed human skills
    • We must have the competence and the will as a profession to be certain that our patients do not suffer unnecessarily

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    3. Families and the Community

    Play an essential role in the care and well-being of patients as they face dying

    • When facing death, patients often need and want closer connections to their loved ones so they can complete their personal affairs and relationships
    • Personal aspects of culture and meaning can be particularly important for patients and families when they are confronting death, and these significant aspects of life exist within the context of a network of people in a community
    • In addition, families can help with decision-making, especially when the patient is no longer fully competent
    • Either way, it is more important than ever to allow the patient to be the center of care along with his or her family

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    4. Teamwork

    On the part of the interdisciplinary professional team is an integral part of providing whole-person end of life care

    • Relief of suffering requires understanding and support of the whole person
      • It is the whole person who lives and dies, not just his or her physiology
    • Support of the whole person requires teamwork. No one person, no matter how skilled, can meet all of the needs of the patient and family facing the end of life
    • Relieving suffering in the physical, psychological, social, and spiritual domains requires a team effort that includes the combined efforts of:
      • Physicians
      • Nurses
      • Social workers
      • Chaplains
      • The host of other medical disciplines
    • Hospice care is the most developed system of interdisciplinary palliative care for patients at the end of life
      • However, this interdisciplinary approach to care does not have to be limited to patients enrolled in a hospice program

      • It is a robust and positive way to relieve suffering and enhance quality of life that needs to be woven into the fabric of our mainstream health care systems

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    5. Advocacy. Is the current system one in which we would like to be cared for when we reach the end of our lives?

    The physician is a critical advocate not only for the individual patient but also for creating the conditions in which to provide the care that patients need

    • Much of what has been covered in this education program is not widely practiced or available to patients in the United States
    • Besides acquiring the knowledge, attitudes, and skills necessary to administer good end of life care, as health care professionals we need to use our moral persuasion to influence the system and advocate for high quality care for our patients
    • There are a host of reasons why needless suffering persists despite the power of palliative care in one of the most advanced health care systems in the world
    • Until recently, one of the greatest barriers has been the absence of health care professional advocacy demanding the best possible end of life care for their patients
    • We should expect the best, both as health care professionals, and as human beings who will one day face the end of life ourselves
    • Is the current system one in which we would like to be cared for when we reach the end of our lives? If not, then it is our duty as health care professionals to advocate for a system that provides good end of life care, both for our patients and for us when we need it
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