PDF 32 KB / 2 pages - Promoting Excellence in End-of-Life Care

Appendix A: Palliative Care Fellowship Curriculum Content AreasI. Background of Palliative CareA. Orientation to Palliative Care1. History of palliative care2. History of hospice care3. Role of interdisciplinary team4. Structure of VIP ProgramB. Ethics in palliative care1. Ethical principles – respect for persons,beneficence, non-maleficence, justice2. Double effect3. Physician-assisted suicide and euthanasia4. FutilityC. Communication skills1. Non-verbal communication2. Giving bad news3. Prognostication4. Advance directives5. Goal-setting6. Answering difficult questions7. Communication with families8. Communication with colleaguesD. Decision making1. Defining and balancing benefits and burdens2. Assessing patient goals, values, andpreferences3. Determining “reasonableness”4. Managing conflictE. Cross-cultural issues1. Symptom management2. Decision making3. Death/funeral ritualsII. Symptom ManagementA. General principles1. Pharmacology of opioids – morphine,oxycodone, hydromorphone, fentanyl, etc.2. Pharmacokinetics in special populations, e.g.elderly, renal/hepatic failure3. Symptom assessment principles andmeasurement tools4. Pharmacoeconomics5. Addressing barriers to use of opioids5. Important drugs – corticosteroids, neuroleptics,benzodiazepines, prokinetic agents, NSAIDs,bronchodilators, antidepressants,anticonvulsants, laxativesB. Specific symptoms – for each: pathophysiology;assessment; pharmacologic, invasive, non-traditionalmanagement approaches; special populations1. Pain2. Nausea/vomiting3. Dyspnea, cough, hiccup4. Fatigue/weakness5. Anorexia/cachexia6. Constipation/bowel obstruction7. Diarrhea8. Pressure sores/wounds/stomas9. Genitourinary symptoms – dysuria,incontinence, bladder spasm, retention10. Oral symptoms – dry mouth, dysgeusia,mucositis11. Neuropsychiatric – delirium, depression,anxiety, agitation, insomniaa. Assessment of decision makingcapacityb. Legal assessment of competencec. Suicidalityd. Assessment of cognitive impairmentIII. Disease-Specific Palliative CareA. Cancer care1. Prognosis of common malignancies2. Principles of chemotherapy3. Principles of hormonal therapy4. Principles of radiation therapy5. Common complications in cancera. Tracheal/laryngeal obstruction – laser,photodynamic, brachy, stent therapyb. Pathologic fracture – prevention andtreatmentc. Effusions – pleural, pericardial, ascitesd. Lymphedemae. Coagulation disordersf. Superior vena cava obstruction6. Oncologic emergencies –recognition/managementa. Spinal cord compressionb. Hyponatremia/SIADHc. Tamponaded. Hypercalcemiae. Adrenal failuref. Pain crisisB. Neurologic diseases – ALS, MS, dementingillnessesC. Cardiopulmonary – CHF, COPDD. End-stage renal diseaseE. AIDS – pain syndromes, illness complications,medication complicationsIV. Psycho/socio/spiritual careA. Psychological adjustment to terminal illnessB. Psychological symptoms – assessment andmanagement1. Depression2. Anxiety3. DeliriumC. Spiritual challenges in terminal illnessD. Assessment and management of spiritualsymptoms

Appendix A (cont.): Palliative Care Fellowship Curriculum Content AreasE. Spiritual management of physical symptomsF. Family dynamics in life threatening illnessG. Conducting family conferencesH. Role of complementary therapies – music therapy, art therapy,hypnosis, etc.V. Last Hours of LifeA. Terminal restlessnessB. Death rattleC. Terminal sedationD. Withdrawal of life-sustaining treatment –ventilator, dialysis, nutrition/hydrationVI. BereavementA. Normal and pathologic grief responses – patientand familyB. Predicting pathologic grief responseC. Managing pathologic grief responseD. Interprofessional bereavement careE. Management of professional grief reactionsF. Community services for grief supportVII. Cultural/Religious Traditions in End-of-Life CareA. Christian – Catholic, Protestant (traditional,fundamentalist, African-American)B. Jewish – Orthodox, Conservative, ReformC. Eastern religions – Buddhist, Hindu, Taoist, otherD. MuslimVIII. Discharge PlanningA. Cost issues1. Medications2. Palliative care services – home care, hospice, prosthetics3. Financing of services – VA, Medicare, Medical/Medicare,managed care, etc.4. Cost-efficiency of inpatient/outpatient/home services5. Appropriate use of expensive treatment modalities – cost-benefitin terminal careB. Home care/hospice1. Legal requirements for home care/hospice2. Role of inpatient hospice/extended care facility3. Management of patients in home care settings4. Professional interactions with home care/hospice teamIX. Pediatric Palliative Medicine