Palliative Medicine

Goals and Learning Objectives

Attitudes

1. be able to propose and defend comfort care for patients when cure is no longer a rational goal.
2. understand palliative care as good medical practice consistent with traditional medical values and goals in appropriate patients.
3. honor medical decisions that are guided by the philosophy and values of the patient.
4. be able to describe the multiple determinants of suffering: physical, psychological, social and spiritual.
5. understand the importance of determining and conveying prognostic information in end of life care.
6. understand the importance of the physician maintaining a continuous relationship with dying patients.
7. understand the physician’s role in an interdisciplinary team, particularly in a hospice setting.

Knowledge

1. be able to evaluate and treat symptoms common in terminally ill patients including:
   • pain
   • nausea/vomiting
   • dyspnea
   • constipation
   • depression
   • anxiety
   • confusion/delirium
   • anorexia
   • weakness/fatigue
2. understand the neuroanatomy and physiology of different pain mechanisms.
3. be familiar with the pharmacology of common analgesics, particularly opioids.
4. understand the pathogenesis of non-pain symptoms in terminally ill patients.
5. be familiar with the anorexia-cachexia syndrome and its implications for treatment.
6. be familiar with and conversant in the published literature regarding medically provided hydration and nutrition in terminally ill patients.
7. know the essential features of insurance coverage for palliative care, particularly the Medicare Hospice Benefit.

Skills

1. be comfortable collaborating with the interdisciplinary team.
2. be able to communicate effectively and compassionately with patient and caregivers with particular attention to:
   • breaking bad news
   • conveying uncertainty
   • formulating decision plans consistent with patients’ values
   • eliciting patients’ goals of treatment, fears, and recognizing non-verbal cues.
   • allaying fears and misconceptions about opioid treatment
3. be able to appropriately evaluate patients using standard history and physical examination skills regarding pain and other distressing symptoms.
4. be capable of evaluating such symptoms with the least invasive and intrusive testing modalities necessary for appropriate treatment.

Bibliography and Resources

Books/Book Chapters/Monographs

1. Eduardo Bruera, Irene Higginson, Charles von Gunten and Carla Ripamonti (Eds) Textbook of Palliative Medicine, 2006, New York: Oxford University Press.
2. Derek Doyle, Geoffrey Hanks, Nathan I. Cherny and Kenneth Calman (Eds) Oxford Textbook of Palliative Medicine, 2003, New York: Oxford University Press.
3. Buckman, Robert, How to Break Bad News : a guide for health care professionals, 1992, Baltimore : Johns Hopkins University Press, W 62 B925H 1992
4. ABIM , Caring for the Dying: Identification and Promotion of Physician Competency, ABIM, Philadelphia, PA, 1996.
5. MacDonald, Neil, Palliative medicine : a case-based manual 1998, Oxford: : Oxford Oxford University Press WB 310 P167 1998
6. Waller, Alexander; Caroline, Nancy L., Handbook of Palliative Care in Cancer 2000, Butterworth-Heinemann Medical.

Articles

Extended Standardized Patient Scenario Student Instructions, medical records, and EBM Resources.

Palliative Medicine Resources on the Internet

Faculty

For more information, contact Dr. Jack Freer, 887-4852, 871-1571, jfreer@acsu.buffalo.edu