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The EPEC-O Project Education in Palliative and End-of-life Care - Oncology

TM. The EPEC-O Project Education in Palliative and End-of-life Care - Oncology. The EPEC ™ -O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

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The EPEC-O Project Education in Palliative and End-of-life Care - Oncology

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  1. TM The EPEC-O Project Education in Palliative and End-of-life Care - Oncology The EPEC™-O Curriculum is produced by the EPECTM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

  2. EPEC– Oncology Education in Palliative and End-of-life Care – Oncology Module 12: Conflict Resolution

  3. Overall message Resolving conflict leads to better outcomes.

  4. Objectives • List factors that can lead to conflict • Understand • How to identify common factors • How to communicate and negotiate to resolve conflict directly • The steps involved in fair processes to resolve intractable conflict

  5. Video

  6. Oncologists and conflict • Patients/families may be invested in interventions. • “I insist on further therapy.” • Physicians/other professionals may be invested in interventions. • “I want to give more therapy.” • Any party may perceive conflict.

  7. Conflict over treatment • Unresolved conflicts lead to misery. • Most can be resolved. • Try to resolve differences. • Support the patient/family. • Base decisions on: • Best evidence • Informed consent • Advance care planning • Goals of care.

  8. Root causes • Misunderstanding • Values differences • Personal factors • Inappropriate decision maker

  9. Misunderstanding of diagnosis/prognosis • Underlying causes • How to assess • How to respond

  10. Misunderstanding: underlying causes . . . • Doesn’t know the diagnosis • Too much jargon • Different or conflicting information • Previous over-optimistic prognosis • Stressful environment

  11. . . . Misunderstanding: underlying causes • Sleep deprivation • Emotional distress • Psychologically unprepared • Inadequate cognitive ability

  12. Types of conflicts • Disagreement over • Goals • Benefits

  13. Difference in values • Religious • Miracles • Value of life

  14. Personal factors • Distrust • Guilt • Grief • Intrafamily issues • Secondary gain • Physician/nurse

  15. Criteria for selection of surrogate decision maker. . . • Patient’s stated preference • Legislated hierarchy • Who is most likely to know what the patient would have wanted?

  16. . . . Criteria for selection of surrogate decision maker • Who is able to reflect the patient’s best interest? • Does the surrogate have the cognitive ability to make decisions?

  17. A seven-step protocol to resolve conflict . . . • Setting • Perception • What is known? • Invitation • Explore hopes and expectations

  18. . . A seven-step protocol to resolve conflict • Knowledge • Attempt to resolve the conflict • Emotion • Respond • Subsequent • Make a plan and follow through • Reassess and revise regularly

  19. Misunderstanding: how to respond . . . • Choose a primary communicator. • Give information in • Small pieces. • Multiple formats. • Use understandable language. • Frequent repetition may be required.

  20. . . . Misunderstanding:how to respond • Assess understanding frequently. • Do not hedge to “provide hope.” • Encourage writing down questions. • Provide support. • Involve other health care professionals.

  21. When conflict persists • Seek assistance • Consultants • External facilitator • Second opinion • Ethics committee • When the team is the source of conflict

  22. Summary Resolving conflict leads to better outcomes.

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