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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 13: Advance Care Planning

  3. Objectives . . . • Define advance care planning; explain its importance. • Describe the steps of advance care planning. • Describe the role of patient, proxy, physician, others.

  4. . . . Objectives • Distinguish between statutory and advisory documents. • Identify pitfalls and limitations in advance care planning. • Utilize planning to help put affairs in order.

  5. Video

  6. What is advance care planning? . . . • Process of planning for future medical care • Values and goals are explored, documented • Determine proxy decision maker • Professional, legal responsibility

  7. . . . What is advance care planning? • Trust building • Uncertainty reduced • Helps to avoid confusion and conflict • Permits peace of mind

  8. Five steps for successful advance care planning 1. Introduce the topic. 2. Engage in structured discussions. 3. Document patient preferences. 4. Review, update. 5. Apply directives when need arises.

  9. Step 1: Introducethe topic • Be straightforward and routine. • Determine patient familiarity. • Explain the process. • Determine comfort level. • Determine proxy.

  10. Step 2: Engage in structured discussions • Proxy decision maker(s) present • Describe scenarios, options for care • Elicit patient’s values, goals • Use a worksheet • Check for inconsistencies

  11. Role of the proxy • Entrusted to speak for the patient • Involved in the discussions • Must be willing, able to take the proxy role

  12. Patient and proxy education • Define key medical terms. • Explain benefits, burdens of treatments. • Life support may only be short-term. • Any intervention can be refused • Recovery cannot always be predicted.

  13. Elicit patient’s values, goals • Ask about past experiences. • Describe possible situations. • Write a letter.

  14. Use a validated advisory document • A number are available • Easy to use • Reduces chance for omissions • Patients, proxy, family can take home

  15. Step 3: Document patient preferences • Review the advance directive. • Sign the documentation. • Enter it into the medical record. • Recommend statutory documents. • Ensure portability.

  16. Step 4: Review, update • Follow up periodically. • Note major life events. • Discuss and document changes.

  17. Step 5: Apply directives • Determine applicability. • Read and interpret the advance directive • Consult with the proxy. • Consult the ethics committee for disagreements. • Carry out the treatment plan.

  18. Common pitfalls • Failing to plan • Failing to include proxy in discussions • Failing to clarify patient preferences • Having too narrow a focus • Ignoring communicative patients • Making assumptions

  19. Preparing for the last hours of life . . . • Advance planning • Personal choices • Caregivers • Setting • Loss, grief, coping strategies

  20. . . . Preparing for the last hours of life • Educating/training patients, families, and caregivers • Communication • Tasks of caring • What to expect • Physiologic changes, events • Symptom management

  21. Advance practical planning . . . • Financial, legal affairs • Final gifts • Bequests • Organ donation • Autopsy

  22. . . . Advance practical planning • Burial / cremation • Funeral / memorial services • Guardianship

  23. Choice of caregivers • Be family first, caregivers only if comfortable • Everyone comfortable in the role • Seek permission • Change roles if stressed

  24. Choice of setting . . . • Burdens, benefits weighed • Permit family presence • Privacy • Intimacy

  25. . . . Choice of setting • Minimize family burden • Risk to career, personal economics, health • Ghosts • Alternate setting as backup

  26. Summary Helping the patient and family engage in advance care planning is an important role for healthcare providers.

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