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The Project to Educate Physicians on End-of-life Care Supported by the American Medical Association and the Robert Wood Johnson Foundation. Next Steps. Plenary 4. Objectives. List the important themes from the conference Identify barriers to good end-of-life care
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The Project to Educate Physicians on End-of-life CareSupported by the American Medical Association andthe Robert Wood Johnson Foundation Next Steps Plenary 4
Objectives • List the important themes from the conference • Identify barriers to good end-of-life care • Develop potential solutions
EPEC themes, next steps • Relief of suffering is a goal of medical care • Palliative care knowledge is now extensive • Role of families • Teamwork • Physician as patient advocate
Relief of suffering • 4 dimensions • physical • psychological • social • spiritual • Expected by patients, families
Palliative care • Not the absence of care • More powerful than ever in the history of medicine • A positive, humanistic philosophy • Technically sophisticated area of expertise
Families . . . • How we die is an important personal legacy • Dying well often demands • the chance to be close to family, friends • family / proxy assistance with decisions • good communication
. . . Families • None of this is possible without good symptom management
Teamwork . . . • The whole person goes through the dying process, not just his / her physiology • No one person can meet all the needs
. . . Teamwork • Teamwork usually includes • physicians • nurses • social workers • chaplains • others • Hospice philosophy can be integrated into mainstream practice
Advocacy • Professional duty to patient care • Professional duty to ensure availability of services • Personal desire to be able to die with quality care
Barriers • Institutional • Regulations • Reimbursement • Attitudes
Physicians’ personal support needs . . . • Patients are asking us to do better • Find a forum for candid discussion of experiences • Transference is powerful; personal comfort is important
. . . Physicians’ personal support needs • Professional distance, empathic closeness must balance • Know yourself
Barrier Plan Action Plan
Barriers • “I” = Institutional • “O” = Others • “U” = Personal
Next Steps Summary