Osteopathic EPEC
description
Transcript of Osteopathic EPEC
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
Osteopathic EPECOsteopathic EPEC Osteopathic EPECOsteopathic EPEC Education for Osteopathic Physicians on End-of-Life
Care
Based on The EPEC Project, created by the American Medical Association and supported by the Robert Wood Johnson
Foundation. Adapted by the American Osteopathic Association for educational use.
American Osteopathic AssociationAOA: Treating Our Family and Yours
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
Module 8 Sudden Illness
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
Objectives
• Describe the features of sudden illness that require special skills
• Know how to • Communicate effectively • Guide decision making
• Explain the benefits and risks of a time-limited trial approach
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
Sudden illness . . .
• Patient, family, caregivers under stress
• Prognostic uncertainty
• Chaotic environment, multiple care providers
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
. . . Sudden illness
• Continuous, sequential decision making• Assess / reassess the goals of
care
• Acute symptom management
• Patient, family, caregivers need support
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
Overview . . .
• Provide structure
• Communicate possible outcomes
• Identify decision points in advance
• Use goals of care to guide decision making
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
. . . Overview
• Take sociocultural issues into account• Address differences
• Use clear language
• Manage symptoms effectively
• Impact of stress on caregivers
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
Provide structured interaction• Encourage one primary spokesperson
• Identify regular communication times
• Prepare early for future decisions
• Set expectations for future communication
• Communicate the plan
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
Communicate range of possible outcomes . . .• Avoid waiting until more is known
• Discuss uncertainty openly
• Provide the full picture
• Identify most and least likely outcomes
• Acknowledge limits of individual experience
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
. . . Communicate range of possible outcomes• Discuss what is likely to happen next
• Be specific and use examples
• Discuss what is known
• Use evidence-based information
• Use gentle repetition
• Identify immediate and future decisions
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
Identify decision points in advance• Signs that a decision may be
near
• Time course expected before next decision
• Prepare for• Changing goals• Discussion of informed consent
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
Use goals of care to guide decision making• Patient-centered goals of care
determine the treatment plan• Values, preferences • Cumulative and integrated goals• Comfort and curative goals
• Identify the degree of• Recovery that would be acceptable• Certainty recovery could be achieved
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
Informed consent
• Nature of the illness
• Recommended treatment
• Reasonable alternatives
• Chance of each alternative achieving its intended goal
• Burdens, benefits of each alternative
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
Benefits, burdens of time-limited trials• Use while more information is
gathered
• Can stop life-sustaining treatment
• Provides structure, helps families
• May result in a poor outcome
• Decision to stop may be more difficult
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
Sociocultural differences . . .• Distrust of the medical system
or physicians
• Unrealistic expectations of the medical system or physicians
• Any life, no matter how compromised, is worth living
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
. . . Sociocultural differences• Belief in miracles
• Death is “the enemy”
• Death should not be discussed openly
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
Manage symptoms
• Essential to quality of life
• Relieve symptoms throughout
• Permits continuation of a portion of the treatment plan
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
Impact of stress on professionals• Physician - Know Thyself
• Acknowledge stress, uncertainty of Dx and Tx, moral and ethical conflict
• Stressful working conditions
• Burnout common
• Communication, common goals help
• Provide support systems
EEPPEECC
American Osteopathic AssociationAOA: Treating Our Family and Yours
Sudden Illness Summary