• Like

Loading…

Flash Player 9 (or above) is needed to view presentations.
We have detected that you do not have it on your computer. To install it, go here.

Uploaded on

 

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
344
On Slideshare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
2
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Linda L. Emanuel, MD, PhD Principal Jamie H. Von Roenn, MD Charles F. von Gunten, MD, PhD Co-Principals Frank D. Ferris, MD Editor EPEC - Oncology Supported by the National Cancer Institute American Society for Clinical Oncology EPEC - O E ducation on P alliative and E nd-of-life C are - O ncology
  • 2. Outline
    • Policy background
      • Charles von Gunten, MD, PhD
    • The EPEC Project
      • Frank Ferris, MD
    • Introduce the EPEC-O Project
      • Charles F von Gunten
  • 3. Charles F von Gunten, MD PhD Director, Palliative Care Associate Professor of Medicine University of California, San Diego EPEC - Oncology Supported by the National Cancer Institute American Society for Clinical Oncology Policy Background
  • 4. Institute of Medicine, 1997 Approaching Death: Improving Care at the End of Life www.nas.edu/iom  
  • 5. ASCO, 1998 Oncologists’ responsibility to care for a patient in a continuum from diagnosis throughout the course of the illness. In addition to appropriate anticancer treatment, this includes symptom control and psychosocial support during all phases of care, including those during the last phase of life. J Clin Oncol 1998;16:1986-96
  • 6. National Cancer Policy Board Report , 1999
    • “ RECOMMENDATION 5: Ensure quality of care at the end of life, in particular, the management of cancer-related pain and timely referral to palliative and hospice care.”
  • 7. National Cancer Policy Board Report , 2001
    • Part I: Summary and Ten Recommendations
    • Part II: Eight Commissioned Chapters
    www.iom.edu
  • 8. “ NCI-designated cancer centers should play a central role as agents of national policy in advancing palliative care research and clinical practice, with initiatives that address many of the barriers identified in this report.”
  • 9. Recommendation 6:
    • Best available practice guidelines should dictate the standard of care for both physical and psychosocial symptoms.
  • 10. …Recommendation 6 Professional societies, particularly the American Society of Clinical Oncology, …should provide leadership and training for nonspecialists, who provide most of the care for cancer patients.
  • 11. Summary from Policy Background
    • NCI and ASCO leadership needed
    • Make best evidence practically available
    • Role of oncologists as teachers
  • 12. The EPEC Project: Education for Physicians on End-of-life Care Frank D. Ferris Co-Principal, The EPEC Project Professor of Medicine University of California, San Diego
  • 13. Background
    • SUPPORT Study, 1995
    • Lack of physician competency in end-of-life care
    • Target: 440,000 practicing physicians in the US
  • 14.  
  • 15. Method
    • Core Curriculum
    • Train-the-trainer dissemination
    • Exposure for every practicing physician
  • 16. EPEC Materials
    • Consensus of experts
  • 17. Session Format
    • 4 Plenaries – large group
  • 18. Session Format
    • 12 Modules – small groups
  • 19. EPEC Materials
    • Trigger Tapes
    • Trainer’s Guide
    • Participants’ Handbook
    • Slide Sets
      • PowerPoint
    • Reproduce with attribution
  • 20. Estimated Reach of EPEC Training of first 555 trainers in 2 years
    • 6,800 training sessions
    • 120,900 health professionals
    • 83,138 physicians, residents, medical students
  • 21. www.EPEC.net
  • 22. Summary from EPEC Project
    • Model for dissemination of new information
    • Best education science as well as best medical science
    • Doctors as teachers
  • 23. Introduction EPEC - Oncology Supported by the National Cancer Institute American Society for Clinical Oncology EPEC-O Project Charles F von Gunten, MD, PHD Associate Professor of Medicine Moores’ Comprehensive Cancer Center, UCSD Medical Director Center for Palliative Studies San Diego Hospice & Palliative Care
  • 24. Background to EPEC-O
    • ASCO with commitment to palliative care throughout the course of the disease
    • NCI to ‘eliminate suffering and death by 2015’
    • Oncologists frequently called upon to teach palliative care
  • 25. Background to EPEC-O
    • Adapt EPEC
      • Best scientific evidence
      • Best education science
      • Train-the-trainer
      • Easy to use and flexible materials
    • Incorporate Oncology-specific issues
  • 26. Imagine
  • 27. Plenary 1 EPEC - Oncology Supported by the National Cancer Institute American Society for Clinical Oncology Gaps in Cancer Care
  • 28. Principle message
    • Gaps between current and desired practice need to be filled so that palliative care becomes an essential and inextricable part of comprehensive cancer care
  • 29. Outline
    • Describe the current state of palliative care in cancer
      • Patients / families
      • Oncologists
    • Describe what is needed
    • Introduce the EPEC-O curriculum
  • 30. Trigger Video
  • 31. Palliative Care
    • Treatment to relieve pain and suffering.
    • May be combined with therapies aimed at remitting or curing cancer, or it may be the total focus of care.
  • 32. Conventional Cancer Care Presentation Death Anti-neoplastic Therapy Bereavement Care 6m Medicare Hospice Benefit
  • 33. Comprehensive Cancer Care Presentation Death Anti-neoplastic Therapy Bereavement Care Symptom Rx Relieve Suffering Palliative Care 6m Hospice Care
  • 34. Gaps
    • Fears
    • Pain & Suffering
    • Be a burden
    • Loss of control
    • Desires
    • Be comfortable
    • Family able to cope
    • Sense of control
    • Large gap between reality, desire
  • 35. 1998 ASCO Survey
    • 6,645 oncologists surveyed
    • 118 questions
    • n = 3227 (48% response rate)
    • No significant differences in answers based on oncology specialty
  • 36. Source of Information about palliative care
    • 90% Trial and Error
    • 73% Colleagues and role models
    • 38% Traumatic Experience
    • Message: No one is teaching this to oncologists
  • 37. Inadequate education about palliative care
    • 81% inadequate mentor or coaching in how to discuss poor prognosis
    • 65% inadequate information about controlling symptoms
  • 38. Personal Failure
    • 76% feel some sense of personal failure if patient dies of cancer
    • 90% feel at least some anxiety discussing poor prognosis
    • 75% feel at least some anxiety discussing symptom control with patients and families
  • 39. Unrealistic Expectations
    • 29% Patient
    • 50% Family
    • 27% Conflict
  • 40. At least some Influence
    • 97% Oncologists reluctant to ‘give up’
    • 99% Patient / family demands for antineoplastic therapy
    • 80% Chemotherapy is reimbursable
    • 80% Reluctance to talk about issues other than antineoplastic therapy
    • 91% Takes more time to do palliative care than give antineoplastic therapy
  • 41. Professional Satisfaction
    • 98% some emotional satisfaction to provide palliative care
    • 92% some intellectual satisfaction to provide palliative care
    • Marked contrast with preparation and a cause for optimism
  • 42. Outline
    • Describe the current state of palliative care in cancer
      • Patients / families
      • Oncologists
    • Describe what is needed
    • Introduce the EPEC-O curriculum
  • 43. Goals of EPEC-O
    • Practicing oncologists
    • Core clinical skills
    • Improve
      • competence, confidence
      • patient - physician relationships
      • Patient / family satisfaction
      • physician satisfaction
    • Not intended to make every oncologist a palliative care expert
  • 44. EPEC-O Curriculum . . .
    • conflict resolution
    • clinical trials – phase I
    • preventing professional burnout
    • goals of care, treatment priorities
  • 45. EPEC-O Curriculum . . .
    • symptom management
    • diagnosis and prognosis
    • advance care planning
    • cancer survivorship
    • whole patient assessment
  • 46. EPEC-O Curriculum . . .
    • physician-assisted suicide / euthanasia
    • withholding and withdrawing Rx
      • Hydration and Nutrition
    • care in the last hours of life
    • grief and bereavement support
    • spiritual and cultural competence
  • 47. EPEC-O Curriculum . . .
    • how to teach
    • models of palliative care
    • Next steps to improve palliative care care in cancer
    • interdisciplinary teamwork (throughout)
  • 48. . . EPEC-O Curriculum
    • apply each skill in your practice
    • enhance professional satisfaction
    • foster creative approaches to create change in cancer care
      • change will not be effective without oncologists
  • 49. Summary Gaps need to be filled so that palliative care becomes an essential and inextricable part of comprehensive cancer care EPEC for Oncologists Supported by the National Cancer Institute American Society for Clinical Oncology Plenary 1