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.

Education in Palliative and End-of-life Care - Oncology

The

ProjectEPEC-OTM

EEPPEECC

OO

Module 1Module 1Comprehensive Comprehensive

AssessmentAssessment

EPEC - Oncology Education in Palliative and End-of-life Care - Oncology

Main message A comprehensive assessment that A comprehensive assessment that

includes the issues that cause includes the issues that cause patients suffering guides cancer carepatients suffering guides cancer care

Objectives Describe conceptions of sufferingDescribe conceptions of suffering Use a framework to guide Use a framework to guide

assessmentassessment Use a validated screening tool, Use a validated screening tool,

NEST, to facilitate an initial screening NEST, to facilitate an initial screening assessmentassessment

Carry out a detailed assessment of Carry out a detailed assessment of active issuesactive issues

Video

Why skill at assessmentis important Patients expect relief of sufferingPatients expect relief of suffering Key diagnostic toolKey diagnostic tool Coordinates team of health Coordinates team of health

professionalsprofessionals Can have therapeutic effectsCan have therapeutic effects Develops the physician-patient Develops the physician-patient

relationshiprelationship

The physician’s role ListenListen AcknowledgeAcknowledge AnalyzeAnalyze Offer information, practical Offer information, practical

suggestionssuggestions Introduce sources of support Introduce sources of support

Conceptions of suffering Fragmentation of personhood – Fragmentation of personhood –

CassellCassell Broken stories – BrodyBroken stories – Brody Challenge to meaning – ByockChallenge to meaning – Byock Total pain – SaundersTotal pain – Saunders

The Nature of SufferingThe Nature of SufferingThe relief of suffering and the cure of The relief of suffering and the cure of

disease must be seen as twin disease must be seen as twin obligations. obligations.

Failure to understand the nature of Failure to understand the nature of suffering can result in medical suffering can result in medical intervention that (though technically intervention that (though technically adequate) not only fails to relieve adequate) not only fails to relieve suffering but becomes a source of suffering but becomes a source of suffering itself. suffering itself. Eric Cassell, MDEric Cassell, MD

Suffering Experienced by persons, not bodiesExperienced by persons, not bodies

Meaning, Context, CopingMeaning, Context, Coping Persons exist in relation to familiesPersons exist in relation to families

Biological, Acquisition, ChosenBiological, Acquisition, Chosen

The Broad perspective A narrow focus will miss the targetA narrow focus will miss the target

depression affects experience of paindepression affects experience of painmedication useless if can’t get itmedication useless if can’t get itspiritual strength may enhance spiritual strength may enhance

tolerancetolerancefeeling abandoned may be expressed as feeling abandoned may be expressed as

physical sufferingphysical suffering

Dimensions of illness, bereavement and cancer care Fixed characteristics of the patientFixed characteristics of the patient Modifiable dimensions of the Modifiable dimensions of the

patient’s experiencepatient’s experience Healthcare interventions including Healthcare interventions including

their associated outcomestheir associated outcomes

Fixed Patient Characteristics

ReligionCulture

SocioeconomicClass

Race, Ethnicity

Culture A group’s learned, repetitive, A group’s learned, repetitive,

characteristic way of behaving, characteristic way of behaving, feeling, thinking and beingfeeling, thinking and being

A strong determinant in attitudes A strong determinant in attitudes toward health, illness, dyingtoward health, illness, dying

Respect Err on the side of formalityErr on the side of formality Ask, don’t assumeAsk, don’t assume

Language Use interpreters when language Use interpreters when language

barriers existbarriers exist Not family membersNot family members

Fixed Characteristics

Modifiable dimensions

Psychological,cognitive

symptoms

SymptomsFunction

Caregivingneeds

End of life,dying

Loss,grief

Social, issues

Patient

Spiritual, existential beliefs

Health system interventions

Informationsharing

Decision-making

Caredelivery

Careplanning

Patient

Process of providing care

Outcomes

Qualityof life

Utilization,errors

Satisfaction

Pain /symptom

relief

Patient

Efficient assessment Initial screeningInitial screening Detailed assessmentDetailed assessment Physical examination, testsPhysical examination, tests

Initial screening Validated questionnairesValidated questionnaires

NESTNESTRAI-PCRAI-PC

NEST: 9 areas to screen

Needs Needs PhysicalPhysicalMentalMental

ExistentialExistentialPersonal Personal

spiritualityspiritualitySpiritual distressSpiritual distress

Social contextSocial contextPracticalPracticalPersonalPersonalFinancialFinancial

TherapeuticTherapeuticCultureCultureDecision-makingDecision-making

Detailed assessment Detailed frameworks in Appendix 1-2 Detailed frameworks in Appendix 1-2 Assessments throughout EPEC-OAssessments throughout EPEC-O Additional not-validated questions in Additional not-validated questions in

Appendix 3Appendix 3

EEPPEECC

OO A comprehensive assessment that includes the issues that

cause patients suffering guides cancer care

SummarySummary