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
