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 Plenary 2Plenary 2
Models of Comprehensive
Care
EPEC - Oncology Education in Palliative and End-of-life Care - Oncology
Main message Funding and service delivery Funding and service delivery
systems must be in place to provide systems must be in place to provide palliative care as a reliable palliative care as a reliable component of comprehensive component of comprehensive cancer carecancer care
Objectives Comprehensive cancer care includes Comprehensive cancer care includes
palliative care from the day of diagnosispalliative care from the day of diagnosis Define hospice and palliative care and Define hospice and palliative care and
relate their historyrelate their history Describe funding and service delivery Describe funding and service delivery
models for providing comprehensive models for providing comprehensive cancer carecancer care
Understand when palliative care services Understand when palliative care services are appropriate for cancer patientsare appropriate for cancer patients
Video
Comprehensive cancer care
Gaps in contemporary cancer careGaps in contemporary cancer care Approaches to relief of sufferingApproaches to relief of suffering
Piloted with hospice programsPiloted with hospice programsMore widely applied through palliative More widely applied through palliative
care programscare programsNow being integrated into Now being integrated into
comprehensive cancer carecomprehensive cancer care
Hospice Historical evolutionHistorical evolution Medicare Hospice BenefitMedicare Hospice Benefit
40% of dying cancer patients referred40% of dying cancer patients referredMedian enrollment 22 daysMedian enrollment 22 days37% of patients die within 7 days37% of patients die within 7 days
Conventional cancer care
Hospice in the US today A placeA place An organization or programAn organization or program An approach to or philosophy of careAn approach to or philosophy of care A system of reimbursementA system of reimbursement
Hospice care
Hospice care Safe and comfortable dyingSafe and comfortable dying Self-determined life closureSelf-determined life closure Effective grievingEffective grieving
Levels of care Routine careRoutine care General inpatient careGeneral inpatient care Continuous careContinuous care Respite careRespite care
Core services Interdisciplinary careInterdisciplinary care
Chaplaincy, nursing, medical social services, Chaplaincy, nursing, medical social services, counseling, volunteerscounseling, volunteers
Primary care physicianPrimary care physicianPalliative care physician (consultation)Palliative care physician (consultation)
Bereavement counselingBereavement counseling Medical equipment, suppliesMedical equipment, supplies Medications and therapies related to the Medications and therapies related to the
terminal diagnosisterminal diagnosis
Palliative care Therapies to relieve suffering and Therapies to relieve suffering and
improve quality of lifeimprove quality of life May be May be combinedcombined with therapies with therapies
aimed at remitting or curing cancer, aimed at remitting or curing cancer, or it may be the total focus of careor it may be the total focus of care
WHO 2002 definition of palliative care"Palliative care is an approach which
improves quality of life of patients and their families facing life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual"
Palliative care
Delivering palliative care
PrimaryPrimary SecondarySecondary TertiaryTertiary
Comprehensive cancer care
Anti-cancer therapyAnti-cancer therapy Supportive careSupportive care End-of-life careEnd-of-life care Bereavement careBereavement care
Comprehensive cancer care
Clinical (secondary) palliative care
ConsultationConsultationServicesServices
InpatientInpatientCareCare
HomeHome
Outpatient Outpatient OfficeOffice
SNFSNF
Case examples
Warren Grant Magnuson Clinical Warren Grant Magnuson Clinical Center, NIH, BethesdaCenter, NIH, Bethesda
Memorial Sloan-Kettering, NYCMemorial Sloan-Kettering, NYC Dana-Farber Cancer Center, BostonDana-Farber Cancer Center, Boston Fox Chase Cancer Center, Fox Chase Cancer Center,
PhiladelphiaPhiladelphia MD Anderson Cancer Center, MD Anderson Cancer Center,
HoustonHouston
Development as a specialty
CurriculaCurricula Certification examsCertification exams JournalsJournals TextbooksTextbooks Fellowship trainingFellowship training Formal recognition as a subspecialtyFormal recognition as a subspecialty
EEPPEECC
OOSummary
Funding and service delivery Funding and service delivery systems must be in place to systems must be in place to provide palliative care as a provide palliative care as a
reliable component of reliable component of comprehensive comprehensive
cancer carecancer care
