The EPEC-O TM Education in Palliative and End-of-life Care - Oncology Project 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. E P E C O EPEC - Oncology Education in Palliative and End-of-life Care - Oncology Plenary 2 Models of Comprehensive Care Main message Funding and service delivery systems must be in place to provide palliative care as a reliable component of comprehensive cancer care Objectives Comprehensive cancer care includes palliative care from the day of diagnosis Define hospice and palliative care and relate their history Describe funding and service delivery models for providing comprehensive cancer care Understand when palliative care services are appropriate for cancer patients Video Comprehensive cancer care Gaps in contemporary cancer care Approaches to relief of suffering Piloted with hospice programs More widely applied through palliative care programs Now being integrated into comprehensive cancer care Hospice Historical evolution Medicare Hospice Benefit 40% of dying cancer patients referred Median enrollment 22 days 37% of patients die within 7 days Conventional cancer care Hospice in the US today A place An organization or program An approach to or philosophy of care A system of reimbursement Hospice care Hospice care Safe and comfortable dying Self-determined life closure Effective grieving Levels of care Routine care General inpatient care Continuous care Respite care Core services Interdisciplinary care Chaplaincy, nursing, medical social services, counseling, volunteers Primary care physician Palliative care physician (consultation) Bereavement counseling Medical equipment, supplies Medications and therapies related to the terminal diagnosis Palliative care Therapies to relieve suffering and improve quality of life May be combined with therapies aimed at remitting or curing cancer, or 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 lifethreatening 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 Primary Secondary Tertiary Comprehensive cancer care Anti-cancer therapy Supportive care End-of-life care Bereavement care Comprehensive cancer care Clinical (secondary) palliative care Home Consultation Services Inpatient Care SNF Outpatient Office Case examples Warren Grant Magnuson Clinical Center, NIH, Bethesda Memorial Sloan-Kettering, NYC Dana-Farber Cancer Center, Boston Fox Chase Cancer Center, Philadelphia MD Anderson Cancer Center, Houston Development as a specialty Curricula Certification exams Journals Textbooks Fellowship training Formal recognition as a subspecialty E P E C Summary O Funding and service delivery systems must be in place to provide palliative care as a reliable component of comprehensive cancer care