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Osteopathic EPEC
Education for Osteopathic Physicians on End-of-Life Care
Based on The EPEC Project, created by the American Medical
Association and supported by the Robert Wood Johnson Foundation.
Adapted by the American Osteopathic Association for educational use.
American
Osteopathic
Association
American
Osteopathic
Association
Treating
Our Family
and Yours
AOA:AOA:
Treating
Our Family
and Yours
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Module 8
Sudden Illness
American Osteopathic Association
AOA: Treating Our Family and Yours
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Objectives
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Describe the features of sudden illness
that require special skills
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Know how to
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Communicate effectively
Guide decision making
Explain the benefits and risks of a timelimited trial approach
American Osteopathic Association
AOA: Treating Our Family and Yours
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Sudden illness . . .
• Patient, family, caregivers under
stress
• Prognostic uncertainty
• Chaotic environment, multiple care
providers
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AOA: Treating Our Family and Yours
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. . . Sudden illness
• Continuous, sequential decision
making
• Assess / reassess the goals of care
• Acute symptom management
• Patient, family, caregivers need
support
American Osteopathic Association
AOA: Treating Our Family and Yours
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Overview . . .
• Provide structure
• Communicate possible outcomes
• Identify decision points in advance
• Use goals of care to guide decision
making
American Osteopathic Association
AOA: Treating Our Family and Yours
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. . . Overview
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Take sociocultural issues into account
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Address differences
Use clear language
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Manage symptoms effectively
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Impact of stress on caregivers
American Osteopathic Association
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Provide structured
interaction
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Encourage one primary spokesperson
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Identify regular communication times
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Prepare early for future decisions
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Set expectations for future
communication
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Communicate the plan
American Osteopathic Association
AOA: Treating Our Family and Yours
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Communicate range of
possible outcomes . . .
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Avoid waiting until more is known
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Discuss uncertainty openly
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Provide the full picture
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Identify most and least likely outcomes
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Acknowledge limits of individual
experience
American Osteopathic Association
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. . . Communicate range
of possible outcomes
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Discuss what is likely to happen next
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Be specific and use examples
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Discuss what is known
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Use evidence-based information
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Use gentle repetition
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Identify immediate and future decisions
American Osteopathic Association
AOA: Treating Our Family and Yours
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Identify decision points in
advance
• Signs that a decision may be near
• Time course expected before next
decision
• Prepare for
• Changing goals
• Discussion of informed consent
American Osteopathic Association
AOA: Treating Our Family and Yours
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Use goals of care to guide
decision making
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Patient-centered goals of care determine
the treatment plan
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Values, preferences
Cumulative and integrated goals
Comfort and curative goals
Identify the degree of
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Recovery that would be acceptable
Certainty recovery could be achieved
American Osteopathic Association
AOA: Treating Our Family and Yours
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Informed consent
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Nature of the illness
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Recommended treatment
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Reasonable alternatives
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Chance of each alternative achieving its
intended goal
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Burdens, benefits of each alternative
American Osteopathic Association
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Benefits, burdens of timelimited trials
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Use while more information is gathered
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Can stop life-sustaining treatment
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Provides structure, helps families
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May result in a poor outcome
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Decision to stop may be more difficult
American Osteopathic Association
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Sociocultural
differences . . .
• Distrust of the medical system or
physicians
• Unrealistic expectations of the
medical system or physicians
• Any life, no matter how
compromised, is worth living
American Osteopathic Association
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. . . Sociocultural
differences
• Belief in miracles
• Death is “the enemy”
• Death should not be discussed
openly
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Manage symptoms
• Essential to quality of life
• Relieve symptoms throughout
• Permits continuation of a portion of
the treatment plan
American Osteopathic Association
AOA: Treating Our Family and Yours
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Impact of stress on
professionals
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Physician - Know Thyself
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Acknowledge stress, uncertainty of Dx and
Tx, moral and ethical conflict
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Stressful working conditions
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Burnout common
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Communication, common goals help
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Provide support systems
American Osteopathic Association
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Sudden Illness
Summary
American Osteopathic Association
AOA: Treating Our Family and Yours