Division of Palliative Care

Goals and Objectives - Four Principles

GOALS AND OBJECTIVES OF THE PALLIATIVE CARE FELLOWSHIP PROGRAM

THE COLLEGE OF FAMILY PHYSICIANS OF CANADA

The philosophy of the program is to provide the resident with a broad and inclusive experience in Palliative Care. The Program will include experience in a number of palliative care settings — community, acute care hospital, and palliative care unit or hospice. It will include a two month block of oncology, and some elective time. Each palliative care block has unique features that give the Fellow exposure to patients with a wide variety of palliative care problems; for example, oncology and renal patients, cardiovascular and trauma patients, and others.

The Resident will have extensive and varied exposure to management of pain and other symptoms, psychosocial care of patients and their families and interprofessional team work.

1. Goals and Objectives

The overall goals of the program

To educate physicians to function with added competency in the area of palliative medicine. These physicians will be providing primary and consultant palliative care services
To provide clinical and initial basic academic education for physicians who will be pursuing academic careers in palliative medicine.

2. Educational Objectives of the Program

Principle #1: The palliative care physician is a skilled clinician

Define palliative care and describe its basic principles
Describe the physical, psychological, social and spiritual issues of dying patients and their families
Demonstrate a systematic approach to symptom assessment and all aspects of psychosocial needs
Demonstrate the ability to develop a management plan that appropriately balances disease-specific treatment and symptom management according to the individual needs of the patient and family
Demonstrate the ability to monitor the efficacy of symptom management plans
Demonstrate skill in assessment of pain and other symptoms via appropriate history, physical examination, and relevant investigations
Demonstrate advanced knowledge of the assessment and classification of pain including nociceptive, somatic, visceral, and neuropathic pain syndromes
Demonstrate knowledge of the neurophysiology of pain
Demonstrate knowledge of the pharmacology of drugs used in pain and symptom management
Demonstrate understanding of the pathophysiology of other symptoms
Demonstrate effective use of analgesic approaches to pain management (including non-opioid and opioid) as they pertain to different pain syndromes.
Demonstrate appropriate pharmacologic management of pain, including understanding of opioid dose equivalency, initiating dosage, dose titration, breakthrough dosing, use of adjuvant modalities and medications, drug monitoring, and prevention and management of drug side effects
Demonstrate appropriate management of other physical symptoms especially dyspnea, constipation, skin care, mouth care, terminal agitation, delirium, nausea and vomiting
Demonstrate adequate knowledge of cancer, its pathophysiology and current principles and management
Demonstrate an understanding of the identification, investigations, and management of oncologic emergencies.
Identify psychological issues associated with life-threatening illness and strategies that may be useful in addressing them, particularly anxiety and depression
Identify the social and existential needs confronting the patient and families and strategies that may be useful in addressing them
Describe the process of normal grief and differentiate from the features of atypical grief
Assist in the rehabilitation/grieving process of persons suffering from the loss of a loved one
Provide supportive counseling and connection to community resources for those coping with loss
Describe an approach to the last hours of care in the home and the responsibilities of the physician at the time of death
Demonstrate knowledge of the field of biomedical ethics and its principles
Outline a general framework for ethical decision-making
Describe an approach to managing the particular ethical issues at the end of life including withdrawing or withholding therapy, advance directives, euthanasia and assisted suicide
Address end-of-life decision-making and planning using basic bioethical and legal frameworks
Demonstrate effective communication skills in dealing with terminally-ill patients and their families, including skills in delivering bad news
Appropriately document holistic management plan
Demonstrate a systematic approach to working with the families of dying patients including bereavement counselling
Develop a proactive approach to managing patient and family expectations and needs
Demonstrate skills in working with the families of dying patients, including conducting effective family meetings
Demonstrate skills in providing educational counselling to dying patients and their families;
Demonstrate an ability to work with the patient and family to establish common, patient-centred goals of care
Demonstrate consultant level diagnostic and therapeutic skills for ethical and effective patient care
Demonstrate the ability to define the elements of suffering in end-of-life care for patients, families and caregivers
Describe and implement a supportive approach to suffering

Principle #2: Palliative medicine is a community-based discipline

Describe current societal attitudes about death and dying;
Describe the societal and environmental factors relevant to the care of the dying;
Describe the models of palliative care delivery and their utilization;
Describe the barriers to effective care across settings;
Describe the elements comprising good palliative home care;
Describe the community resources available to support patients in their homes;
Demonstrate knowledge and skill in providing home visits to dying patients;
Describe the physician’s role in managing patients in their homes;
Describe the roles of other disciplines in providing palliative care
Participate in interdisciplinary care of patients, including family conferences
Communicate effectively with other team members;
Demonstrate adequate skills in educating and learning from members of the interdisciplinary team
Demonstrate the ability to work effectively in institutional and community-based palliative care programs
Assist institutional and community palliative care programs in developing standards of care consistent with accepted standards

Principle #3: The palliative care physician is a resource to a defined practice population

Articulate the philosophical basis of effective palliative/hospice care
Describe current barriers in providing better care for the dying
Outline the basic standards of palliative care as identified by the Canadian Hospice Palliative Care Association
Incorporate accepted standards of palliative care and evidence based decision-making into the practice of caring for dying patients and their families
Utilize specific resources available to assist with care of terminally ill patients
Identify issues in death and dying relevant to different cultures, spiritual beliefs and traditions
Act as a role model for other residents and physicians
Become a role model by demonstrating skillful care of the dying
Describe the role of family physicians and specialists in the care of the terminally ill
Describe the role of palliative care consultants
Demonstrate effective consultation and communication skills in working with referring physicians
Advocate for the needs of palliative and home care patients
Access and use the relevant literature in helping to solve clinical problems
Apply critical appraisal skills to literature in palliative medicine

Principle #4: The patient-physician relationship is central to the role of the palliative care physician

Demonstrate an ongoing commitment to a patient and family from the time of palliative medicine consultation for a terminal illness until a patient dies and to the family around the time of death
Demonstrate a holistic approach to caring for dying patients and their families
Demonstrate integrity, honesty, and compassion in the care of patients
Ensure patients' privacy and dignity are maintained
Act as an effective advocate for the rights of patients and family in clinical situations involving serious ethical considerations
Describe his/her own concerns about dealing with dying patients and their families
Demonstrate an awareness of how his/her own personal experiences of death and dying have influenced attitudes
Demonstrate self-awareness and self-care in caring for terminally ill patients
Describe strategies for managing his/her own stress in dealing with the dying

3. How will the residents and faculty be made aware of the objectives?

Circulation of document stating objectives to the resident and involved faculty.
Pre-meeting of the Faculty Group and discussion with Program Director
Fellows will meet regularly with their supervisor to review objectives.

4. How will objectives be used to guide resident experience?

Reviews with supervisor/mentor quarterly
Objectives will reform the basis of the evaluation process
Overall objectives will form the basis of rotation-specific objectives

McMaster University