EEPPEECC

American Osteopathic AssociationAOA: Treating Our Family and Yours

Osteopathic EPECOsteopathic EPEC Osteopathic EPECOsteopathic 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 AssociationAOA: Treating Our Family and Yours

EEPPEECC

American Osteopathic AssociationAOA: Treating Our Family and Yours

Module 8 Sudden Illness

EEPPEECC

American Osteopathic AssociationAOA: Treating Our Family and Yours

Objectives

• Describe the features of sudden illness that require special skills

• Know how to • Communicate effectively • Guide decision making

• Explain the benefits and risks of a time-limited trial approach

EEPPEECC

American Osteopathic AssociationAOA: Treating Our Family and Yours

Sudden illness . . .

• Patient, family, caregivers under stress

• Prognostic uncertainty

• Chaotic environment, multiple care providers

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American Osteopathic AssociationAOA: Treating Our Family and Yours

. . . Sudden illness

• Continuous, sequential decision making• Assess / reassess the goals of

care

• Acute symptom management

• Patient, family, caregivers need support

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American Osteopathic AssociationAOA: Treating Our Family and Yours

Overview . . .

• Provide structure

• Communicate possible outcomes

• Identify decision points in advance

• Use goals of care to guide decision making

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American Osteopathic AssociationAOA: Treating Our Family and Yours

. . . Overview

• Take sociocultural issues into account• Address differences

• Use clear language

• Manage symptoms effectively

• Impact of stress on caregivers

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American Osteopathic AssociationAOA: Treating Our Family and Yours

Provide structured interaction• Encourage one primary spokesperson

• Identify regular communication times

• Prepare early for future decisions

• Set expectations for future communication

• Communicate the plan

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American Osteopathic AssociationAOA: Treating Our Family and Yours

Communicate range of possible outcomes . . .• Avoid waiting until more is known

• Discuss uncertainty openly

• Provide the full picture

• Identify most and least likely outcomes

• Acknowledge limits of individual experience

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American Osteopathic AssociationAOA: Treating Our Family and Yours

. . . Communicate range of possible outcomes• Discuss what is likely to happen next

• Be specific and use examples

• Discuss what is known

• Use evidence-based information

• Use gentle repetition

• Identify immediate and future decisions

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American Osteopathic AssociationAOA: Treating Our Family and Yours

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

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American Osteopathic AssociationAOA: Treating Our Family and Yours

Use goals of care to guide decision making• Patient-centered goals of care

determine the treatment plan• Values, preferences • Cumulative and integrated goals• Comfort and curative goals

• Identify the degree of• Recovery that would be acceptable• Certainty recovery could be achieved

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American Osteopathic AssociationAOA: Treating Our Family and Yours

Informed consent

• Nature of the illness

• Recommended treatment

• Reasonable alternatives

• Chance of each alternative achieving its intended goal

• Burdens, benefits of each alternative

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American Osteopathic AssociationAOA: Treating Our Family and Yours

Benefits, burdens of time-limited trials• Use while more information is

gathered

• Can stop life-sustaining treatment

• Provides structure, helps families

• May result in a poor outcome

• Decision to stop may be more difficult

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American Osteopathic AssociationAOA: Treating Our Family and Yours

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

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American Osteopathic AssociationAOA: Treating Our Family and Yours

. . . Sociocultural differences• Belief in miracles

• Death is “the enemy”

• Death should not be discussed openly

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American Osteopathic AssociationAOA: Treating Our Family and Yours

Manage symptoms

• Essential to quality of life

• Relieve symptoms throughout

• Permits continuation of a portion of the treatment plan

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American Osteopathic AssociationAOA: Treating Our Family and Yours

Impact of stress on professionals• Physician - Know Thyself

• Acknowledge stress, uncertainty of Dx and Tx, moral and ethical conflict

• Stressful working conditions

• Burnout common

• Communication, common goals help

• Provide support systems

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American Osteopathic AssociationAOA: Treating Our Family and Yours

Sudden Illness Summary