The goal of this clerkship is for you recognize and critically evaluate those behaviors that allow clinicians to provide excellent palliative/hospice care to patients and families living with chronic, life limiting illness. Conversely you should be able to recognize and critically evaluate those behaviors that hinder the provision of palliative/hospice care.
To meet the goals of assisting you in recognizing and critically evaluating behaviors in clinicians that optimally promote palliative/hospice care you are about to explore a Best Practice Model based upon well-documented research as well as clinical experience. It is a simplified way of describing what experts in the field usually do when caring for patients and families with chronic, life limiting illness. The goals of introducing this model include:
Providing you with a framework to critically observe the complex processes of discussing and providing palliative care in the clinical setting.
Providing you and your preceptors a common model and language for discussing the complex processes observed while providing palliative care in the clinical setting.
Providing you discrete, concrete behaviors to practice that approximate expert behavior both in the clinical and educational setting.
Providing you with a model that you can use to guide your future education and development in palliative care during residency, fellowship and clinical practice.
How well are medical professionals doing in their role of helping patients and families transition from curative to palliative/hospice care at the end of life? The evidence is sketchy but clearly indicates there is much room for improvement. The best-documented review is the Institute of Medicine report, Approaching Death.  Key deficiencies noted in the report include:
1. Too many patients needlessly suffer during the end of life from errors of omission (when caregivers fail to provide palliative and supportive care known to be effective) and commission (when caregivers do what is known to be ineffective and even harmful).
Studies have repeatedly indicated that a significant proportion of dying patients experience serious pain despite effective options for relieving most pain. While patients fear dying in an over-treated state, they also fear the opposite, medical abandonment. Patients and those close to them may suffer physically and emotionally when physicians or nurses conclude that a patient is dying and withdraw care, e.g., passing by the hospital room on rounds, failing to follow up on the patient at home, and disregarding the patient’s pain and other symptoms.
2. Legal, organizational, and economic factors can inhibit the delivery of reliably excellent care during the end of life.3. Education and training programs of physicians and other health care professionals fail to give them the knowledge, skills, and attitudes needed to provide good care for the patient and family.4. Too little is known about how people die, how they want to die, and how different types of physical, emotional, and spiritual care might better serve dying patients and those close to them.5. It seems that most people in the United States have not learned how to talk realistically and comfortably about the end of life, nor how to value the end of life experienced by most patients.
The Palliative Care Track of the Chronic Care Clerkship will discuss core issues to be considered when providing quality medical care at the end of life. These include specific medical and professional values, knowledge and skills in providing palliative care. Values are at the center of the opportunities that exist during this unique and often spiritual period of a person’s life.
In most cases, dying, like birthing, is a process requiring assistance. It is an event that asks us to be present for one another with heart and mind, bringing not only practical help as necessary, but also attentive awareness and appreciation of the individual involved. At its finest, it elicits from us the frankly and fully offered human companionship that brings positive benefits, and a kind of joy, to any shared venture. -Sandol Stoddard
We are a culture that denies death…therefore we are all walking towards death backwards! It is better to turn around. -Michael Meade
Students in the Palliative Care track will gain understanding of a Best Practice Model to effectively providing palliative care to patients and families dealing with life limiting illness.
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