Attitudes

• Death is a natural part of the life cycle
• Death is cross-cultural experience with the patient, family caregivers and health care team each possessing different perspectives
• Death may be one of many acceptable outcomes to the patient and family within the context of chronic illness.
• The physician plays a key role in recognizing when death is a likely outcome

• After recognizing death as a likely outcome of disease, then it is the physician’s responsibility to discus with the patient and family their cultural perspectives on living with a chronic, life threatening illness
• Such a discussion requires relational and communication skills
• Understanding the patient and family’s goals and values within their cultural framework allows the physician to provide medical care that supports a better quality of life for all involved: patient, family and health care professionals

• It is the physician’s responsibility to develop a plan of care congruent with the patient’s and family’s values and goals
• A palliative plan of care requires physicians’ effort to develop the necessary knowledge, attitudes, and skills over time
• The professional role of the physician includes the motivation to acquire the needed attitudes, knowledge and skills in palliative care to benefit patients, families and self

Knowledge

• Describe multiple trajectories of common chronic illnesses that lead to death
• Describe the barriers that makes it difficult to acknowledge death as an acceptable outcome
• Understand the uncertain nature of prognosis

Skills

• Can answer the question “Would I be surprised if this patient died in the next year?” based upon an understanding of the trajectories of common chronic illnesses
• Ability to assess their confidence in answering question 1
• Demonstrate the ability to consider the appropriateness of curative and palliative care approaches for a particular patient and family considering the palliative care transition

• Recognize the elements of effective patient centered communication when dealing with chronically ill patients and their families near the end of life
• Recognize how to build therapeutic relationships with chronically ill patients and their families near the end of life
• Demonstrate fundamental skills of patient-entered communication and relationship building

• When appropriate pain and symptom management is individualized to a chronically ill patient and their family near theeol
• When hospice and palliative care are appropriately individualized to a patient and their family near the end of life.

Demonstrate skills in:

• Pain and symptom management
•  Assessing patient and family situation and individualize the palliative plan of care in congruence with changing patient and family goals