Summary of Competencies

Stage I:


Stage 2:


Stage 3:



  • 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


  • 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


  • 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

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