MDE 8150: Intro to Palliative Medicine and Hospice LVHN 15-16

Owned by mcook
Last updated: Oct 23, 2015
3 min read

This elective is designed to introduce the basic philosophy of palliative care and how these principles are applied to patients with advanced complex diseases.   A three-week OACIS inpatient rotation will consist of full participation on the inpatient consulting service, including daily rounds, weekly interdisciplinary team meetings (IDT), weekly staff meeting, and participation in regular interdisciplinary education sessions and case presentations (Schwartz Rounds and PalMS). Students will assist with inpatient consultations with precepting and support from the full inpatient team as well as a designated supervising physician. Focus will be on assessment and treatment of pain and non-pain symptoms, fundamental skill development in patient and relationship centered care, and coordination of care including family meetings, goals of care discussions, conflict resolution, and withdraw of life sustaining therapies. The fourth week will be focused on understanding the process of offering palliative care under the hospice medical benefit.  Students will participate in home visits under the supervision of the hospice medical director and the guidance of the RN case manager and other members of the hospice team.  Focus will be on the recognition of the dying process, the pharmacokinetics and pharmacological effects of medication commonly used to treat symptoms in dying patients, and an introduction to the regulatory requirements for hospice. 

Objectives

  1. Initiate palliative care consults on patients in the hospital to include a comprehensive medical history, physical examination and assessment of patient and family understanding of illness and prognosis. Gather a psychosocial, coping history, and spiritual and values history.
  2. Provide a comprehensive assessment of patients with pain identifying physical, psychosocial and spiritual components of distress.
  3. Explain the relevant basic science, pathophysiology, associated symptoms and signs, and diagnostic options useful in differentiating among different etiologies of pain and non-pain syndromes.
  4. In patient encounters, identify and address common patient, family, health care provider, and health care system barriers to effective symptom treatment.
  5. List indications, clinical pharmacology, alternate routes, equianalgesic conversions, appropriate titration, toxicities, and management of common side effects in opioid administration.
  6. Initiate informed relationship-centered dialogues about care.
  7. Demonstrate empathy.
  8. Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds.
  9. Communicate effectively with physicians, other health professionals, and health related agencies.
  10. Define patient requirements to qualify for the hospice medical benefit and describe how these benefits are delivered in through an interdisciplinary team.

Evaluation

For the inpatient eduactional experience, the trainee will see patients at Lehigh Valley Hospital-Cedar Crest and on the consultation sevices of the OACIS/Palliative Care Consult Service.  They will actively participate in daily team rounds and weekly Inter-Disciplinary Rounds (IDT).  Trainees will be assigned patients by the supervising faculty and will be integrally involved in the assessment of the patient's medical history, physical exam, and evaluation of patient and family understanding of illness and prognosis.  They will actively participate in family meetings regarding goals of care and treatment plans.  In addition, students will complete daily journal entries using a standardized question template to process their emotional/spiritual reaction to the work that is being done.  Communication skills will be taught through didactic sessions, role play scenarios, and direct observations.

For the hospice experience, the student will see patients at the inpatient hospice unit at 17th and Chew St.  Additionally, trainees will see patients who are enrolled in LVH Hospice Services at home with a member of the hospice team including pastoral care, social worker, nurse case manager, and medical director.  They will participate in either one inpatient or home-based IDT during the week.

During  the entire month, students will attend palliative care journal club, weekly hospice and palliative medicine fellow education sessions, Schwartz Rounds, and PalMS.  Additionally, students will be required to read the UNIPAC series, and landmark journal articles regarding  key palliative care topics.

Formal evaluation of students communication skills will be through a formal standardized patient encounter in the simulation lab.  Knowledge will be assessed through a pre-post knowledge exam in addition to an oral presentation given at one of the IDT rounds on a palliative care topic of interest. Finally, an overall evaluation will be completed by each member of the IDT using a competency-based assessment tool.