Distance Learning

The Education in Palliative & End-of-Life Care (EPEC) curriculum includes 16 modules that consist of information, video cases and discussion boards. The target audience for these distance learning programs is physicians and other healthcare professionals who are engaged in palliative care education and clinical practice. There is 1.0AMA PRA Category 1 Credit(s)™ available per module. EPEC distance learning is sponsored by the Postgraduate Institute of Medicine. The estimated time for each module is 60 minutes. Modules can be purchased individually or in clusters. Each module is priced at $30. Once a module has been purchased, you will have unlimited access the module for one year. The EPEC curriculum is available on our Canvas platform.

Purchase Materials

Gaps & Elements of Care

This module provides background for the EPEC curriculum. It presents a profile of how people currently die in the United States and contrasts this with data about the way they would like to die. In doing so, it highlights how the current system fails to meet the expectations and needs of our patients and families who are living with advanced life-threatening illness.

Legal Issues

A broad legal consensus has developed around issues of end-of-life care in the United States. This module discusses the clear and consistent legal principles directing treatment limitation, decision-making for patients who lack capacity and the use of opioids, as well as the legal aspects of the more controversial issues of physician-assisted suicide and futility.

Goals of Care

Negotiating and determining the goals of care are essential issues for good palliative care. There are many possible goals of care, from prevention, to cure, to prolongation of life, to achieving a good death. No one goal is inherently more valid than another, and multiple goals may apply simultaneously.

Whole Patient Assessment

Patient assessment in end-of-life care focuses on the relief of suffering. Suffering can be conceptualized as having physical, psychological, social and spiritual components. Consequently, assessment must include all of these aspects of a patient's condition and experience. A standard assessment should include disease history, physical symptoms, psychological symptoms, decision-making capacity, information sharing, social circumstances, spiritual needs, practical needs and anticipatory planning for death.

 

Advance Care Planning

Advance care planning is about future medical care in case of being unable to make decisions. It should be a routine matter. It is a stepwise process that can be flexibly integrated into encounters with the physician or other care team members. Steps include introduction of the topic, structured discussions covering potential scenarios, documentation of preferences, periodic review and update and application of the directives when needed.

Communicating Bad News

Communicating bad news is an essential skill for physicians. This module presents a six-step approach to communicating bad news. The steps include getting started, finding out what the patient knows, finding out how much the patient wants to know, sharing information, responding to feelings and planning/follow-up. Approaches for handling the family who says "don't tell" the patient, for using a translator and for communicating prognosis are also discussed.

Pain Management Modules

Pain management is one of the most prominent and important symptom control skills that physicians possess. It requires a sophisticated knowledge of pathophysiology, pharmacology and therapeutics. There are three pain management modules in our program: analgesic/opioid dosing, equianalgesic dosing and managing specific pains.

 

Common Physical Symptoms

Many symptoms are commonly encountered in patients with advanced illness. This module discusses the assessment and management of breathlessness, nausea and vomiting, constipation, diarrhea, loss of appetite/weight loss, edema, skin ulcers, insomnia and fatigue. Each one can both be debilitating and prevent the patient and family from either continuing their lives or completing life closure.

 

Physician-Assisted Suicide

Physician-assisted suicide is the act by a physician of assisting a patient to commit suicide. Most physicians have received one or more requests to help a patient end their life prematurely. This module focuses on the skills that the physician can use to respond compassionately and with confidence, not by using ethical arguments but by using solid clinical skills.

Sudden Illness

Sudden illness, particularly when it is severe and unexpected and has an uncertain prognosis, challenges everyone. Structured communication is especially important and goals for care may need to change rapidly. Sociocultural differences may need rapid and sensitive appreciation to keep urgent care consistent with the patient's values.

 

Depression, Anxiety & Delirium

Anxiety, confusion (part of delirium) and depression are three common and serious symptoms that occur in patients nearing the end of their lives. All three are under-recognized and undertreated. As approaches to their assessment and management are widely known, all three symptoms can be pursued by any physician.

 

Last Hours of Living

The last hours of living are important not only for the comfort of the patient, but for all who are bereaved by, or simply witness, the death. Normal death is explained in this module, as are the key tasks that need to be accomplished before, at and after the death.

Withholding/ Withdrawing Treatment

The withholding and withdrawing of life-sustaining therapies is ethical and medically appropriate in some circumstances. Physicians need to develop facility with general aspects of the subject, as well as specific skills and approaches. In this module, general aspects are discussed first. Then, three areas where this general knowledge frequently needs to be applied are covered: cessation of artificial nutrition/hydration, ventilator withdrawal and resuscitation.

 

Medical Futility

Clear and unequivocal situations of medical futility are rare. More often than not the issue is conflict resolution. The physician may be pursuing unrealistic or unwanted plans. There may be difficulty for the proxy to perform his or her role. There may be misunderstandings over prognosis. There may be personal factors such as distrust or guilt, or there may be differences in values. Understanding the nature of the conflict may allow ready resolution. For intractable difficulties, a fair process for conflict resolution is recommended.

Statement of Disclosure & Content Validation

Current guidelines set by the Accreditation Council for Continuing Medical Education (ACCME) state that participants in CME activities should be made aware of any affiliation or financial interest that may affect the speaker’s presentation(s). Each speaker has been requested to complete a Statement of Disclosure and Content Validation Form.

Northwestern University Feinberg School of Medicine adheres to the conflict of interest policy of the University as well as to the guidelines of the Accreditation Council for Continuing Medical Education and the American Medical Association.

Every effort is made to develop a CME activity that is balanced, objective, independent and scientifically rigorous. Speakers have been instructed to use generic names for drugs/devices, when possible, in their presentations and to include various commercial products within and across classes. Speakers have also been asked to disclose “off-label” use of a commercial product, or an investigational use not yet approved by the FDA for any purpose, and provide adequate scientific and clinical justification for such use. The names of speakers declaring a potential conflict of interest or those who will be discussing off-label usage are indicated below. If at any time during this activity you feel that there has been commercial or promotional bias, please call it to the program director’s attention. In addition, please respond candidly to the questions about balance and objectivity included in the activity evaluation.

Privacy Statement

Registration is necessary for participation in the distance learning curriculum and includes name, demographic and practice information. This information is for our own internal purposes. We do not share this identifiable information with any outside parties. If aggregated statistics are reported to outside parties, they are free of names and other identifying information. We will not sell, rent, or share your information to any third party.

Physician Continuing Medical Education

Accreditation Statement: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Postgraduate Institute for Medicine and Buehler Center on Aging, Health & Society. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: The Postgraduate Institute for Medicine designates this enduring material for a maximum of 1.0AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

For More Information

Continuing Education credit is jointly provided by Postgraduate Institute of Medicine and Northwestern University Feinberg School of Medicine.

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