Education in Palliative and End-of-life Care - Oncology

1. The EPEC-O TM Education in Palliative and End-of-life Care - Oncology Project The EPEC-O Curriculum is produced by the EPECTM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

2. EPEC – Oncology Education in Palliative and End-of-life Care – Oncology Module 3a Symptoms – General Introduction

3. Objectives . . . • Discuss general assessment and management guidelines • Describe the possible causes and underlying pathophysiology • Conduct a careful assessment • Initiate management including rapid and breakthrough dosing

4. . . . Objectives • Describe principles of multi-symptom management • Understand principles of double effect

5. Video

6. Introduction • Most cancer patients have fatigue, pain, other symptoms • Poor symptom control undermines completion of anti-neoplastic treatment • Symptom control necessary for patient goals

7. Symptom management • Best medicine - treat cause & experience • Pharmacology • Surgery • Radiation • Chemotherapy • Clinical trials • Other

8. Assessment and plan • Comprehensive assessment • Conceptualize likely causes • Discuss treatment options • Negotiate goals of care, treatment priorities

9. Information gathering • Common symptoms • Collect chart information: • Onset, location, quality, timing, severity, effect of medication, adverse effects • Use scales to assess, chart severity

10. Manage quickly • Treat the cause of the symptom • Manage the experience • Continuous dosing • Breakthrough / intermittent dosing

11. Rationalize management • Multiple symptoms • Optimize non-invasive, non-pharmacological approaches • Avoid polypharmacy • Use 1 agent for 2 symptoms if you can • Consider adverse effects • Preempt interactions • Use renal and hepatic dosing as needed

12. Coordinate care • Educate the patient, family, caregivers • Include the interdisciplinary team • Use palliative care consultants • Reassess often

13. Intended vs. unintended consequences • Primary intent dictates ethical medical practice • Double effect • Definition • Minimal application in palliative care • Terminal sedation • Involve palliative care specialists

14. Summary • Principles of symptom management • Understand the pathophysiology • Manage quickly; continuous & breakthrough dosing • Rationalize multisymptom management • Coordination of care • Patient, family education • Interdisciplinary team • Intended versus unintended effects • Terminal sedation requires consultation