Transcript Slide 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.
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EPEC - Oncology
Education in Palliative and End-of-life Care - Oncology
O
Module 1
Comprehensive
Assessment
Main message

A comprehensive assessment that
includes the issues that cause
patients suffering guides cancer care
Objectives

Describe conceptions of suffering
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Use a framework to guide
assessment
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Use a validated screening tool, NEST,
to facilitate an initial screening
assessment

Carry out a detailed assessment of
active issues
Video
Why skill at assessment
is important

Patients expect relief of suffering

Key diagnostic tool
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Coordinates team of health
professionals
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Can have therapeutic effects
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Develops the physician-patient
relationship
The physician’s role
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Listen
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Acknowledge
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Analyze
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Offer information, practical
suggestions
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Introduce sources of support
Conceptions of suffering
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Fragmentation of personhood –
Cassell
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Broken stories – Brody
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Challenge to meaning – Byock
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Total pain – Saunders
The Nature of Suffering
The relief of suffering and the cure of
disease must be seen as twin
obligations.
Failure to understand the nature of
suffering can result in medical
intervention that (though technically
adequate) not only fails to relieve
suffering but becomes a source of
suffering itself.
Eric Cassell, MD
Suffering
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Experienced by persons, not bodies
Meaning, Context, Coping
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Persons exist in relation to families
Biological, Acquisition, Chosen
The Broad perspective
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A narrow focus will miss the target
depression affects experience of pain
medication useless if can’t get it
spiritual strength may enhance
tolerance
feeling abandoned may be expressed as
physical suffering
Dimensions of illness,
bereavement and cancer care
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Fixed characteristics of the patient
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Modifiable dimensions of the
patient’s experience
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Healthcare interventions including
their associated outcomes
Fixed Patient
Characteristics
Race, Ethnicity
Culture
Religion
Socioeconomic
Class
Culture

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A group’s learned, repetitive,
characteristic way of behaving,
feeling, thinking and being
A strong determinant in attitudes
toward health, illness, dying
Respect
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Err on the side of formality
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Ask, don’t assume
Language
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Use interpreters when language
barriers exist
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Not family members
Modifiable dimensions
Spiritual,
existential beliefs
Symptoms
Function
Fixed
Characteristics
Patient
Caregiving
needs
Loss,
grief
End of life,
dying
Social,
issues
Psychological,
cognitive
symptoms
Health system interventions
Decisionmaking
Care
planning
Information
sharing
Care
delivery
Patient
Process of providing care
Patient
Utilization,
errors
Quality
of life
Pain /
symptom
relief
Satisfaction
Outcomes
Efficient assessment
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Initial screening
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Detailed assessment
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Physical examination, tests
Initial screening
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Validated questionnaires
NEST
RAI-PC
NEST: 9 areas to screen
 Needs
 Social context
Physical
Practical
Mental
Personal
 Existential
Personal
spirituality
Spiritual distress
Financial
 Therapeutic
Culture
Decision-making
Detailed assessment
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Detailed frameworks in Appendix 1-2
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Assessments throughout EPEC-O
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Additional not-validated questions in
Appendix 3
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Summary
A comprehensive assessment
that includes the issues that
cause patients suffering guides
cancer care