Abstract
BackgroundPalliative medicine is assuming an increasingly important role in patient care. The Education for Physicians in End-of-life Care (EPEC) Project is an ambitious program to increase core palliative care skills for all physicians. It is not intended to transmit specialty level competencies in palliative care.MethodThe EPEC Curriculum was developed to be a comprehensive syllabus including trainer notes, multiple approaches to teaching the material, slides, and videos of clinical encounters to trigger discussion are provided. The content was developed through a combination of expert opinion, participant feedback and selected literature review. Content development was guided by the goal of teaching core competencies not included in the training of generalist and non-palliative medicine specialist physicians.ResultsWhole patient assessment forms the basis for good symptom control. Approaches to the medical management of pain, depression, anxiety, breathlessness (dyspnea), nausea/vomiting, constipation, fatigue/weakness and the symptoms common during the last hours of life are described.ConclusionWhile some physicians will have specialist palliative care services upon which to call, most in the world will need to provide the initial approaches to symptom control at the end-of-life.
Highlights
Palliative medicine is assuming an increasingly important role in patient care
Whole patient assessment forms the basis for good symptom control
After an overview of the approaches to whole patient assessment, we summarize the management of several of the more common symptoms that occur at the end-of-life
Summary
Whole Patient Assessment Management strategies to relieve suffering in end-of-life care begin with a comprehensive assessment of the whole patient, and his or her family. To control any extra or "breakthrough" pain, provide the patient with "as needed" rescue doses of the same immediate-acting opioid. Opioids may provide significant relief of the sense of breathlessness without having a measurable impact on their respiratory rate or blood gas concentrations [49] Through both central and peripheral effects, doses lower than those used to relieve pain may be effective in opioid naïve patients. Cytoprotective agents (eg, misoprostol) may be effective in treating the nausea associated with mucosal erosion secondary to NSAIDs. Heterogeneous groups of medications that have unclear mechanisms of action, but uncontested benefits in some patients include glucocorticoids (eg, dexamethasone), cannabinoids (eg, tetrahydrocannabinol), and benzodiazepines (eg, lorazepam) [61,62,63]. If the patient is in the last hours of his or her life with other concurrent signs of Figure 3: Restless
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