Anesthesia — Core of Discipline

C23 Managing goals of care discussions with patients and families, including perioperative care plans

- The focus of this EPA is the communication around a patient’s goals of care, such as end-of-life decisions during the course of a critical care or hospital admission.
- This includes breaking bad news and leading goals of care discussions, and building consensus around end-of-life decision making such as withdrawal of life sustaining therapies and potential organ and tissue donation.
- It also includes discussions surrounding the explicit interpretation of perioperative do-not-resuscitate (DNR)/no-CPR orders and the level of care wished by the patient
and family (CPR, shock, intubation, postop ICU, etc.).
- This EPA may be observed in the perioperative, ICU or on the inpatient ward.

Form

F1: Observation

Milestones

• ME 2.3. Address the impact of the medical condition on the patient’s ability to pursue life goals and purposes

• COM 3.1. Provide information on diagnosis, risks and benefits of options, and prognosis in a clear, compassionate, respectful, and objective manner

• COM 4.3. Answer questions from the patient and family

• ME 2.3. Work with the patient and family to establish goals of care.

• ME 2.4. Formulate and implement management plans that are relevant to the patient and context, in collaboration with patients and their families and the health care team

• ME 2.4. Develop and implement management plans that consider all of the patient’s health problems and context, in collaboration with patients and their families and, when appropriate, the interprofessional team

• ME 3.2. Use shared decision-making in the consent process, taking risk and uncertainty into consideration

• COM 1.1. Communicate in a manner that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion

• COM 1.3. Recognize when the values, biases, or perspectives of patients, physicians, or other health care professionals may have an impact on the quality of care, and modify the approach to the patient accordingly

• COM 1.5. Recognize when strong emotions (such as, anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately

• COM 1.6. Tailor approaches to decision-making to a patient’s and/or family’s capacity, values, and preferences

• COM 2.1. Actively listen and respond to patient cues

• COM 1.5. Manage the flow of challenging patient encounters, including those with angry, anxious or distressed individuals

• COM 5.1. Document clinical encounters and care plans to adequately convey clinical reasoning and the rationale for decisions

• P 1.3. Recognize the role the Anesthesiologist might play in the provision of Medical Assistance in Dying

• P 1.3. Manage ethical issues encountered in the clinical and academic setting

Context Variables

No context variables defined.

Requirements

• Direct observation by supervisor
• Use Form 1 or local alternative. Form collects information on:
• Type of setting: perioperative; ICU; ward; other setting
• Type of discussion [write in box]:
• Collect 3 observations of achievement
• At least one from perioperative setting