Critical Care Medicine — Foundation of Discipline

F4 Identifying and providing care for patients’ and their family’s needs around the end-of-life

Key Features:
- This EPA focuses on the application of communication skills to support patients and families. At this stage, it is limited to clinical interactions that are not characterized by conflict.
- 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 integrating rituals and end-of-life practices in keeping with the patient’s and family’s cultural, spiritual and religious beliefs.
- This EPA may be observed in the ICU, in the ER, on the inpatient ward or in a simulated setting.

Assessment Plan:
Direct observation by attending physician with input from TTP level trainee, bedside RN, social worker, family and/or other members of the care team
Use form 1. Form collects information on:
- Activity observed: family discussion/meeting; note written after meeting; simulated activity; other (write in)
Collect 5 observations of achievement
- At least 1 family meeting/discussion
- At least 1 review of written documentation of the meeting
- At least 3 different observers

Form

F1: Observation

Milestones

• COM 1.1. Develop trusting and supportive relationships with families in distress

• COM 3.1. Convey information about diagnosis and prognosis clearly and compassionately

• COM 3.1. Use appropriate language and avoid medical jargon

• COM 3.1. Use strategies to verify and validate the understanding of the patient and/or family

• COM 4.1. Ask about and integrate rituals and end-of-life practices in keeping with the patient’s and family’s cultural, spiritual and religious beliefs

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

• ME 2.4. Develop palliative care management plans that align with patient and family goals of care

• COM 1.4. Respond to non-verbal communication and use appropriate non-verbal behaviours to enhance communication

• COM 1.5. Manage emotionally charged conversations including breaking bad news and end of life conversations

• COM 1.5. Recognize when personal feelings in an encounter are valuable clues to the patient’s emotional state

• COM 5.1. Document the clinical encounter to accurately reflect discussion and decisions

• HA 1.1. Facilitate access to bereavement support for a patient’s family, as appropriate

• P 1.3. Recognize and respond to the moral and ethical challenges in end-of-life care

• P 4.1. Exhibit self-awareness, recognizing and managing the impact of end-of-life care on personal well-being and professional performance

Context Variables

• Activity observed (single-choice)
  • simulated activity
  • family discussion/meeting
  • other (write details below)
  • note written after meeting

Requirements

• Collect 5 observations of achievement (minimum 5)
• At least 1 family meeting/discussion (minimum 1)
  • Only counts when Activity observed is family discussion/meeting
• At least 1 review of written documentation of the meeting (minimum 1)
  • Only counts when Activity observed is note written after meeting
• At least 3 different observers (minimum 3)
  • Counted once per distinct Assessor