Internal Medicine — Core of Discipline

C9b Caring for patients at the end of life - Part B: Discussion about transition away from disease modifying treatment

Key Features:

- This EPA focuses on symptom management at the end of life, up to and including referral to palliative care services. It includes the discussions with patients and families about progression of illness and evolution of the goals of care.

- The observation of this EPA is divided into two parts: symptom management in end of life care and the communication with patients/families regarding the transition away from disease modifying treatment.

Assessment Plan:

Part B: Discussion about transition away from disease modifying treatment Direct observation by supervisor

Use Form 1. Form collects information on:
- Setting: ambulatory; inpatient; simulation
- Scenario: cancer; organ failure; neurodegenerative diseases

Collect 2 observations of achievement
- 2 different scenarios
- At least 1 from clinical setting

Milestones

• 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 1.4. Respond to patients’ non-verbal communication and use appropriate non-verbal behaviours to enhance communication with patients

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

• COM 1.5. Establish boundaries as needed in emotional situations

• COM 2.2. Manage the flow of challenging patient encounters, including those with angry, distressed, or excessively talkative individuals

• COM 3.1. Provide information to patients and their families clearly and compassionately

• COM 3.1. Provide information related to progression of illness and evolution of care

• COM 3.1. Educate patients and caregivers about end of life care options including palliative care and medical assistance in dying

• COM 4.1. Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally safe

• COM 4.3. Answer questions from the patient and family about next steps

• ME 2.3. Share concerns, in a constructive and respectful manner, with patients and their families about their goals of care when they are not felt to be achievable

• ME 2.3. Establish goals of care in collaboration with the patient and family

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

• HA 1.1. Facilitate timely patient access to services and resources