This is a comprehensive, longitudinal curriculum covering the knowledge and skills required to provide primary palliative care for patients with serious illness. It is interwoven into the existing curriculum to reinforce and integrate general palliative care principles in all aspects of care. The main structure of the curriculum is divided into didactic learning through online modules created in coordination with City of Hope and then reinforcement of these principles through practice, reflection and feedback in LACE Clinical Reasoning, Doctoring and throughout years three and four clinical experiences.
General competencies covered are: palliative care principles and practice, psychosocial, spiritual, and cultural aspects of care of the seriously and terminally ill, pain and symptom management in the context of serious illness, advanced communication skills, and terminal care and bereavement.
Kristyn Pellecchia – Palliative Care Thread Director
- Describes hospice & palliative care history and mission.
- Defines the philosophy and role of palliative care across the life cycle.
- Describes disease trajectories using functional terms and clinical implications for common serious illnesses in adult and pediatric patients.
- Compares the roles of members of an interdisciplinary palliative care team, including nurses, social workers, case managers, chaplains and pharmacists.
- Completes personal reflection project, reflecting on personal reactions to patients’ dying and deaths.
- Identifies spiritual and existential suffering in patients and families.
- Assesses patients’ and families’ cultural values, beliefs and practices related to serious illness and end-of-life care.
- Develops strategies for responding to psychosocial distress in patients and families.
- Assesses pain holistically.
- Distinguishes nociceptive from neuropathic pain syndromes.
- Assesses non-pain symptoms.
- Describes key issues and principles of pain management with opioids, including equi-analgesic dosing, common side effects, addiction, tolerance, and dependence.
- Evaluates approaches to the diagnosis of anxiety, depression, and delirium in context of serious medical illness.
- Explores patient and family understanding of illness, concerns, goals and values that inform the plan of care.
- Demonstrates patient-centered communication techniques when giving difficult/serious news, discussing resuscitation preferences and identifying a surrogate decision-maker.
- Demonstrates approaches to handling emotion in patients and families facing serious illness.
- Practices communication techniques with patients, families and other team members, incorporating cultural sensitivity and cultural humility.
- Discusses advanced care planning with patients and families, including organ donation.
- Interprets ethical and legal issues that inform decision-making in serious illness, including euthanasia and physician-assisted death, the right to forgo or withdraw life-sustaining treatment (including life support, fluids, antibiotics, CPR, artificial nutrition) and the rationale for obtaining a surrogate decision maker.
- Examines and explains one’s own views regarding death and dying.
- Demonstrates empathic communication to family of patient regarding what to expect at end-of-life.
- Identifies normal grief and bereavement, and risk factors for prolonged grief disorder.
- Identifies signs of imminently dying patient.
- Assesses and manages symptoms of dying patient.
- Summarizes the communication tasks of a physician when a patient dies, such as pronouncement, family notification and support, and request for autopsy.