Teaching MDs to spread palliative care message
Teaching MDs to spread palliative care message
KY coalition stresses interdisciplinary approach
Navigating both patients and providers toward improvements in palliative care has by no means been a short-lived journey. Recently, 23 coalitions of providers, insurers, and academicians undertook efforts to reverse the trends that have been a hindrance to improving end-of-life care. Sponsored by the Princeton, NJ-based Robert Wood Johnson Foundation’s grant program, Community-State Partnership to Improve End-of-Life Care, the coalitions hope to create a clearer road map.
One of the coalitions is called Kentuckians for Compassionate Care, a partnership of 50 agencies and individuals. The group received a three-year grant of more than $375,000 in January to coordinate a communitywide effort to engage senior groups, physicians, clergy, and policy leaders in efforts to improve care for all seriously ill and dying people in the state. The program is called Journey’s End — A Kentucky Partnership for End-of-Life Care.
One of the highlights of the Journey’s End project is its training program for physicians and nurses. Education for Physicians on End-of-Life Care (EPEC) not only provides information for professionals, it relies upon physicians and nurses who have gone through the program to spread the word on palliative care.
"We all acknowledge that medical schools in this country don’t provide enough education on palliative care. EPEC fills that gap," says Mark Pfeifer, MD, vice dean for clinical services at the University of Louisville’s school of medicine and principal investigator for the Kentucky coalition.
"We’re limited in our ability to reach all physicians and nurses," says Carla Hermann, PhD, RN, an associate professor with the University of Louisville’s school of nursing and a co-investigator with the project. "It’s expensive to try and reach everyone. This works for us because we can train a few people who will train others."
EPEC was developed by the American Medical Association with grant support from the Robert Wood Johnson Foundation. It was designed to educate all U.S. physicians on the essential clinical competencies required to provide quality end-of-life care. Rather than reinvent a curriculum to teach physicians about end-of-life care, the Kentucky coalition chose to use EPEC because the program fit its educational goals, Hermann says.
The EPEC curriculum consists of four 30-minute plenary modules and 12 45-minute workshop modules. (See box, p. 56.) Developers of the curriculum say its value lies, in part, in its practicality and portability. It teaches fundamental skills in communication, ethical decision making, palliative care, psychosocial considerations, and pain and symptom management, Hermann says.
While the AMA developed the training program for physicians, Journey’s End has encouraged physicians who take the course to recruit nurses and social workers to promote an interdisciplinary approach to improving end-of-life care.
Journey’s End began training physicians and nurses using EPEC last fall. So far, a little more than a handful of physicians and nurses have gone through the program. Project officials hope to have as many as 70 EPEC-trained physicians and nurses by year’s end, and 140 by the time the grant expires. "The hope is that physicians and nurses will talk openly with their patients so that the decision to move from a curative mode to comfort care is made in a timely fashion," Hermann says.
Pfeifer says because the program is taught by physicians in a variety of specialties, it has the potential for wide appeal among physicians because they tend to relate better to other physicians in like specialties. "It’s not designed to create experts, but it educates physicians on the basics. Hopefully, it will generate a fair amount of enthusiasm so that they will share what they have learned."
Hermann stresses that EPEC is only part of its overall plan to educate physicians and nurses. The coalition also hopes to revamp the mandatory teaching curriculum in the state’s medical and nursing schools.
• The EPEC Project, Institute for Ethics, American Medical Association, 515 N. State St., Chicago, IL 60610. Telephone (312) 464-4979. E-mail [email protected].
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