Osteopathic EPEC Module 8 - American Osteopathic Association

January 5, 2018 | Author: Anonymous | Category: Science, Health Science, Psychiatry
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Osteopathic EPEC Education for Osteopathic Physicians on End-of-Life Care Based on The EPEC Project, created by the American Medical Association and supported by the Robert Wood Johnson Foundation. Adapted by the American Osteopathic Association for educational use.

American Osteopathic Association American Osteopathic Association Treating Our Family and Yours AOA:AOA: Treating Our Family and Yours

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Module 8

Sudden Illness

American Osteopathic Association AOA: Treating Our Family and Yours

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Objectives •

Describe the features of sudden illness that require special skills



Know how to • •



Communicate effectively Guide decision making

Explain the benefits and risks of a timelimited trial approach

American Osteopathic Association AOA: Treating Our Family and Yours

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Sudden illness . . . • Patient, family, caregivers under stress

• Prognostic uncertainty • Chaotic environment, multiple care providers

American Osteopathic Association AOA: Treating Our Family and Yours

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. . . Sudden illness • Continuous, sequential decision making • Assess / reassess the goals of care

• Acute symptom management • Patient, family, caregivers need support

American Osteopathic Association AOA: Treating Our Family and Yours

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Overview . . . • Provide structure • Communicate possible outcomes • Identify decision points in advance • Use goals of care to guide decision making

American Osteopathic Association AOA: Treating Our Family and Yours

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. . . Overview •

Take sociocultural issues into account • •

Address differences Use clear language



Manage symptoms effectively



Impact of stress on caregivers

American Osteopathic Association AOA: Treating Our Family and Yours

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Provide structured interaction •

Encourage one primary spokesperson



Identify regular communication times



Prepare early for future decisions



Set expectations for future communication



Communicate the plan

American Osteopathic Association AOA: Treating Our Family and Yours

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Communicate range of possible outcomes . . . •

Avoid waiting until more is known



Discuss uncertainty openly



Provide the full picture



Identify most and least likely outcomes



Acknowledge limits of individual experience

American Osteopathic Association AOA: Treating Our Family and Yours

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. . . Communicate range of possible outcomes •

Discuss what is likely to happen next



Be specific and use examples



Discuss what is known



Use evidence-based information



Use gentle repetition



Identify immediate and future decisions

American Osteopathic Association AOA: Treating Our Family and Yours

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Identify decision points in advance • Signs that a decision may be near • Time course expected before next decision • Prepare for • Changing goals • Discussion of informed consent

American Osteopathic Association AOA: Treating Our Family and Yours

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Use goals of care to guide decision making •

Patient-centered goals of care determine the treatment plan • • •



Values, preferences Cumulative and integrated goals Comfort and curative goals

Identify the degree of • •

Recovery that would be acceptable Certainty recovery could be achieved American Osteopathic Association AOA: Treating Our Family and Yours

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Informed consent •

Nature of the illness



Recommended treatment



Reasonable alternatives



Chance of each alternative achieving its intended goal



Burdens, benefits of each alternative

American Osteopathic Association AOA: Treating Our Family and Yours

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Benefits, burdens of timelimited trials •

Use while more information is gathered



Can stop life-sustaining treatment



Provides structure, helps families



May result in a poor outcome



Decision to stop may be more difficult

American Osteopathic Association AOA: Treating Our Family and Yours

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Sociocultural differences . . . • Distrust of the medical system or physicians

• Unrealistic expectations of the medical system or physicians • Any life, no matter how compromised, is worth living

American Osteopathic Association AOA: Treating Our Family and Yours

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. . . Sociocultural differences • Belief in miracles • Death is “the enemy” • Death should not be discussed openly

American Osteopathic Association AOA: Treating Our Family and Yours

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Manage symptoms • Essential to quality of life • Relieve symptoms throughout • Permits continuation of a portion of the treatment plan

American Osteopathic Association AOA: Treating Our Family and Yours

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Impact of stress on professionals •

Physician - Know Thyself •

Acknowledge stress, uncertainty of Dx and Tx, moral and ethical conflict



Stressful working conditions



Burnout common



Communication, common goals help



Provide support systems American Osteopathic Association AOA: Treating Our Family and Yours

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Sudden Illness

Summary

American Osteopathic Association AOA: Treating Our Family and Yours

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