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Palliative Care


Hospice and Palliative Medicine (HPM) Competencies

 

Patient and Family Care

Competency

Sub-competency

Sample Behavior

Assessment Method

1.1 Gathers comprehensive and accurate information from all pertinent sources, including patient, family members, health care proxies, other health care providers, interdisciplinary team members and medical records

1.1.1.  Obtains a comprehensive medical history and physical exam, including:

·    Patient understanding of illness and prognosis

·    Goals of care/advance care planning/proxy decision-making

·    Detailed symptom history (including use of validated scales)

·    Psychosocial and coping history including loss history

·    Spiritual history

·    Functional assessment

·    Quality of life assessment

·    Depression evaluation (including stressors and areas of major concern)

·    Pharmacologic history including substance dependency or abuse

·    Detailed neurological exam, including mental status exam

 

 

DO

PFS

360

 

IPS

consult

 

1.6  Manages physical symptoms, psychological issues, social stressors, and spiritual aspects of the patient and family

1.6.1  Assesses pain and non-pain symptoms

 

MCQ

360

CR

 

IPS, consult

1.8  Provides care to patients and families that reflects unique characteristics of different settings along the palliative care spectrum

1.8.1  Performs palliative care assessment and management for the home visit, nursing home visit, inpatient hospice unit visit, outpatient clinic visit, and hospital patient visit

 

360

GE

 

hospice

 

1.9  Bases care on patient’s past history and patient and family preferences and goals of care, prognostic information, evidence, clinical experience and judgment

1.9.1  Demonstrates a patient-family centered approach to care

Produces a patient and family-centered plan of care

360

PFS

 

Consult

hospice

 

Medical Knowledge

Competency

Sub-competency

Sample Behavior

Assessment Method

2.2  Recognizes the role of the interdisciplinary team in hospice and palliative care

2.2.1  Describes the role of the palliative care physician in the interdisciplinary team

Identifies the roles performed by a physician on a particular team and evaluates this in terms of the potential range of roles that physicians can play

DO

MCQ

 

-hospice

2.3  Describes how to assess and communicate prognosis

2.3.1 Identifies what elements of the patient’s history and physical examination are critical to formulating prognosis for a given patient 

In evaluating patients, identifies key elements (history, physical examination, and laboratory) that are useful in prognostication.

MCQ

DO

360

-consult

2.7  Describes the use of opioids in pain and non-pain symptom management

2.7.1  Lists the indications, clinical pharmacology, alternate routes, equianalgesic conversions, appropriate titration, toxicities, and management of common side effects for opioids

Demonstrates an ability to correctly prescribe opioids for pain and non-pain symptom management in a variety of settings, including choice of route, dosage, intervals, steps in titration, and prevention and management of side effects and toxicity

 

 

 

DO

MCQ

 

-clinic

-consult

 

2.7.4  Describes the concepts of addiction, pseudoaddiction, dependence and tolerance, and describes their significance in pain management, as well as approaches to managing pain in patients with current or prior substance abuse

For a patient in the recovery from opioid abuse and now with pain from widely metastatic bony metastasis, counsels the patient about the risks of the dependence and tolerance, the importance of good analgesia and a regimen that allows for careful monitoring while minimizing the risk of addiction

DO

 

-clinic

-consult

-add

MCQ- haz

2.8  Describes the use of non-opioid analgesics, adjuvant analgesics, and other pharmacologic approaches to the management of both pain and non-pain symptoms

2.8.1 Identifies the indications, clinical pharmacology, alternate routes, appropriate titration, toxicities, and management of common side effects for: acetaminophen, aspirin, NSAIDs, corticosteroids, anticonvulsants, anti-depressants, and local anesthetics used in the treatment of pain and non-pain symptoms.

Recognizes neuropathic pain and correctly prescribes anticonvulsants or antidepressants

 

Correctly describes the use of non-opioid analgesics, their common toxicities, contraindications, and how they are prescribed

 

In prescribing corticosteroids at low doses for pain, identifies additional beneficial and harmful effects

DO

MCQ

 

-clinic

-consult

2.9  Describes pharmacologic approaches to the management of common non-pain symptoms

2.9.1  Describes use of common agents used to treat dyspnea, nausea, vomiting, diarrhea, constipation, anxiety, depression, fatigue, pruritus, confusion, agitation, and other common problems in palliative care practice

Describes a clinical approach to managing nausea and vomiting refractory to common agents, including the utility of various diagnostic efforts

 

In evaluating patients with delirium, provides a comprehensive differential diagnosis based on history, physical examination, and laboratory tests, and correctly prescribes treatments aimed at the etiology of the delirium or at the symptom, including both pharmacological and nonpharmacological treatments

 

Correctly diagnosis and prescribes treatment for small bowel obstruction, including surgical approaches, pharmacological approaches, and counseling of the patient and family

 

In evaluating a lung cancer patient with new onset dyspnea, describes a differential diagnosis, evaluation plan, and first-line treatments for various etiologies

 

DO

MCQ

 

-consult

-hospice

2.11.4  Recognizes the diagnostic criteria and management issues of brain death, persistent vegetative state, and minimally conscious state

 

Lists the diagnostic criteria for brain death and persistent vegetative state,

 

Describes common management issues around brain death and  persistent vegetative state

MCQ

DO

 

-consult

 

2.13  Recognizes common social problems experienced by patients and families facing life-threatening conditions and describes appropriate clinical assessment and management

2.13.1  Able to assess, counsel, support, and make appropriate referrals to alleviate the burden of caregiving

Identifies signs of caregiver burden

 

Explains  strategies to relieve caregiver burden

 

Routinely assesses for level of caregiver burden

 

Refers appropriately to colleagues to address caregiver burden

 

MCQ

DO

360

 

-consult

-hospice

2.16  Recognizes the components of management for the syndrome of imminent death

2.16.1  Identifies common symptoms, signs, complications and variations in the normal dying process and their management

Describes stages of dying, including common symptoms, signs, and complications, as well as relevant management strategies

 

DO

MCQ

-consult

-IPS

-hospice

2.20  Describes ethical and legal issues in palliative and end-of-life care and their clinical management

2.20.1  Discusses ethical principles and frameworks for addressing clinical issues

Explains common  ethical principles and their application in palliative medicine

 

Applies ethical principles to given ethical dilemma

WA

-ethics

 

 

 

 

Practice-Based Learning and Improvement

Competency

Sub-competency

Sample Behavior

Assessment Method

3.2  Accesses, analyzes and applies the evidence base to clinical practice in palliative care

3.2.1  Demonstrates knowledge of, and recognizes limitations of, evidence-based medicine in palliative care

Differentiates the quality of research in palliative care for patient care applications.

Able to analyze the evidence-base for a particular clinical question with discussion of limitations

JC

portfolio

 

 

Interpersonal and Communication Skills

Competency

Sub-competency

Sample Behavior

Assessment Method

4.2  Demonstrates empathy

 

4.2.1  Uses empathic and facilitating verbal behaviors such as: naming, affirmation, normalization, reflection, silence, listening, self-disclosure, and humor in an effective and appropriate manner

Demonstrates empathic and facilitating verbal  behaviors when giving bad news

 

Demonstrates these behaviors in response to empathic opportunities

DO

PFS

360

-consult

-IPS

-hospice

-PSM

-HIV

4.5  Uses age, gender, and culturally-appropriate concepts and language when communicating with families and patients

4.5.1  Routinely assesses patients/families to identify individuals who might benefit from age, gender, and culturally-appropriate interventions or support

Ask if there are any religious or spiritual traditions the team should know about when talking to families

DO

360

-consult

-PSM

-hospice

 

 

Professionalism

Competency

Sub-competency

Sample Behavior

Assessment Method

5.7  Demonstrates respect and compassion towards all patients and their families, as well as towards other clinicians

5.7.1  Demonstrates willingness and ability to identify own assumptions, individual and cultural values, hopes and fears related to life-limiting illness and injury, disability, dying, death and grief

 

360

PFS

 

 

Systems-Based Practice

Competency

Sub-competency

Sample Behavior

Assessment Method

6.3  Integrates knowledge of health care system in developing plan of care

6.3.1  Describes policies and procedures of pertinent health care systems

Lists elements of care at commonly encountered systems of care within institutional environment

MCQ

6.4  Demonstrates knowledge of the various settings and related structures for organizing, regulating, and financing care for patients at the end of life

6.4.1  Describes differences in admission criteria for various settings such as hospitals, palliative care units, skilled-nursing and assisted-living facilities, acute/sub-acute rehab facilities, and long-term acute care settings as well as traditional home hospice

Distinguishes between services provided at each locus of care and determines which site of care is most applicable for each patient

GRS

DO

-consult

-hospice

 

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