1. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours Osteopathic EPEC 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 AOA: Treating Our Family and Yours

2. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours Module 8 Sudden Illness

3. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours 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 time- limited trial approach

4. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours Sudden illness... Patient, family, caregivers under stress Prognostic uncertainty Chaotic environment, multiple care providers

5. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours... Sudden illness Continuous, sequential decision making Assess / reassess the goals of care Acute symptom management Patient, family, caregivers need support

6. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours Overview... Provide structure Communicate possible outcomes Identify decision points in advance Use goals of care to guide decision making

7. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours... Overview Take sociocultural issues into account Address differences Use clear language Manage symptoms effectively Impact of stress on caregivers

8. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours Provide structured interaction Encourage one primary spokesperson Identify regular communication times Prepare early for future decisions Set expectations for future communication Communicate the plan

9. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours 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

10. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours... 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

11. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours 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

12. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours 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

13. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours Informed consent Nature of the illness Recommended treatment Reasonable alternatives Chance of each alternative achieving its intended goal Burdens, benefits of each alternative

14. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours Benefits, burdens of time- limited 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

15. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours 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

16. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours... Sociocultural differences Belief in miracles Death is “the enemy” Death should not be discussed openly

17. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours Manage symptoms Essential to quality of life Relieve symptoms throughout Permits continuation of a portion of the treatment plan

18. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours 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

19. EPECEPECEPECEPEC American Osteopathic Association AOA: Treating Our Family and Yours Sudden Illness Summary