3. EPECEPECEPECEPEC EPECEPECEPECEPEC Next Steps Next Steps Plenary 4 The Project to Educate Physicians on End-of-life Care Supported by the American Medical Association and the Robert Wood Johnson Foundation

4. Objectives l List the important themes from the conference l Identify barriers to good end-of-life care l Develop potential solutions l List the important themes from the conference l Identify barriers to good end-of-life care l Develop potential solutions

5. EPEC themes, next steps l Relief of suffering is a goal of medical care l Palliative care knowledge is now extensive l Role of families l Teamwork l Physician as patient advocate l Relief of suffering is a goal of medical care l Palliative care knowledge is now extensive l Role of families l Teamwork l Physician as patient advocate

6. Relief of suffering l 4 dimensions physicalpsychologicalsocialspiritual l Expected by patients, families l 4 dimensions physicalpsychologicalsocialspiritual l Expected by patients, families

7. Palliative care l Not the absence of care l More powerful than ever in the history of medicine l A positive, humanistic philosophy l Technically sophisticated area of expertise l Not the absence of care l More powerful than ever in the history of medicine l A positive, humanistic philosophy l Technically sophisticated area of expertise

8. Families... l How we die is an important personal legacy l Dying well often demands the chance to be close to family, friends family / proxy assistance with decisions good communication l How we die is an important personal legacy l Dying well often demands the chance to be close to family, friends family / proxy assistance with decisions good communication

9. ... Families l None of this is possible without good symptom management

10. Teamwork... l The whole person goes through the dying process, not just his / her physiology l No one person can meet all the needs l The whole person goes through the dying process, not just his / her physiology l No one person can meet all the needs

11. ... Teamwork l Teamwork usually includes physiciansnurses social workers chaplainsothers l Hospice philosophy can be integrated into mainstream practice l Teamwork usually includes physiciansnurses social workers chaplainsothers l Hospice philosophy can be integrated into mainstream practice

12. Advocacy l Professional duty to patient care l Professional duty to ensure availability of services l Personal desire to be able to die with quality care l Professional duty to patient care l Professional duty to ensure availability of services l Personal desire to be able to die with quality care

13. Barriers l Institutional l Regulations l Reimbursement l Attitudes l Institutional l Regulations l Reimbursement l Attitudes

14. Physicians’ personal support needs... l Patients are asking us to do better l Find a forum for candid discussion of experiences l Transference is powerful; personal comfort is important l Patients are asking us to do better l Find a forum for candid discussion of experiences l Transference is powerful; personal comfort is important

15. ... Physicians’ personal support needs l Professional distance, empathic closeness must balance l Know yourself l Professional distance, empathic closeness must balance l Know yourself

16. Action Plan BarrierBarrierPlan

17. Barriers l “I” = Institutional l “O” = Others l “U” = Personal l “I” = Institutional l “O” = Others l “U” = Personal

18. EPECEPECEPECEPEC EPECEPECEPECEPEC Next Steps Summary Summary