NOTE: AS OF MAY 1, 2007 THIS PROGRAM IS NO LONGER OFFERED; HOWEVER, THE MATERIALS REMAIN ACCESSIBLE ON THE WEBSITE.

MODULES & OBJECTIVES

Download the Adobe Acrobat Reader to access these files.

IMPORTANT NOTES:

• When saved to your computer, the slide presentations must be opened in Acrobat Reader NOT PowerPoint.
• To present the PDF file as a slide show in full screen format without the toolbars showing choose "VIEW" and then "FULL SCREEN".
• Use the 'page up' and 'page down' buttons on your keyboard to advance and reverse the slides.
• To exit full screen view, press the 'Esc' button.

How to access the teaching materials in different formats.

[Modules are formatted for double-sided printing and insertion into a binder.]

Including:

• Definition of palliative care and its basic principles
• Standards of palliative care.
• Blocks in providing better end-of-life care and describe strategies to overcome such blocks
• Models of palliative care delivery
• The role of family physicians and specialist physicians in the care of the terminally ill
• Community resources available to support patients in their homes
• The physician’s role in home care
• The roles of other disciplines in providing palliative care
• Effective communication and team skills
• Education of members of the interdisciplinary team
• Being a role model for other physicians
• Incorporating quality indicators or audit methods into their practice
• Applying critical appraisal skills and the skills of evidence-based medicine to medical practice in end-of-life care

  MODULE	SLIDES
  CASE & TEACHING TIPS	APPENDIX I: FERRIS SQUARE

Including:

• Pain syndromes affecting patients at the EOL
• The use of opioids and adjuvants
• Management of the side effects and toxicities of opioids and adjuvants
• Ethical issues around the use of analgesics/sedatives at the EOL
• Use of non-pharmacological interventions

  MODULE	SLIDES
  CASE & TEACHING TIPS

Including:

• Management of other symptoms at EOL
• A preventive approach to managing patient and family expectations and needs

  MODULE	SLIDES
  CASE & TEACHING TIPS

4. End-of-Life Decision-Making

Including:

• Constructing a care plan that includes patient centred goals of care
• An approach to decision making for a capable and incapable patient
• The role of advanced care planning
• Be able to assess capacity in terms of EOL decision- making
• Elements of consent
• Use of life sustaining treatments
• Ethical issues in the use of advanced directives including DNR orders
• Withholding and withdrawing of therapies
• Effects of personal and professional experiences of death and dying
• The ethical and legal role of Substitute Decision Makers in EOL decision-making
• Issues in euthanasia/assisted suicide
• Caregiver stress

  MODULE	SLIDES
  CASE & TEACHING TIPS	Aid to Capacity Evaluation (ACE)

Video: 'Making Hard Decisions'

5. Communication with Patients and Families

Including:

• Components of effective communication
• Breaking bad news, listening and responding to the needs (informational and emotional) of patients and their families
• Addressing the concerns of the patient and family
• Understanding consequences of the language used to impart information
• Not destroying hope or providing false hope
• Demonstrating empathy and caring
• Being sensitive to issues of culture and religion
• Recognizing difficulties in interacting with the patient and/or family and overcoming those difficulties

  MODULE	SLIDES
  CASE & TEACHING TIPS

6. Psychological Symptoms

Including:

• The physical, psychological, social and spiritual issues of dying patients and their families
• Sources of suffering in dying patients
• Treat anxiety, agitation and depression in dying patients
• Fostering appropriate hope at the EOL
• Providing counselling
• Recognize normal grief and complicated grief
• Grief management
• Community resources for bereavement counseling

  MODULE	SLIDES
  CASE & TEACHING TIPS

7. The Last Hours

Including:

• The final hours of the dying process with the patient and family
• Family communication with the dying person
• Effective pain and symptom control in the last hours of life

  MODULE	SLIDES
  CASE & TEACHING TIPS

8. Culture

Including:

• Current societal and health care practice related to attitudes about death and dying
• How culture and religion shape the understanding and meaning of death and dying
• Accepting and integrating cultural and religious perspectives

  MODULE	SLIDES
  CASE & TEACHING TIPS

9. Conflict Resolution

Including:

• Common sources of conflict in EOL decision making
• Physician attitudes, values and reaction to conflict that contribute to conflict with families
• Factors of family dynamics, history and values
• Basic principles and skills in conflict management
• The issue of futility

  MODULE	SLIDES
  CASE & TEACHING TIPS

10. Indigenous Perspectives on Death and Dying

Including:

• Describe differences in culture, traditions and beliefs that may affect communication with indigenous people at the end of life
• Demonstrate knowledge about the traditions surrounding death and dying in indigenous cultures
• Describe how such traditions can be accommodated when caring for dying indigenous patients

  MODULE	SLIDES
  CASE & TEACHING TIPS

11. Collaboration

Including:

• Describe the importance of collaboration in the provision of quality end-of-life care
• Describe the stages of team formation and development
• Describe different types and styles of leadership and effects on team function
• Reflect upon how own personal character, values and beliefs affect ability to work on a team
• Describe and recognize issues that may arise when two teams converge to provide patient care
• Demonstrate skill in resolving difficulties in team function
• [ Note that this module is NOT CE accredited]

  MODULE	NO SLIDES AVAILABLE
  CASE & TEACHING TIPS

12. End-of-Life Decision-Making in Pediatric Palliative Care

Including:

• Describe the major factors that complicate decision-making for children living with and dying from life-threatening conditions.
• Improve knowledge about how to effectively involve families, children and adolescents, substitute decision-makers, and the healthcare team in pediatric decision-making
• Be familiar with a variety of creative methods that can be used to communicate with young patients about care decisions and how to access these methods
• Demonstrate an understanding of the legal, ethical, medical, and social aspects of decisions necessary in the field of pediatric palliative care related to:
  - Identifying the goals of care
  - Treatments aimed at ameliorating or curing disease
  - Treatments aimed at potentially life-sustaining treatments
  - Treatments aimed at relieving symptoms
  - Planning care for the last days and/or hours of life
  - Location of care
• Understand that discussions concerning palliative care treatment options should begin early and continue as often as required with patients who may die prematurely and/or their families, and that such discussions can be conducted without eroding hope
• Have an increased repertoire of statements, approaches, resources, and questions that can be used with patients and families when discussing palliative care options
• Recognize that children and adolescents have an ever-evolving understanding of illness and death, and that assessments of this understanding should be done individually and repeatedly
• Understand how to appropriately frame discussions and facilitate consensus-building during pediatric palliative care decision-making
• List techniques for improving continuity with the healthcare team, and between the patient, family and healthcare providers during pediatric palliative care
• Understand that disagreements are common during pediatric palliative care decision-making but that good communication skills and a structured process for working through disagreement can help prevent conflict in most cases
• List a variety of methods for training healthcare professionals in pediatric palliative-care decision-making and for providing support for healthcare professionals doing this work
• Become acquainted with the published literature concerning aspects of decision-making in pediatric palliative care
  

  MODULE	SLIDES
  CASE & TEACHING TIPS

Including:

• Define grief & bereavement
• Describe some of the models of grief
• Describe factors influencing grief
• Describe complicated grief
• Describe a practical approach in the management of grief
  

  MODULE	SLIDES
  CASE & TEACHING TIPS

  ---

Neurological Death, Organ and Tissue Donation Module

---

Click here for information on how to run a small group program using the modules.

---

"BUILD A CASE" SLIDE PRESENTATION

Use this technique in your small group sessions to create another case.

Top of page

Laura Hawryluck, MSc, MD, FRCPC
Physician Leader

Nancy Bush, Coordinator

Ian Anderson Continuing Education Program
in End-of-Life Care
University of Toronto
500 University Avenue, Suite 650
Toronto, Ontario, Canada M5G 1V7
Tel. 416.978.1837    Fax 416.971.2200
E-mail ian.anderson.program@utoronto.ca