Course program 2005-2007

Lars Ofstad January 11th, 2007

List of all modules

Course Content

MODULE 1- 26-30 September 2005, Trondheim, Norway, 5 days

A. INTRODUCTION TO PALLIATIVE MEDICINE (1/2 day)

Aim: To have an understanding of palliative medicine, its characteristics, advantages and limitations, and its relationship to oncology and other medical specialties. To introduce the participants to the basic ideas of the course .

Topics: The history of palliative medicine. Concepts and definitions. Hospice philosophy. The palliative medicine curriculum and the contents and working methods of the Nordic course.

B. EVIDENCE-BASED PALLIATIVE MEDICINE – PART 1 (2 days)

Aim: To be able to read and analyse scientific literature. To be prepared to plan a simple study in a palliative medical subject, write a protocol, find a tutor, and start the study.
Topics: Introduction to evidence-based medicine. Epidemiology and research methods in palliative medicine. Introduction to quantitative and qualitative research methods. Scientific theory. Literature review. How to write a protocol. Planning of own project.

Please see introduction for details on work on own project.

C. SYMPTOM CONTROL IN CANCER PATIENTS (2 ½ days)

Aim: To know and understand the epidemiology, biology, and complexity of symptoms in palliative medicine, and to be able to assess and handle the symptoms of the advanced cancer patient.

Topics: Assessment, diagnosis and management (treatment) of symptoms, such as anxiety, depression, fatigue, cognitive failure, gastrointestinal symptoms, respiratory symptoms, cachexia, anorexia.

MODULE 2 – 23-27 January 2006, Helsinki, Finland

A. THE IMMINENTLY DYING (4 days)

Aim: To acknowledge the special needs of the dying patient and his or her family; including religious, cultural and spiritual aspects. The influence of nearby death on suffering and family structure.

Topics: The dying process, including biology and pharmacology of the dying patient. Ethical aspects, hydration, withdrawal of treatment, psychological problems in patient and relatives. Social needs. Role of family in the treatment. Role of volunteers. How to handle young patients and children. Cultural problems, in- cluding other cultures, cultural and ethnic differences. Coping with emotional stress in yourself and your staff. Spiritual aspects in life and death. Follow-up in bereavement and bereavement support. Symptom control – need of sedation? How to organise the treatment of dying persons optimally (including different choices).

B. AUDIT (1 day)

Aim: To have the knowledge and the ability to construct and carry out a clinical audit in palliative care, elucidating the content of the unit regarding physical, social, psychological and spiritual matters.

Topics: The principles and practice of quality control and audit. Differences and relations between audit and research. Audit in palliative care.

MODULE 3 – 24-28 April 2006, Malmø, Sweden, 5 days

A. COMMUNICATION – PART 1 (2 days)

Aim: To improve the knowledge and skills of the participants in communicating with patients and relatives during all stages of the patient’s illness. To improve the knowledge and skills of the participants in communicating with colleagues.

Topics: Skills in empathic listening and open questioning to:
- elicit concerns across physical, psychological, social and spiritual domains
- establish extent of awareness about illness and prognosis
Common barriers to communication with both patients and professionals.
Management of difficult questions and information given sensitively and as
appropriate to wishes and needs of the individual.
Facilitation of decision-making and promotion of patient autonomy.
Recognition and management of conflicts between confidentiality and the need
to share information with others.
Theories and evidence base for communication practice.
Awareness and practice of a range of structures and styles of consultations.
Critical evaluation of own consulting skills.

The course focuses on theoretical teaching alternating with intense practice in small groups. The main emphasis is laid on role-plays, using the clinical experience of the participants and focusing on problems in their own clinical
practice. Starting with the more simple situations and gradually increasing the degree of difficulty.

B. ETHICS (1 day)

Aim: To know the principles of medical ethics which apply to palliative medicine.
Topics: Theories of human nature. The declaration of human rights. Values and norms in palliative medicine. The issues surrounding requests for euthanasia and terminal sedation. The issues of stopping treatment with curative intent. Involvement of patients and relatives in decision-making. How to weight and assess benefits and burdens of treatment and clinical decisions. Evaluate decisions involved in resource allocation. How to decide for the incompetent patient.

C. TEAMWORK (2 days)

Aim: To know and understand the concept of multi-disciplinary team work and to be able to contribute to practical team work.

Topics: Different types of teams. Why teamwork? Understand group processes and be sensitive to team dynamics. Leadership in teams. Different forms of team support. Strategies which facilitate team functioning. The skills and contributions of other team members and other professions. Understanding of boundaries and professional rivalries. Handling of team conflicts. Be aware of the presence of the unconscious in teamwork.

MODULE 4 – 25-29 September 2006, Bergen, Norway , 5 days

A. EVIDENCE-BASED PALLIATIVE MEDICINE – PART 2 (1 1/2 days)

Aim: To receive the necessary follow-up of own project. To be able to analyse, interpret and publish the results from own study. To have an understanding of research ethics. To be able to analyse difficult situations in palliative medicine and make the appropriate decisions.

Topics: Follow-up of ongoing projects. Introduction to statistics. Research ethics. Critical reading. How to apply critical appraisal skills and the skills of evidencebased medicine to daily medical practice. Decision-making.

B.PALLIATIVE RADIOTHERAPY, CHEMOTHERAPY, AND SURGERY. EMERGENCIES IN PALLIATIVE MEDICINE (1 ½ days)

Aim: To obtain the necessary knowledge of oncological treatment modalities and their use in palliative medicine. To be able to handle emergencies in palliative medicine.

Topics: Palliative radiotherapy, chemotherapy, and surgery. Indications, treatment options, side effects, evaluation. Emergencies in palliative medicine: spinal cord compression, hypercalcemia, acute delirium, gastrointestinal obstruction, acute dyspnoea, bleeding and convulsions.

C. COMPLEMENTARY AND ALTERNATIVE TREATMENTS (1/2 DAY)

Aim: To know about complementary and alternative treatments used by patients in palliative care, and where to find more information on these therapies, their backgrounds and use. To have a balanced view on these treatment options. To know the national regulations applying to these therapies.

Topics: Concepts and definitions. Examples of common practice of alternative/comple-mentary treatments in end-of-life care, effects and side effects. Statutory regulations.

D. TEACHING (1 ½ days)

Aim: To learn about different teaching methods and their application in palliative medicine. To develop teaching skills.

Topics: Theory and practice of different teaching methods. Different learning styles. How to make a presentation, handle teaching equipment, make and evaluate a teaching programme, and evaluate own teaching.

MODULE 5 – 22-26 January 2007, Copenhagen, Denmark, 5 days

A. COMMUNICATION – PART 2 (2 days)

Aim: As in part 1, with an increasing degree of difficulty.
Topics:

As in part 1, with an increasing degree of difficulty.

Increasing emphasis on role-plays and video.
In the time span between communication part 1 and part 2, the participants will be requested to practice the communicative skills acquired in part 1. All participants must prepare a video illustrating clinical communication in palliative care, which will be used in the teaching sessions in part 2. Approval of the course will be subject to the preparation of such a video.

C. PAIN (3 days)

Aim: To know the definition of pain and to know and understand the epidemiology, biology and complexity of the symptom pain in palliative medicine, including the psychological, social and spiritual characteristics. To be able to assess, evaluate and treat the different kinds of pain, including knowledge of the pharmacology and handling of medical pain treatment and the non-pharmacological interventions in pain management.

Topics: Introduction: The pain problem.
Classification of pain (acute-chronic, non-malignant- and cancer pain).
Pain epidemiology. Physiology of pain. History taking, physical examination and pain assessment. A mechanism-based evaluation (understanding of nociceptive, visceral, neuropathic and breakthrough pain conditions). Pain assessment tools, including Health Related Quality of Life measures. Drug treatment principles (WHO analgesic ladder). Opioids: Opioid sensitivity, opioid side effects (including tolerance, addiction, opioid induced neurotoxicity) and opioid rotation. Adjuvant analgesics: Indications and drug selection (including anti-convulsants, antidepressants, NMDA receptor antagonists, NSAID’s, steroids etc.). Spinal/epidural/parenteral pain treatment. Nerve blocks and neurosurgical procedures. Syringe drivers and pain treatment. Pain treatment in oncology (radiotherapy and chemotherapy). Non-drug pain therapy: TENS, acupuncture, physiotherapy etc. Psychological interventions in pain management. Shared care with pain management services.

MODULE 6 – 23-27 April 2007, Stockholm area, Sweden, 5 days

A. SYMPTOM CONTROL IN NON-CANCER PATIENTS (1 day)

Aim: To be able to handle common symptoms and situations in advanced neurological disease (ALS), heart failure, obstructive lung disease, AIDS, and dementia.

Topics: Natural history of the diseases, chronic stage and palliative phase. Special considerations in symptom management.

B. MANAGEMENT, AUDIT, ORGANISATION (2 days)

Aim: To have the knowledge and the ability to set up a palliative care program, including principles for management and staff recruitment.
To construct and carry out a clinical audit in palliative care, elucidating the content of the unit regarding physical, social, psychological and spiritual matters.

Topics: Different organisational models for palliative care programmes, e.g. consulting teams, home care teams, in-bed units, consulting function in the hospital and in the nursing home. Recruiting and staff selection. Person specifications, job descriptions and interviewing techniques. Appraisal systems and staff develop-ment, counselling and disciplinary procedures. Budgetary systems. Leadership. The role of the administrator. Differentiation between clinical and management issues. The principles and practice of quality control, audit, triangle evaluation system and external multi-professional evaluation. Co-operation with national and international organisations and associations.

C. PRESENTATION OF RESEARCH PROJECTS (1 day)

Aim: The student should be able to present the results from his/her own study in a concise and precise way, in English, at a scientific level.

Topics: Presentation of own project. To be able to write an abstract, make a power-point presentation and write an article. Evaluation and feedback in the course group (colleagues and teachers).

C. EVALUATION; EXAMINATION (1 day)

Aim: a) To evaluate if each course is well enough designed and carried out to fulfill the expectations of the participants. To check if the teaching aims have been reached and to get feed-back to teachers.
b) To assure that the participants have the required knowledge, skills and attitudes for a specialist in palliative medicine.

Topics: Evaluation, examination.

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