Introduction and Goals
Neurologists care for patients with a variety of serious, life-limiting diseases. Functional impairment and communication barriers present unique challenges to optimizing quality of life in patients. This senior elective in palliative care will offer the neurology resident exposure to this important area of medicine, providing him or her with knowledge and skills that will enhance their care of patients and families suffering from neurological disease.
Objectives and Evaluation Matrix
As with all of the neurology rotations, the specific objectives are reflected in the entrustable professional activities and individual milestones listed below. These form the basis for the end-of-rotation evaluation. (Please see the section End-of-Rotation Evaluations above for the list of milestone abbreviations).
| Rotation Objectives | ||
| Upon completion of the curriculum, residents will . . . | ||
| # | Description | Milestones |
| 1 | Define palliative care medicine and hospice and discuss these appropriately with patients and families. | PR1, IC1 |
| 2 | Describe when a patient is most appropriately cared for at home vs. an inpatient hospice unit. | PC3, PC4, PC5, SP3, SP4 |
| 3 | List three steps for starting a family meeting. | IC1, IC2 |
| 4 | Identify clinical signs commonly seen in actively dying patients. | PC3, PC4, PC5 |
| 5 | State three reasons why a health care power of attorney is important. | SP3, SP4 |
| 6 | Describe the role of spiritual care in supporting a patient with serious illness. | SP3, IC3 |
| 7 | Write an order for an opioid-naïve patient for immediate-release morphine sulfate PO as needed for pain. | PC4, PC5 |
| Milestones | ||
| Please grade the resident on any of the following milestones you were able to evaluate during this rotation: | ||
| PL2, PR2 | ||
Schedule
Overview:
The work day is from 8:30 am – 5pm, but there may be days when the resident will need to stay later depending on clinical need. Residents will not be expected to work on the palliative care service on weekends or UWHC Holidays.
Daily Schedule:
9:00 am Interdisciplinary Rounds in B6/688, followed by patient rounds. Residents will be expected to follow 1-2 patients daily.
Educational Conferences:
· Thursday 11:00-12:00: Fellow Didactic Lecture (7170 WIMR)
· Thursday 12:00-1:00pm: Case Conference, Journal Club, or Reflection Conference (7170 WIMR). This rotates each week. Residents will receive a weekly email from Matt Kronberger listing the conferences for the next week.
Work Hours
The estimated work hours is 40 hours per week.
Suggested References
Online:
The first two resources below have free apps that are highly recommended for this rotation and future use:
- PC Fast Facts (evidenced based, brief overview of HPM topics) https://www.mypcnow.org/fast-facts
- Vital Talk (vital Tips is the app) – communication frameworks and video examples https://www.vitaltalk.org/resources/
- HPM blogs:
- Pallimed: https://www.pallimed.org/
- Geripal: https://www.geripal.org/
Readings:
Communication
- Baile, W. F., Buckman, R., Lenzi, R., Glober, G., Beale, E. A., & Kudelka, A. P. (2000). SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist, 5(4), 302-311.
- Quill, T. E. (2000). Perspectives on care at the close of life. Initiating end-of-life discussions with seriously ill patients: addressing the “elephant in the room”. JAMA, 284(19), 2502-2507.
- Quill, T. E., Arnold, R. M., & Platt, F. (2001). “I wish things were different”: expressing wishes in response to loss, futility, and unrealistic hopes. Annals of Internal Medicine, 135(7), 551-555.
- von Gunten, C. F. (2001). Discussing do-not-resuscitate status: Furthering the discourse – Reply. Journal of Clinical Oncology, 19(13), 3302-3302.
- von Gunten, C. F. (2003). Discussing hospice care. J Clin Oncol, 21(9 Suppl), 31s-36s. doi: 10.1200/JCO.2003.01.163
- Sudore, R. L., & Fried, T. R. (2010). Redefining the “planning” in advance care planning: preparing for end-of-life decision making. Annals of Internal Medicine, 153(4), 256-261. doi: 10.7326/0003-4819-153-4-201008170-00008
- Creutzfeldt, C. J., et al. (2016). “Neurologists as primary palliative care providers.” Neurology Clinical Practice 6: 40-48.
- Holloway, R. G., et al. (2013). “Estimating and communicating prognosis in advanced neurologic disease.” Neurology 80: 764-772.
- Gofton, T. E., et al. (2018). “Challenges facing palliative neurology practice: A qualitative analysis.” J Neurol Sci 385: 225-231.
Hospice and Palliative Medicine General
- Temel, J. S., Greer, J. A., El-Jawahri, A., Pirl, W. F., Park, E. R., Jackson, V. A., . . . Ryan, D. P. (2017). Effects of Early Integrated Palliative Care in Patients With Lung and GI Cancer: A Randomized Clinical Trial. J Clin Oncol, 35(8), 834-841. doi: 10.1200/JCO.2016.70.5046
- Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admane, S., Jackson, V. A., . . . Lynch, T. J. (2010). Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer. New England Journal of Medicine, 363(8), 733-742. doi: Doi 10.1056/Nejmoa1000678
- Yoong, J., Park, E. R., Greer, J. A., Jackson, V. A., Gallagher, E. R., Pirl, W. F., . . . Temel, J. S. (2013). Early palliative care in advanced lung cancer: a qualitative study. JAMA Intern Med, 173(4), 283-290. doi: 10.1001/jamainternmed.2013.1874
Dementia and End-of-Life
- Sachs, G. A., Shega, J. W., & Cox-Hayley, D. (2004). Barriers to excellent end-of-life care for patients with dementia. J Gen Intern Med, 19(10), 1057-1063. doi: 10.1111/j.1525-1497.2004.30329.x
- Givens, J. L., Jones, R. N., Shaffer, M. L., Kiely, D. K., & Mitchell, S. L. (2010). Survival and comfort after treatment of pneumonia in advanced dementia. Archives of Internal Medicine, 170(13), 1102-1107. doi: 10.1001/archinternmed.2010.181
Teno, J. M., Gozalo, P. L., Mitchell, S. L., Kuo, S., Rhodes, R. L., Bynum, J. P., & Mor, V. (2012). Does feeding tube insertion and its timing improve survival? J Am Geriatr Soc, 60(10), 1918-1921. doi: 10.1111/j.1532-5415.2012.04148.x
Latest revision: 05-14-2021
