POGOe - Portal of Geriatrics Online Education - Medical Ethics

Intended learner audience:

Learning resource types:

Intro to Clinical Medicine/Clinical Skills/Doctoring

Discipline/specialty:

Family Medicine

Internal Medicine

Medical Ethics

Nursing

Estimated time to complete:

30 minutes

POGOe Id:

22012

Date posted:

Mon, 01/28/2019

Date Submitted or Reviewed/Updated for Clinical Accuracy:

Wed, 12/19/2018

No CME credits available

Not peer reviewed

HIPAA and Caregivers.pdf
- 271.4 KB

Assigned Editor:

Emedinagall

Posting status:

Posted

Conflict of Interest Disclosure:

No, I (we) have nothing to disclose.

Author(s):

Julie Carter JD

Catherine Bourque JD

Contact Person/Corresponding Author:

Laura Vitkus MPH

Contact Person Email:

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Interprofessional Geriatric Education and Training in Texas: Elder Mistreatment

Natalie Lavelle — Wed, 21 Sep 2016 16:21:41 +0000

University of North Texas Health Science Center (UNTHSC) Texas College of Osteopathic Medicine (TCOM) Reynolds Interprofessional Geriatric Education and Training in Texas (IGET-IT)

Abstract:

Although estimates vary, it is generally believed that 11% of the elderly are abused. According to the National Incidence Study on Elder Abuse, approximately 450,000 elderly experienced abuse each year. If self-neglect is included, the number increases to 551,000. Elder mistreatment is too large of a problem for any one person or one discipline to resolve. Incorporating the expertise of all the members of the interprofessional healthcare team is critical to determine the facts in the situation and the motives of the people involved. Healthcare providers can only see what is presented in the clinical setting. There is so much of the story that may not be manifested in a routine exam and encounter. Having all team members knowledgeable about the sometimes subtle signs of elder mistreatment is helpful for eliciting information and devising a holistic intervention plan.

The University of North Texas Health Science Center (UNTSHC) Reynolds Interprofessional Geriatric Education and Training in Texas (IGET-IT) Program has developed an Elder Mistreatment module as part of the Interprofessional Communication Improvement Modules (ICIM) Elder Safety series. The ICIM Elder Safety modules were created in collaboration with the National Board of Osteopathic Medical Examiners (NBOME) and are supported, in part, by a grant from the Donald W. Reynolds Foundation. The goal of the Elder Safety ICIMs is to provide innovative and sustainable programs to improve the ability of physicians to work with other health disciplines in teams to provide better care for geriatric patients. The care of older adults can be very complex and studies have shown that a team approach can be most effective in leading to quality outcomes.

Educational objectives:

Upon completion of this activity, participants will be able to:

Define “elder mistreatment”
Describe the prevalence of elder mistreatment in the US
Define the multiple forms of elder mistreatment
Identify risk factors for elder mistreatment
List indicators of elder mistreatment
Prioritize the steps of elder mistreatment assessment
Determine the approach for including an elder mistreatment assessment in an IP team model of geriatric assessment

Content Categories:

Geriatric Syndromes

Patient Safety

Intended learner audience:

Patient

Therapist

Geriatric Competencies:

5 CBD: Formulate a diagnosis and evaluate the 3D's

SELF-CARE CAPACITY

10 SCC: Develop management plan for patients with functional deficits

11 SCC: Identify safety risks in home

22 HOSP: Identify hazards of hospitalizations

Learning resource types:

Audio

Evaluation Tool

Index/Glossary/Bibliography

Lecture

Video

Discipline/specialty:

Estimated time to complete:

1 hour

POGOe Id:

21924

Date posted:

Wed, 10/05/2016

Date Submitted or Reviewed/Updated for Clinical Accuracy:

Wed, 10/05/2016

CME credits available

Not peer reviewed

NBOME Learning Center

Posting status:

Posted

Resident Level Competencies:

Conflict of Interest Disclosure:

No, I (we) have nothing to disclose.

Author(s):

Janice Knebl, DO, MBA

Amy Moss, DO, FACOI, DABHPM

Jennifer Heffernan, MD, CMD

Barbara L. Harty, RN, MSN, GNP

Debra Aaron, PT, DPT, GCS

Lyn Dart, PhD, RD, LD

Brad Cannell, PhD, MPH

Gail M. Berky, MSSW, LMSW, CCM

Contact Person Email:

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The Geriatric Experience Multimedia Menu for Residents and Medical Students on Geriatrics Rotation

agoroncy — Mon, 19 Sep 2016 21:11:50 +0000

University of Cincinnati

Abstract:

This multimedia menu was created to add variety to a geriatrics rotation for third- and fourth-year medical students and family medicine residents while exposing learners to different aspects of the social and ethical issues integral to the care for older adults. The menu includes multiple books, movies, online videos and podcasts that learners may choose from during an assigned half-day of the rotation. Afterward, learners complete a written, personal reflection that is submitted to the course director. Reflective ability is an important skill for practicing physicians that is rarely taught in a formal curriculum. This simple menu broadens the breadth of the geriatric rotation and creates an opportunity to practice reflection.

Educational objectives:

After completing this experience, learners will:

1. Critically reflect on clinical experiences through the lens of multimedia portrayals of issues related to older adults.

2. Discuss ethical issues related to the care of older adults.

3. Describe new insights from a variety of media types and apply these insights to future practice.

Content Categories:

Intended learner audience:

Fellow

Geriatric Competencies:

14 HCP: Define and differentiate code status, proxies, and advance directives

16 HCP: When to override recommendations for treatment

Learning resource types:

Intro to Clinical Medicine/Clinical Skills/Doctoring

Discipline/specialty:

Family Medicine

Internal Medicine

Medical Ethics

Estimated time to complete:

3 hours

POGOe Id:

21920

Date posted:

Wed, 10/05/2016

Date Submitted or Reviewed/Updated for Clinical Accuracy:

Wed, 10/05/2016

No CME credits available

Not peer reviewed

The Geriatric Experience Multimedia Menu
- 128.79 KB

Sample Reflection 1
- 135.55 KB

Sample Reflection 2
- 158.26 KB

Sample Reflection 3
- 15.44 KB

Sample Reflection 4
- 19.92 KB

Sample Reflection 5
- 135.42 KB

Posting status:

Posted

Resident Level Competencies:

Complex or Chronic Illness(es) in Older Adults

Palliative and End of Life Care

Transitions of Care

Conflict of Interest Disclosure:

No, I (we) have nothing to disclose.

Author(s):

Anna Goroncy, MD

Jeffrey Schlaudecker, MD, MEd

Contact Person/Corresponding Author:

Anna Goroncy, MD

Contact Person Email:

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Building Caregiver Partnerships Through Interprofessional Education

barb palmisano — Thu, 01 Sep 2016 14:35:09 +0000

Northeast Ohio Medical University

Abstract:

Family caregivers are on the frontlines managing complicated chronic illnesses, assisting with day-to-day functioning, and providing direct care to manage symptoms and improve the quality of life of their loved ones. Yet, health professions students, medical/surgical residents, and care providers receive little, if any, training on the vital role that caregivers play on the healthcare team and how, effective partnering optimizes patient care throughout the illness trajectory and at end-of life.

The goal of Building Caregiver Partnerships through Innovative Interprofessional Education is to create effective partnerships between healthcare providers and family caregivers to reduce the burdens, ease suffering, and enhance the meaning of the caregiving experience for the patient, family and health care providers. The project centers on a 20-minute film, No Roadmap: Caregiver Journeys, which features the compelling stories of four caregiving families. The film and companion discussion guides as well as resources for case-based learning and structured clinical encounters are freely accessible on the website. http://www.neomed.edu/medicine/palliativecare/building-caregiver-partnerships/

The website is designed so that faculty can easily select the materials that best fit their learners’ needs and the time constraints within their programs. The curricula is appropriate for medical, pharmacy, nursing, and other health professions educational programs at both undergraduate and graduate levels. Additionally, tools have been developed for interdisciplinary team-based forums and health provider training. For medical/surgical residency programs, relevant ACGME milestones are identified.

Educational objectives:

The objectives of the educational tools are to prepare learners to:
• Describe home-based eldercare as a shared experience and the importance of building a relationship with family caregivers and care recipients based on trust, compassion and open communication;
• Describe the vital role of family caregivers as important, but under recognized, members of the health care team;
• Discuss the meaning and challenges of family caregiving;
• Engage caregivers in meaningful discussions to identify the needs, values and goals of their caregiving family;
• Identify resources to address caregiver concerns and provide ongoing support; and
• Provide holistic team-based care to family caregivers that improves the quality of life for the care recipient and the caregivers.

Content Categories:

Care Settings & Models

Intended learner audience:

Health professions faculty and health providers of all levels

Other Intended Learner Audiences:

Geriatric Competencies:

SELF-CARE CAPACITY

9 SCC: Assess and describe functional abilities

10 SCC: Develop management plan for patients with functional deficits

11 SCC: Identify safety risks in home

15 HCP: When to override standard recommendations for screening tests

16 HCP: When to override recommendations for treatment

20 PC: Identifiy psychological, social, and spiritual needs

21 PC: Present palliative care as a positive option

25 HOSP: Communicate a discharge plan

Learning resource types:

Intro to Clinical Medicine/Clinical Skills/Doctoring

Discipline/specialty:

Estimated time to complete:

45 minutes

POGOe Id:

21916

Date posted:

Mon, 12/12/2016

Date Submitted or Reviewed/Updated for Clinical Accuracy:

Wed, 09/23/2020

No CME credits available

Not peer reviewed

Building Caregiver Partnerships Through Interprofessional Education

Posting status:

Posted

Resident Level Competencies:

Complex or Chronic Illness(es) in Older Adults

Palliative and End of Life Care

Transitions of Care

Conflict of Interest Disclosure:

No, I (we) have nothing to disclose.

Author(s):

Barbara Palmisano, MA

Margaret Sanders, MA

Steven Radwany, MD

Erin Scott, MD

David Sperling, MD

Jon Thomas, PhD

Jennifer Drost, DO

Kristin Baughman, PhD

Ronald Jones, MD

Michael Blackie, PhD

Contact Person/Corresponding Author:

Margaret Sanders, MA

Contact Person Email:

Assessing Capability of Medical Decision Making Capacity

lvitkus — Thu, 13 Aug 2015 16:58:51 +0000

University of Arizona College of Medicine

Abstract:

A multifacted program focused on Assessment of Medical Decision Making Capacity. It includes the following education and assessment tools:

Elder Care Provider Sheet, “Medical Decision-Making Capacity”
A needs assessment for all medical and surgical specialties
Just-in-time reference cards
Mini-CEX to assess residents

Educational objectives:

Determine if the patient has the:

Ability to clearly communicate their choice for treatment or non-treatment
Ability to understand the relevant information (regarding medical condition and treatment)
Ability to understand the situation and the consequences of treatment options
Ability to reason about treatment choices, consistent with personal values

Additional information/Special implementation requirements or guidelines:

Subscribers to POGOe are free to reprint Elder Care on their own stationery or in other publications without obtaining specific permission, so long as:

Content is not changed,
No one is charged a fee to use or read the publication,
Authors and their affiliated institutions are noted without change, and
The reprint includes the following statement: “Reprinted courtesy of the Arizona Reynolds Program of Applied Geriatrics and the Arizona Geriatric Education Center."

Content Categories:

Geriatric Syndromes

Intended learner audience:

Geriatric Competencies:

7 CBD: Perform and interpret a cognitive assessment

Learning resource types:

Evaluation Tool

Learner Assessment

Medical Decision Making.pdf
- 290.34 KB

Discipline/specialty:

Estimated time to complete:

1 hour

POGOe Id:

21860

Date posted:

Mon, 09/28/2015

Date Submitted or Reviewed/Updated for Clinical Accuracy:

Thu, 03/29/2018

No CME credits available

Not peer reviewed

Posting status:

Posted

Resident Level Competencies:

Conflict of Interest Disclosure:

No, I (we) have nothing to disclose.

Author(s):

Michelle Rhodes, MD

Monica Vandivort, MD

Paul Gee, MD

Contact Person/Corresponding Author:

Laura Vitkus

Contact Person Email:

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Interprofessional Collaborator Mini-Course

tjames3 — Wed, 08 Jul 2015 20:38:36 +0000

Indiana University School of Medicine

Abstract:

Physicians (and other health professionals) are often expected to participate with teams of health professionals; however, postgraduate training infrequently includes interprofessional (IP) or team training. Thus, this curriculum was developed to teach and demonstrate the knowledge, skills and attitudes which lead to successful IP collaboration. While created for an audience of in-training physicians, it may be used with other health professional audiences.

During a four-week geriatrics rotation, medicine interns complete a fifty-minute, in-person, multimedia lecture to introduce the IP collaborator concept and the Canadian and American IP competency frameworks. The IP pocket card is demonstrated and interns complete a guided, team-meeting video observation exercise. Using a SurveyMonkey, narrative reporting tool, interns analyze team competencies that they observe or initiate during geriatrics team meetings during the rotation. They report on two interactions. They complete a closing SurveyMonkey questionnaire and have an in-person debriefing.

Educational objectives:

Given opportunity to work with interprofessional teams for patient care on the Geriatrics Block Rotation:

Learner will recognize interprofessional competencies.
Learner will understand the role of interprofessional collaborator.
Learner will observe and demonstrate the knowledge, skills and attitudes necessary to be an interprofessional collaborator according to CIHC and IPEC competencies

Content Categories:

Patient Safety

Care Settings & Models

Intended learner audience:

Geriatric Competencies:

22 HOSP: Identify hazards of hospitalizations

25 HOSP: Communicate a discharge plan

Learning resource types:

Complex or Chronic Illness(es) in Older Adults

Estimated time to complete:

1 hour

POGOe Id:

21853

Date posted:

Tue, 06/14/2016

Date Submitted or Reviewed/Updated for Clinical Accuracy:

Wed, 04/03/2019

No CME credits available

Peer reviewed

[email protected]_.docx">

Collaborator Curriculum
- 16.33 KB

[email protected]_.ppt">

Collaborator PowerPoint Introduction
- 729 KB

[email protected]_.docx">

Collaborator Introduction Lecture Transcript
- 17.4 KB

[email protected]_.pdf">

Collaborator Survey Monkey Observation Tool
- 167.57 KB

[email protected]_.doc">

Collaborator Pocket Card
- 56 KB

[email protected]_.pdf">

Collaborator Survey Monkey Closing Tool
- 125.36 KB

Posting status:

Posted

Resident Level Competencies:

Conflict of Interest Disclosure:

No, I (we) have nothing to disclose.

Author(s):

Todd James, MD

Steven Counsell, MD

Glenda Westmoreland, MD

Contact Person/Corresponding Author:

"Todd James, MD"

Contact Person Email:

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Patient Complexity and Interprofessional Team Care

tjames3 — Wed, 10 Dec 2014 15:34:40 +0000

Indiana University School of Medicine

Abstract:

Patient Complexity and Interprofessional Team Care is a geriatrics block rotation mini-course designed to improve medicine trainee’s understanding of health care teams. It was developed in the setting of a new model of care collaboration for vulnerable seniors, Geriatric Resources for Assessment and Care of Elders. The course is a blended curriculum offered during a 4-week residency block rotation in geriatrics. It is composed of a web-based, audio, PowerPoint lecture to introduce the Minnesota Complexity Assessment Method (MCAM) tool and application of the tool using paper cases. The tool is then applied to actual patients discussed at an interprofessional team meeting of the GRACE care management program.

Educational objectives:

Given a screening of the patient medical record, attendance at the patient’s GRACE interprofessional team meeting and completion of the Minnesota Complexity Assessment Method (MCAM) tool, the health professional trainee will identify patient situation complexity and describe ways that interprofessional team care members address patient care.

Given a printed Likert scale questionnaire, the resident will indicate positive change in degree of agreement with beliefs about interprofessional teams.

Content Categories:

Intended learner audience:

2 MM: Identify medications that should be avoided

Geriatric Competencies:

MEDICATION MANAGEMENT

7 CBD: Perform and interpret a cognitive assessment

SELF-CARE CAPACITY

9 SCC: Assess and describe functional abilities

10 SCC: Develop management plan for patients with functional deficits

11 SCC: Identify safety risks in home

FALLS, BALANCE, GAIT DISORDERS

12 FBG: Ask about falls and intrepret tests

15 HCP: When to override standard recommendations for screening tests

16 HCP: When to override recommendations for treatment

19 PC: Assess and manage pain and non-pain symptoms

20 PC: Identifiy psychological, social, and spiritual needs

Learning resource types:

Demonstration

Lecture

Discipline/specialty:

Estimated time to complete:

2 hours

POGOe Id:

21820

Date posted:

Wed, 04/03/2019

Date Submitted or Reviewed/Updated for Clinical Accuracy:

Wed, 04/03/2019

No CME credits available

Peer reviewed

[email protected]_.pdf">

Patient Complexity Curriculum Outline and Table of Contents
- 60.52 KB

[email protected]_.pdf">

Complexity Curriculum Exhibits 1, 2, 3
- 360.73 KB

[email protected]_.pdf">

Complexity Curriculum Exhibits 4, 5, 6
- 1.47 MB

[email protected]_.pdf">

Complexity Curriculum Exhibits 7, 8, 9, 10, 11, 12, 13
- 488.47 KB

Assigned Editor:

rramaswamy

Posting status:

Posted

Resident Level Competencies:

Medication Management

Conflict of Interest Disclosure:

No, I (we) have nothing to disclose.

Author(s):

Todd James, MD

Steven Counsell, MD

Glenda Westmoreland, MD

Contact Person/Corresponding Author:

"Todd James, MD"

Contact Person Email:

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When Eating Problems Arise in Advanced Dementia: An Interdisciplinary Trigger Video

erikaman — Wed, 08 Oct 2014 13:28:30 +0000

University of Michigan

Abstract:

This is an interactive seminar centered on a trigger video depicting a family meeting with the treating physician, the speech and language pathologist and the family of a patient with advanced dementia who suffers from dysphagia/poor oral intake. The seminar can be provided to a small group of 4-10 healthcare trainees (medical residents or students, nursing students, speech and language pathology students, social work students). The seminar is designed to present the learners with an interdisciplinary approach to conducting a family meeting on this topic. It starts with reading a case presentation, which is meant to emphasize the need for a family meeting, followed by playing the video until a trigger question comes up. At that point the participants are asked to reflect on the question and share their answers with the group. The group then watches the video exemplifying a way the question can be discussed. The process is repeated for all the trigger questions. At the end of the seminar the trainees are encouraged to debrief on language that could be modeled for goals of care discussions as well as aspects of the discussion that could have been approached differently. They are also provided with all the references used in the video as a resource for future family meetings. Trainees are asked to complete a short retrospective pre/post self-assessment survey.

Educational objectives:

Review importance of completing advance directives (applied to patients with dementia); define surrogate decision maker, substituted judgment, and best interest concepts and discuss advance care planning for the case presented.
Describe the natural history of advanced dementia.
Become familiar with potential treatment burdens associated with tube feeding in patients with advanced dementia.
Appreciate various options for eating/feeding in advanced dementia and swallowing problems.
Analyze aspects of difficult conversations with surrogate decision makers.

Content Categories:

Geriatric Syndromes

Care Settings & Models

Intended learner audience:

APRN

Nurse Educator

Fellow

2 MM: Identify medications that should be avoided

Geriatric Competencies:

MEDICATION MANAGEMENT

5 CBD: Formulate a diagnosis and evaluate the 3D's

14 HCP: Define and differentiate code status, proxies, and advance directives

16 HCP: When to override recommendations for treatment

20 PC: Identifiy psychological, social, and spiritual needs

21 PC: Present palliative care as a positive option

Learning resource types:

Evaluation Tool

Index/Glossary/Bibliography

Video depicting family meeting
- 245.13 MB

Video

Discipline/specialty:

Estimated time to complete:

1 hour 30 minutes

POGOe Id:

21791

Date posted:

Fri, 06/17/2016

Date Submitted or Reviewed/Updated for Clinical Accuracy:

Fri, 06/17/2016

No CME credits available

Not peer reviewed

Learning Objectives and Case.docx
- 20.48 KB

Faculty booklet.docx
- 52.83 KB

Participant blank worsheet 1_14_15.docx
- 20.81 KB

Completed work sheet.docx
- 24.81 KB

Participant handout-When Eating problems Arise in Advanced Dementia_An Interdisc...
- 33.75 KB

Participant Survey.docx
- 36.74 KB

Posting status:

Posted

Resident Level Competencies:

Medication Management

Palliative and End of Life Care

Conflict of Interest Disclosure:

No, I (we) have nothing to disclose.

Editor's notes:

5/23: Sent to Rainier

Author(s):

Erika Manu, MD

Alan Dengiz, MD

Joseph Murray, PhD, CCC-SLP

Mary Rumman, MSW

Tom Fitzgerald, PhD

Caroline Vitale, MD

Contact Person/Corresponding Author:

Erika Manu, MD

Contact Person Email:

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AEGIS - Surgical Informed Consent of the Geriatric Patient: First Do No Harm

mdeverbumba — Sat, 28 Sep 2013 19:38:43 +0000

University of South Carolina School of Medicine

Abstract:

Informed Consent is an essential surgical skill that has moral, ethical and practical implications for the older patient. This module uses three video trigger tapes that present the “Typical” surgical informed consent, its potential aftermath, and follows with an example of an “Effective” informed consent. This module is part of the Advanced Education in Geriatrics for Surgeons (AEGIS) project.

Educational objectives:

Upon completion, learners should be able to

1. Describe the informed consent process including components

2. Discuss unique concerns for the geriatric surgical patient during consent

Content Categories:

Intended learner audience:

Fellow

Learning resource types:

Surgical Informed Consent
- 85.45 KB

Video

Discipline/specialty:

Estimated time to complete:

1 hour 30 minutes

POGOe Id:

21694

Date posted:

Wed, 12/04/2013

Date Submitted or Reviewed/Updated for Clinical Accuracy:

Wed, 12/04/2013

No CME credits available

Not peer reviewed

AEGIS Informed Consent Trigger videos

Posting status:

Posted

Previous Taxonomy Authors: R Bell, MD; V Hirth, MD; J Ali, MD; M Dever-Bumba, DrPH(c); J Nottingham, MD; R Rosenthal, MD; Walter Pofahl, MD; T Stewart, PhD; D Wieland, PhD;

Conflict of Interest Disclosure:

No, I (we) have nothing to disclose.

Author(s):

R. Bell, MD

V. Hirth, MD

J. Ali, MD

M. Dever-Bumba

J. Nottingham, MD

R. Rosenthal, MD

Walter Pofahl, MD

T. Stewart, PhD

D. Wieland, PhD

Contact Person/Corresponding Author:

Maureen Dever-Bumba

Contact Person Email:

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How to discuss Code Status and make a recommendation

joshuy — Fri, 30 Aug 2013 02:58:38 +0000

Perelman School of Medicine at the University of Pennsylvania

Abstract:

Code status discussions are often rushed events done during a hospital admission by a doctor that the patient has never met. The content, and therefore the quality, of these discussions varies widely and often contains very incomplete information that fails to meet a person at their individual health literacy level. Additionally, once a physician decides to make a recommendation for a DNR status, the methods used may be crude and border on coercive.

The goal of this lecture is to provide the listener with a complete understanding of CPR outcomes that can be presented flexibly at the level of the health literacy of the patient and family. Second, the lecture provides a framework for making a recommendation of CPR by not viewing it soley as a health literacy problem but as a fit between a patient's stated values and the likely outcomes of CPR. In this way, there are many reasons why a person may choose to be DNR.

First, an evidence review of outcomes are discussed by site of care (inpatient, outpatient and nursing home) including immediate failure, prolonged death in a hospital, survival with impaired neurological status and survival with intact neurological status. Both absolute and relative rates are presented. An evidence review of the risks are summarized including the trauma of CPR, what happens when a person fails to survive to hospital discharge and surviving with impaired neurological status. Success rates in studies are analyzed by diagnosis, age, and functional baseline. Finally, how to translate the outcomes into goals and values is discussed including when being DNR is appropriate for a patient. Ideally, the learner will have more tools for helping a patient understand why DNR may be appropriate than before this educational session.

Educational objectives:

The purpose of this lecture is to allow the listener to have a much more complete understanding of the pros and cons of CPR and its outcomes and have a framework for making recommendations. The goal is to move beyond simply thinking about the trauma and success rates of a procedure-oriented CPR discussion and move towards a value-based, patient-centered discussion.

Additional information/Special implementation requirements or guidelines:

The power point lecture is accompanied by a handout that serves as a literature review. There is also a bibliography. In a small group setting, the handout could be the starting point of an interactive discussion. I usually start by asking the housestaff and students when they have felt a patient who was full code should be DNR, why they felt that way, and how they went about trying to change the code status. I ask what they communicate and how they communicate it. Having learners provide their own vignettes gets them more engaged in the discussion and at the end they can think about what they might have done differently.

Content Categories:

Patient Safety

Intended learner audience:

Patient

Geriatric Competencies:

14 HCP: Define and differentiate code status, proxies, and advance directives

21 PC: Present palliative care as a positive option

Learning resource types:

Intro to Clinical Medicine/Clinical Skills/Doctoring

Lecture

Other Resource Type

Other Learning Resource Type:

Handout

Discipline/specialty:

Emergency Medicine

Internal Medicine

Medical Ethics

Palliative Care

Estimated time to complete:

1 hour

POGOe Id:

21680

Date posted:

Mon, 10/07/2013

Date Submitted or Reviewed/Updated for Clinical Accuracy:

Mon, 10/07/2013

No CME credits available

Not peer reviewed

Lecture
- 175.17 KB

Handout
- 73.79 KB

Posting status:

Posted

Previous Taxonomy Authors: Joshua Uy

Conflict of Interest Disclosure:

No, I (we) have nothing to disclose.

Editor's notes:

Authors original obectives. POY candidate 2013

By the end of the lecture, the learner will

1. Appreciate that the decision regarding code status is separate from decisions regarding life sustaining care

2. Understand that explaining all the possible outcomes of CPR (failure, prolonged death, survival with poor neurological function and survival with intact function) sets up a better value based discussion than simple survival rate.

3. Be able to communicate CPR outcomes in absolute rates, relative rates and value/goal oriented terms to meet a patient's health literacy. Additionally, the learner will understand why the seemingly high success rates of CPR in the literature may not be applicable to the patient sitting in front of them. The learner will understand how age, diagnosis, time in the hospital and function affects outcomes.

4. Have a basic understanding of shared decision making frameworks and why CPR discussions involve as much listening as explaining.

5. Recognize that conflicts between providers and patients regarding CPR decisions rarely gets solved by the physician giving long explainations.

6. Have a dozen ways to recommend being DNR that does not involve extinguishing hope, asking the patient to give up longevity goals, describing CPR in pejorative terms or hiding that it can be effective for older adults.

7. Apply the appropriate framework of shared decision making (Agent vs Informed Consent) for a specific patient in order to guide how to make a recommendation.

Author(s):

Joshua Uy, MD

Contact Person/Corresponding Author:

Joshua Uy

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