Approaching Death: Improving Care at the End of Life (1997)
Chapter: Appendix H
H American Board of Internal Medicine Clinical Competence in End-of-Life Care*
|
Components |
Core Competencies |
|
Medical Knowledge |
Palliative care • Assessment and treatment of psychological distress • Pharmacological and nonpharmacological treatment of pain and other symptoms |
|
Interviewing/Counseling skills |
Listening Truth telling Giving bad news Discussing dying as a process Dealing with families of dying patients |
|
Team Approach |
Understanding multidisciplinary natures of end-of-life care (physician, nursing staff, social services, palliative care or hospice team, pharmacist, chaplain, patient, patient's family, patient advocate) |
|
Symptom Assessment and Management |
Communication skills Comfort Use of opioids, sedatives, or adjuvant analgesics, NSAIDs Control of dyspnea AHCPR and WHO guidelines |
|
Professionalism |
Altruism Accountability Confidentiality Transference and counter transference Nonabandonment Honoring patients' wishes Respect for colleagues |
|
Humanistic Qualities |
Integrity Compassion Sensitivity to patient needs for comfort and dignity Respect Courtesy |
|
Medical Ethics |
Advance directives, DNR/DNI orders, Conflicts of interest Futility Physician-assisted suicide Nutrition/hydration Surrogate decisionmaking Double effect |
