Physicians Bring End-of-Life Program Back to Communities

CLEVELAND—Nearly 450 physicians have been trained to teach the American Medical Association’s curriculum on the appropriate care of dying patients. The program, known as Education for Physicians on End-of-Life Care, or EPEC, provides physicians with the basic skills and knowledge needed to care for the seriously ill and dying.

The program is intended for all generalist physicians, not just hospice or palliative care physicians, Frank D. Ferris, MD, said at the 33rd annual meeting of the American Association for Cancer Education. “We know there is a lack of physician competency in end-of-life care,” he said. Dr. Ferris, medical director of San Diego Hospice, is a member of the EPEC curriculum design team.

The EPEC project is being spread across the country by the physicians who participated in the training sessions. After receiving instruction, the physician-trainers are expected to return to their home institutions and present the EPEC program as continuing education to their colleagues, Dr. Ferris said.

Six regional sessions were offered last year to prepare physicians to become EPEC trainers. Almost 450 physicians attended. They then proceeded to offer more than 180 EPEC programs in their communities.

Nearly 10,000 people have received instruction in the EPEC project as a result of their efforts, Kathryn A. Meshenberg, administrative director of the EPEC Project, told ONI. At least another 40 EPEC programs have been planned for 2000.

The trainers’ activities will be tracked over a 2-year period to determine the project’s success. Initial evaluations show that the physician-trainers significantly improve their knowledge of the material after attendance at a training session, Dr. Ferris said. The 56 trainers who attended the first regional session scored 73% on a pretest before attending the session and 81% on a post-test at the session’s end.

In addition to this method of outreach, the AMA is also sending all of its renewing physician members a CD-ROM version of the EPEC curriculum to use for self-education or to establish educational programs within their own practice or institution. Furthermore, the CD-ROM curriculum is being sent to presidents of state, county, and national specialty societies.

To encourage the addition of end-of-life skills and core competencies to medical education, EPEC is sending residency program directors and medical school department chairmen a complimentary CD-ROM. All medical school deans will receive a print version of the EPEC curriculum as well.

The Curriculum

The EPEC curriculum consists of four plenary modules and 12 workshop modules. The plenary topics are: Gaps in End-of-Life Care, Legal Issues in End-of-Life Care, Elements of End-of-Life Care, and Next Steps. The workshop modules include Communicating Bad News, Pain Management, Withholding/Withdrawing Treatment, and Last Hours of Living. [See ONI January 2000, page 23, for articles describing some of the program topics.]

The CD-ROM version of the curriculum, a print version of the Participant’s Handbook, and the complete Trainer’s Guide, which includes videotapes and slides in Power Point, are also available for purchase through the AMA catalogue.

In the future, EPEC would also like to see the creation of opportunities for physicians who are highly skilled in end-of-life care to share their expertise, Dr. Ferris said. For instance, San Diego Hospice is developing a visiting scholar program, he told ONI.

In addition to Dr. Ferris, the EPEC project has been led by Linda Emanuel, MD, PhD; Charles F. von Gunten, MD, PhD; and Russell Portenoy, MD. The project is supported by the AMA and a grant from The Robert Wood Johnson Foundation. It is housed within the End-of-Life-Care Section of the Institute for Ethics at the AMA. The EPEC website is www.ama-assn.org/ethic/epec