Goals/Objectives

Primary Goal

• Communication Skills. This largely focuses on the areas of bad news delivery, as well as establishing and implementing goals of care in a shared fashion. Communication skills are tightly interwoven into the fabric of medical decision making. Nowhere is this more obvious than in end-of-life care. From the very outset, the physician's ability (or inability) to share bad news with patients will dictate the course of diagnostic and therapeutic interventions. Sadly, it is not unusual to see the spectacle of a dying patient subjected to continuing invasive burdensome studies and therapies simply because the physician was never able to frankly discuss the poor prognosis with the patient. It is easier for many physicians to maintain the struggle against the disease, than to deliver the bad news and begin to address the illness and its meaning to the patient.

Secondary Goals

• Evidence Based Medicine in End-of-Life Care. It is not uncommon for dying patients to grasp at burdensome long shot treatments when encouraged by consultants. While this may be an informed competent decision, it is sometimes made with superficial understanding of risks, burdens and likely benefits. Arguably, the role of the primary physician in such cases is to provide an objective framework for decision making to the patient. Evidence Based Medicine (EBM) provides the tools necessary to frame such decisions in understandable fashion, but focused upon published outcomes data.
• Competent Palliative Medicine Practices. The characteristic of comprehensive palliative care that distinguishes it from simple symptom management is the recognition that total suffering is complex and requires exploration of emotional, social and spiritual factors. The ESPS permits (and encourages) this but requires attention to details that are often unexpected at the outset.