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Suggested Citation:"Appendix H." Institute of Medicine. 1997. Approaching Death: Improving Care at the End of Life. Washington, DC: The National Academies Press. doi: 10.17226/5801.
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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)

*  

American Board of Internal Medicine, Caring for the Dying: Identification and Promotion of Physician Competency. Philadelphia, Author, 1996, p. 41. Used with permission.

Suggested Citation:"Appendix H." Institute of Medicine. 1997. Approaching Death: Improving Care at the End of Life. Washington, DC: The National Academies Press. doi: 10.17226/5801.
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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

Suggested Citation:"Appendix H." Institute of Medicine. 1997. Approaching Death: Improving Care at the End of Life. Washington, DC: The National Academies Press. doi: 10.17226/5801.
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Page 405
Suggested Citation:"Appendix H." Institute of Medicine. 1997. Approaching Death: Improving Care at the End of Life. Washington, DC: The National Academies Press. doi: 10.17226/5801.
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Page 406
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Approaching Death: Improving Care at the End of Life Get This Book
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When the end of life makes its inevitable appearance, people should be able to expect reliable, humane, and effective caregiving. Yet too many dying people suffer unnecessarily. While an "overtreated" dying is feared, untreated pain or emotional abandonment are equally frightening.

Approaching Death reflects a wide-ranging effort to understand what we know about care at the end of life, what we have yet to learn, and what we know but do not adequately apply. It seeks to build understanding of what constitutes good care for the dying and offers recommendations to decisionmakers that address specific barriers to achieving good care.

This volume offers a profile of when, where, and how Americans die. It examines the dimensions of caring at the end of life:

  • Determining diagnosis and prognosis and communicating these to patient and family.
  • Establishing clinical and personal goals.
  • Matching physical, psychological, spiritual, and practical care strategies to the patient's values and circumstances. Approaching Death considers the dying experience in hospitals, nursing homes, and other settings and the role of interdisciplinary teams and managed care. It offers perspectives on quality measurement and improvement, the role of practice guidelines, cost concerns, and legal issues such as assisted suicide. The book proposes how health professionals can become better prepared to care well for those who are dying and to understand that these are not patients for whom "nothing can be done."
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