Universitat Internacional de Catalunya
Palliative Care Medicine
Teaching staff
Students may ask lecturers questions at the end of each class. For enquiries outside of class time, students must make an appointment by email:
Dr. Christian Villavicencio: cavillavicencio@uic.es
Dra. Deborath Moreno: dmoreno@uic.es
Dra. Natalia De Iriarte: ndeiriarte@uic.es
Dr. Miguel Alsina: malsina@uic.es
Mireia Baylina: mbaylina@uic.es
Introduction
Palliative Medicine is the medical discipline devoted to the study and treatment of patients with a limited life prognosis due to incurable and progressive diseases, where the goal is to offer the best quality of life through adequate symptom control, psychosocial social and spiritual support.
Palliative Medicine is a term referred to the medical activity, while activity developed by a multidisciplinary team, that usually includes physicians, nurses, social workers, psychologists, physiotherapists, pastoral agents and volunteers, is recognized worldwide as palliative care.
Palliative care in general and Palliative Medicine, in particular, is a discipline of more than 50 years of development around the world, and in some countries is a medical specialty, like in the United Kingdom or United States of America.
The Palliative Care, in Spain in the last 25 years, has been an activity recognized, regulated and funded within the NHS.
Nowadays, the training of future physicians would be partial if do not incorporate the basic knowledge and skills to manage major physical, emotional, social and spiritual problems that arise on the medical care of patients at the end of life.
Pre-course requirements
Not applicable
Objectives
The subject of Palliative Medicine aims that future physicians can recognize the importance, necessity and responsibility they have in the care of people with diseases that will not cure and evolve to death.
The subject of Palliative Medicine also wants to provide to the students a basic knowledge and skills to facing common clinical problems, from the clinical and ethical point of view.
Learning outcomes of the subject
1. – At the end of the course, students must be able to give a reasoned explanation of the principles and tools of Palliative Medicine.
2. – The students must be able to carry out a multidimensional and interdisciplinary assessment of patients with progressive advanced illness.
3. - The students must be able to prescribe opioids (specially morphine) for chronic cancer and non-cancer pain, adjust the dose properly and, prevent and treat its main side effects.
4. - The students must be able to identify the main problems related to the last days of life and to plan an interdisciplinary approach.
5. - The students must be able to reasonably identify and discuss the ethical principles governing decision making in patients with progressive advanced illness.
Syllabus
- Principles and tools of Palliative Medicine: Objectives from cure to palliation. The natural history of progressive diseases and end of life. WHO palliative care model. The multidimensionality of the human being. Definition of Palliative Medicine and Palliative Care. Basic structure of the model of palliative care.
- Models and organization of Palliative Care: A brief history and development of palliative care. The Catalonia Palliative Care Model and it evolution in Spain. The organization core: the multidisciplinary team. Basis of the interdisciplinary teamwork.
- Communication: Ethical Principles and practice of communication. How to break bad news (6-step protocol).
- Multidimensional assessment: Evaluation and multidimensional assessment instruments in Palliative Medicine. Physical, emotional, social and spiritual dimensions.
- Pain: Epidemiology, nociception pathophysiology, taxonomy, assessment. Pharmacological and non-pharmacological measures. The clinical use of morphine and other opioids.
- Palliative Care and Pediatrics: Focus of care for newborns who are going to die and their families.
- Gastrointestinal symptoms: Sd. Cachexia-anorexia, xerostomia, nausea and vomiting, constipation. Epidemiology, pathophysiology, differential diagnosis, pharmacological and non-pharmacological treatment.
- Respiratory symptoms: Dyspnea, cough. Epidemiology, pathophysiology, differential diagnosis, pharmacological and non-pharmacological treatment.
- Neuropsychiatric symptoms: Delirium, depression, anxiety, insomnia. Epidemiology, pathophysiology, differential diagnosis, pharmacological and non-pharmacological treatment.
- Last days of life: Characteristics. Overall treatment strategy. Common symptoms: pain, delirium, dyspnea, death rattle. Pharmacological and non-pharmacological treatment. Family care.
- Palliative Sedation: Ethical and clinical practice.
- Family Care : Specific aspects related with the care of the family, as part of the Plliative Medicine unit of care.
- Bearevement: Adaptative process to loss. Complicate bearevement and its features.
Teaching and learning activities
In person
Principles and tools of Palliative Medicine: It will be taught by lecture.
- Models and Palliative Care Organization: It will be taught by lecture. Keep in mind that aspects of teamworking are present in most of the practical activities of the subject.
- Communication: The theoretical aspects will be taught by lecture, while the application of knowledge will be worked specifically within skill’s laboratory. It must be keep in mind that communication is an instrumental ability and will be present in most of the educational activities through the subject.
- Multidimensional assessment: The theoretical aspects will be taught by lecture, while the application of knowledge will be worked specifically within skill’s laboratory, case method and problem based learning.
- Pain: The theoretical aspects will be taught by lecture, while the application of knowledge will work specifically with skill’s laboratory, case method and problem based learning.
- Gastrointestinal symptoms: The theoretical aspects will be taught by lecture, while the application of knowledge will be worked specifically with case method.
- Respiratory symptoms: The theoretical aspects will be taught by lecture, while the application of knowledge will be worked specifically with skill’s laboratory.
- Neuropsychiatric symptoms: The theoretical aspects will be taught by lecture, while the application of knowledge will be worked specifically with case method.
- Last days of life: The theoretical aspects will be taught by lecture, while the application of knowledge will be worked specifically on problem-based learning.
- Palliative Sedation: The theoretical aspects will be taught by lecture, while the application of knowledge will be worked specifically with case method.
- Family care and Bearevement: It will be taught by lecture.
Evaluation systems and criteria
In person
Systems and evaluation criteria
The final mark will be obtained from the weighted average (with a one decimal) obtained from following assessments:
- Midterm Exam: 15%
- Final exam: 60%
- Educational Participatory Activities (EPA): 25%
They include: skills lab (SL) + Case method (CM) + Participation and professionalism
Midterm Exam*:
- Corresponds to 15% of the final mark of the course.
- No examined matter releases for the final exam.
- It is an essential requirement to have taken the midterm exam to appear at the end
- No attending the exam marks 0. In case of excused absence for medical reasons, each case will be assessed individually to decide whether the weight of the exam will be totally or partially absorbed by the final exam.
- The exam will consist of multiple choice questions (40 multiple choice questions) that will put special emphasis on clinical application of the knowledge acquired and practiced until then. Each type of test will have a value of 0.25 points (10 points in total)
Final exam*:
- Corresponds to 60% of the final mark of the course.
- The exam will consist of written and multiple choice questions (2 written questions and 40 multiple choice questions) that will put special emphasis on clinical application of the knowledge acquired and practiced throughout the course. The written questions will have a value of 4 points at the end of the note (2 points for each question) and each type of test will have a value of 0.15 points (6 points in total)
* In both cases, the questions will be made from the concepts taught in class, the required reading provided in the moodle and the bibliography recommended in the teaching guide.
Participatory teaching activities.
- Corresponds to 25% of the final mark of the course.
- CM is a collaborative activity and organized by groups. The individual mark is the same mark obtained by the group. No attendance marks 0.
-In SL the mark is individual. No attendance marks 0.
-In addition, participation and professionalism will be taken into account in each activity.
- The mark of EPA will be the weighted average of all EAPs.
"Matricula"
Students with final marks ≥9 are eligible for possible “matricula de honor”, which were elucidated based on faculty evaluation of teachers of the subject and according to all marks and evaluations.
It is not scheduled to do any further examination or other activity to up-grade the final mark obtained.
Second opportunity exam
For those students who have not passed the subject is expected to undertake a second opportunity exam.
It should be noted that previous marks on EPAs and Participation and professionalism will be keep. Students who pass the second opportunity exam (score greater than or equal to 5), would get at maximum a mark of 8.
Bibliography and resources
·
· Manual de Medicina Paliativa. Carlos Centeno Cortés et al. Editorial EUNSA
· Manual de control de síntomas en pacientes con cáncer avanzado y terminal. Josep Porta et al. Editorial ARAN
· Medicina Paliativa . (Ed. Española). Declan Walsh et al. Editorial Elsevier Saunders
· Societat Catalana-Balear de Cures Pal.liatives. http://webs.academia.cat/societats/curespal
· Sociedad Española de Cuidados Paliativos. http://www.secpal.com
· European Asociación for Palliative Care. http://www.eapcnet.eu
· International Associacion for Hospice and Palliative Care. http://www.hospicecare.com
· Qualy. Centre col.laborador de la OMS per a programes públics de cures pal.liatives. Institut Català d’Oncologia. http://www.iconcologia.net
· Regional Palliative Care Program. Edmonton (Alberta). http://www.palliative.org
· MD Anderson, Palliative Care. http://www.mdanderson.org