Journal of Cancer Education
ISSN: 0885-8195 (Print) 1543-0154 (Online) Journal homepage: http://www.tandfonline.com/loi/hjce20
Special communication — Palliative medicine education: Bridging the gap between acute care and hospice David E. Weissman MD To cite this article: David E. Weissman MD (1991) Special communication — Palliative medicine education: Bridging the gap between acute care and hospice, Journal of Cancer Education, 6:2, 67-68 To link to this article: http://dx.doi.org/10.1080/08858199109528093
Published online: 01 Oct 2009.
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Article views: 4
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=hjce20 Download by: [Australian Catholic University]
Date: 18 August 2017, At: 13:02
J. Cancer Education. Vol. 6, No. 2, pp. 67-68, 1991 Printed in the U.S.A. Pergamon Press plc
0885-8195/91 $3.00 + .00 © 1991 American Association for Cancer Education
SPECIAL COMMUNICATION PALLIATIVE MEDICINE EDUCATION: BRIDGING THE GAP BETWEEN ACUTE CARE AND HOSPICE
Downloaded by [Australian Catholic University] at 13:02 18 August 2017
DAVID E. WEISSMAN, MD*
There is a growing movement in Canada, Europe, and Australia to define, teach, and evaluate a new medical specialty, palliative medicine. Such a movement is slowly beginning in the United States as well. There is now at least one training fellowship within the United States in palliative medicine and there is increasing medical literature written by US authors on topics relevant to palliative care. The impetus for the palliative medicine movement is clearly a reaction to the observation that the existing framework of medical education and the medical care delivery system does not meet the needs of the dying patient.1 Because of the increasing international and national interest in palliative medicine several issues need to be explored: What is palliative medicine, why should it be defined as separate from existing medical specialties, and what should be the relationship of palliative medicine education to cancer education? Palliative medicine or, put into a clinical term, palliative care, can be thought of as "the active total care of patients at a time when their disease is not responsive to curative treatment." The goal of palliative care is the highest possible quality of life for the patient and family." 2 Another definition states, "when the goal of cure is no longer realistic, or when the balance between length of life and acceptable quality of life is lost, there is a shift away from the future and toward the present. This is the focus of palliative care." 3 Palliative medicine is concerned with the care of patients who will die at a time in their life
when the certainty of death is reasonable and when "active" therapy has no significant role in prolonging life. In regards to cancer patients, "many aspects of palliative care are also applicable earlier in the course of the illness in conjunction with anticancer treatment."2 Palliative medicine recognizes the patient and family as a unit, with distinct problems and needs. Finally, palliative medicine recognizes that no single health-care professional has the skills to effectively manage all facets of the death experience and that interdisciplinary care is essential to provide optimal patient care. If palliative medicine is concerned with the care of dying patients, how does it relate to the concept of hospice? As a movement, hospice arose from the similar observation that dying patients had needs unmet by conventional medicine. In general, the hospice movement has been antitechnology and as such, has been largely excluded from mainstream medicine, including medical education. Although most medical schools now offer classes in death and dying, there is little emphasis placed on a more thorough discussion of the dying patient, particularly in the clinical years or during postgraduate education. This has led to polarization of hospice and palliative care as something distinct and unorthodox from acute care medicine and, as such, there is little integration of hospice principles in medical education. By defining a distinct body of knowledge within the format of conventional medical education and care, palliative medicine can, it is hoped, bridge the existing gap between hospice and acute care medicine. Table 1 lists an example of the kind of topics that could be included in a palliative medicine curriculum. Canada has been working for several years to develop formal curriculum goals in palliative medicine. No such effort has yet occurred in the United States.
*Assistant Professor of Medicine, Division of Hematology/Oncology, Medical College of Wisconsin; Chairperson, AACE Section of Medical Oncology Education. Reprint requests to: David E. Weissman, MD, Medical College of Wisconsin, Division of Hematology/Oncology, 8700 W. Wisconsin Ave., Milwaukee, WI 53226.
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D. E. WEISSMAN
Table 1. Example of a palliative care curriculum
Downloaded by [Australian Catholic University] at 13:02 18 August 2017
Symptom control Pain Nausea Edema Mouth care Dyspnea Delirium Decúbitos Death/Dying Physiology of dying process Psychology of the dying process—patient/family/ community Bereavement Health professional attitudes Interdisciplinary treatment Communication/Counseling skills Ethics/Legal issues Resuscitation Feeding/Fluids Advanced directives Assisted suicide Euthanasia
The question remains whether or not palliative medicine should exist as an independent specialty or be incorporated within existing medical specialties. One can argue that every physician in clinical specialties will care for dying patients and thus must develop at least a minimal expertise in palliative medicine. Alternatively, for palliative medicine to develop an identity and thus gain legitimacy within conventional American medicine, it perhaps should become an independent specialty. Palliative care is already a recognized specialty in the United Kingdom and academic posts in palliative care currently exist in Canada, Australia, and the United Kingdom.4 Whatever the outcome, I urge that the discipline of oncology, including all of the oncology subspecialties, become a leading force in developing palliative care education and clinical care
programs. Clinical oncologists and oncology nurses are already viewed by many as experts in caring for the dying patient, and, thus, the move towards more formal recognition of palliative medicine would seem a logical extension. To effect such a move, many obstacles to better palliative care need to be overcome. These include lack of a national policy, lack of financial resources, and lack of clinical role models. The World Health Organization has come to recognize the importance of palliative care and has issued specific recommendations for member countries.3 These include development of a national policy and incorporation of palliative care education and training programs into existing health care systems. The time has come in the United States to recognize that not all cancer is curable — approximately 500,000 Americans will die of cancer this year. As health professionals interested in cancer education, we have a fundamental responsibility to teach our students that caring for dying cancer patients is not only a responsibility but a privilege. Legitimizing the concept of palliative medicine will help make this a reality.
REFERENCES 1. Brescia FJ: The goals and challenges of palliative care: thoughts of a deathwatcher. Journal of Pain and Symptom Management. 5:382-384, 1990. 2. Twycross RG: Palliative cancer care and its implications for national cancer policy. A discussion paper prepared for Second WHO Workshop on National Cancer Control Policy Development, Vienna, June 6-8, 1990. 3. Tuohey JF: Palliative care. In: Caring for Persons with AIDS and Cancer. St. Louis: Catholic Health Association of the United States, 1988, pp 83-90. 4. Cancer Pain Relief and Palliative Care: Report of a WHO Expert Committee. Geneva: World Health Organization, 1990, pp 1-75.
ISSN: 0885-8195 (Print) 1543-0154 (Online) Journal homepage: http://www.tandfonline.com/loi/hjce20
Special communication — Palliative medicine education: Bridging the gap between acute care and hospice David E. Weissman MD To cite this article: David E. Weissman MD (1991) Special communication — Palliative medicine education: Bridging the gap between acute care and hospice, Journal of Cancer Education, 6:2, 67-68 To link to this article: http://dx.doi.org/10.1080/08858199109528093
Published online: 01 Oct 2009.
Submit your article to this journal
Article views: 4
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=hjce20 Download by: [Australian Catholic University]
Date: 18 August 2017, At: 13:02
J. Cancer Education. Vol. 6, No. 2, pp. 67-68, 1991 Printed in the U.S.A. Pergamon Press plc
0885-8195/91 $3.00 + .00 © 1991 American Association for Cancer Education
SPECIAL COMMUNICATION PALLIATIVE MEDICINE EDUCATION: BRIDGING THE GAP BETWEEN ACUTE CARE AND HOSPICE
Downloaded by [Australian Catholic University] at 13:02 18 August 2017
DAVID E. WEISSMAN, MD*
There is a growing movement in Canada, Europe, and Australia to define, teach, and evaluate a new medical specialty, palliative medicine. Such a movement is slowly beginning in the United States as well. There is now at least one training fellowship within the United States in palliative medicine and there is increasing medical literature written by US authors on topics relevant to palliative care. The impetus for the palliative medicine movement is clearly a reaction to the observation that the existing framework of medical education and the medical care delivery system does not meet the needs of the dying patient.1 Because of the increasing international and national interest in palliative medicine several issues need to be explored: What is palliative medicine, why should it be defined as separate from existing medical specialties, and what should be the relationship of palliative medicine education to cancer education? Palliative medicine or, put into a clinical term, palliative care, can be thought of as "the active total care of patients at a time when their disease is not responsive to curative treatment." The goal of palliative care is the highest possible quality of life for the patient and family." 2 Another definition states, "when the goal of cure is no longer realistic, or when the balance between length of life and acceptable quality of life is lost, there is a shift away from the future and toward the present. This is the focus of palliative care." 3 Palliative medicine is concerned with the care of patients who will die at a time in their life
when the certainty of death is reasonable and when "active" therapy has no significant role in prolonging life. In regards to cancer patients, "many aspects of palliative care are also applicable earlier in the course of the illness in conjunction with anticancer treatment."2 Palliative medicine recognizes the patient and family as a unit, with distinct problems and needs. Finally, palliative medicine recognizes that no single health-care professional has the skills to effectively manage all facets of the death experience and that interdisciplinary care is essential to provide optimal patient care. If palliative medicine is concerned with the care of dying patients, how does it relate to the concept of hospice? As a movement, hospice arose from the similar observation that dying patients had needs unmet by conventional medicine. In general, the hospice movement has been antitechnology and as such, has been largely excluded from mainstream medicine, including medical education. Although most medical schools now offer classes in death and dying, there is little emphasis placed on a more thorough discussion of the dying patient, particularly in the clinical years or during postgraduate education. This has led to polarization of hospice and palliative care as something distinct and unorthodox from acute care medicine and, as such, there is little integration of hospice principles in medical education. By defining a distinct body of knowledge within the format of conventional medical education and care, palliative medicine can, it is hoped, bridge the existing gap between hospice and acute care medicine. Table 1 lists an example of the kind of topics that could be included in a palliative medicine curriculum. Canada has been working for several years to develop formal curriculum goals in palliative medicine. No such effort has yet occurred in the United States.
*Assistant Professor of Medicine, Division of Hematology/Oncology, Medical College of Wisconsin; Chairperson, AACE Section of Medical Oncology Education. Reprint requests to: David E. Weissman, MD, Medical College of Wisconsin, Division of Hematology/Oncology, 8700 W. Wisconsin Ave., Milwaukee, WI 53226.
67
68
D. E. WEISSMAN
Table 1. Example of a palliative care curriculum
Downloaded by [Australian Catholic University] at 13:02 18 August 2017
Symptom control Pain Nausea Edema Mouth care Dyspnea Delirium Decúbitos Death/Dying Physiology of dying process Psychology of the dying process—patient/family/ community Bereavement Health professional attitudes Interdisciplinary treatment Communication/Counseling skills Ethics/Legal issues Resuscitation Feeding/Fluids Advanced directives Assisted suicide Euthanasia
The question remains whether or not palliative medicine should exist as an independent specialty or be incorporated within existing medical specialties. One can argue that every physician in clinical specialties will care for dying patients and thus must develop at least a minimal expertise in palliative medicine. Alternatively, for palliative medicine to develop an identity and thus gain legitimacy within conventional American medicine, it perhaps should become an independent specialty. Palliative care is already a recognized specialty in the United Kingdom and academic posts in palliative care currently exist in Canada, Australia, and the United Kingdom.4 Whatever the outcome, I urge that the discipline of oncology, including all of the oncology subspecialties, become a leading force in developing palliative care education and clinical care
programs. Clinical oncologists and oncology nurses are already viewed by many as experts in caring for the dying patient, and, thus, the move towards more formal recognition of palliative medicine would seem a logical extension. To effect such a move, many obstacles to better palliative care need to be overcome. These include lack of a national policy, lack of financial resources, and lack of clinical role models. The World Health Organization has come to recognize the importance of palliative care and has issued specific recommendations for member countries.3 These include development of a national policy and incorporation of palliative care education and training programs into existing health care systems. The time has come in the United States to recognize that not all cancer is curable — approximately 500,000 Americans will die of cancer this year. As health professionals interested in cancer education, we have a fundamental responsibility to teach our students that caring for dying cancer patients is not only a responsibility but a privilege. Legitimizing the concept of palliative medicine will help make this a reality.
REFERENCES 1. Brescia FJ: The goals and challenges of palliative care: thoughts of a deathwatcher. Journal of Pain and Symptom Management. 5:382-384, 1990. 2. Twycross RG: Palliative cancer care and its implications for national cancer policy. A discussion paper prepared for Second WHO Workshop on National Cancer Control Policy Development, Vienna, June 6-8, 1990. 3. Tuohey JF: Palliative care. In: Caring for Persons with AIDS and Cancer. St. Louis: Catholic Health Association of the United States, 1988, pp 83-90. 4. Cancer Pain Relief and Palliative Care: Report of a WHO Expert Committee. Geneva: World Health Organization, 1990, pp 1-75.
