Introduction to ACSM 402-48, Palliative Care, University of North Carolina at Chapel Hill School of Medicine

Course Syllabus for ACSM 402-48

Optional Time and Lecture Site: In order to accommodate the student’s hospice rotation change, lectures will be varied depending on the instructor. In general they will be given on Wednesday afternoon in Room 3004, Old Clinic Building. We have reserved this room for these times for those who wish to use it. Please contact Terri King at 966 1996 if you need audiovisual equipment 2-3 days in advance of your talk.

Module 1, Pain

Case 1:

Medical management of pain, pathophysiology, pharmacology, and equi-analgesic dosing.-Valgus, Week 1,Months 1 and 3, Bernard Week 1, Months 2 and 4

Non-medical techniques in pain management-Anesthesiology, Radiation Therapy-Blau, Week 1, Months 1 and 3, Morris, Week 1, Months 2 and 4

Module 2, Symptom management

Case: 2

Pediatric Issues, Nausea and Vomiting, Management of symptoms in individuals with liver or renal dysfunction-Gold Week 2, Months 1, 4, Walko, Week 2, Month 2, Hanson, Week 2, Month 3

Cancer Cachexia/ Anorexia, Role of Physical Therapy, Surgical Issues –Bernard, Week 2, Months 1, 4, Rosemond Week 2, Month 2, Stafford, Week 2, Month 3

Module 3, Communication

Case 3:

Communication between Health Professional, Patient and Family- Caprio, Week 3,Months 1 and 3, Winzelberg Week 3, Months 2 and 4

Communication between Health Professionals- Winzelberg, Week 3,Months 1 and 3, Caprio, Week 3, Months 2 and 4

Module 4, Psychological, Spiritual, and Social Issues

Case 4:

Nursing, Psychiatric and Spiritual concerns in the setting of advanced disease-Baker, Week 4, Months 1 and 4, Gala, Week 4, Month 2, Rawlings, Week 4, Month 3

The Role of Hospice: Michelle Parlet , Rob Lewis, and Jan Clark, Week 4, each month

Fall Semester Lecture Schedule, 2007-2008

	Month 1 (Aug 27 – Sept 21)	Month 2 (Sept 24 – Oct 19)	Month 3 Oct 22 – Nov 16)	Month 4 Nov 26 – Dec 21)
Week 1	Valgus (Tues)	Bernard (Tues)	Valgus (Tues)	Bernard (Tues)
	Blau (Thurs)	Morris (Thurs)	Blau (Thurs)	Morris (Thurs)
Week 2	Gold (Tues)	Walko (Tues)	Hanson (Tues)	Gold (Tues)
	Bernard (Thurs)	Rosemond (Thurs)	Stafford (Thurs)	Bernard (Thurs)
Week 3	Caprio (Tues)	Winzelberg (Tues)	Caprio (Tues)	Winzelberg (Tues)
	Winzelberg (Thurs)	Caprio (Thurs)	Winzelberg (Thurs)	Caprio (Thurs)
Week 4	Baker (Tues)	Gala (Tues)	Rawlings (Tues)	Baker (Tues)
	UNC Hospice (Thurs)	UNC Hospice (Thurs)	UNC Hospice (Thurs)	UNC Hospice (Thurs)

 

Spring Semester Lecture Schedule, 2007-2008

 

 

	Month 1 (Jan 2-Jan 25)	Month 2 (Jan 28-Feb 22)	Month 3 (Mar 10-Apr 4))	Month 4 (Apr 7-May 2)
Week 1	Valgus	Bernard	Valgus	Bernard
	Blau	Morris	Blau	Morris
Week 2	Gold	Walko	Hanson	Gold
	Bernard	Rosemond	Stafford	Bernard
Week 3	Caprio	Winzelberg	Caprio	Winzelberg
	Winzelberg	Caprio	Winzelberg	Caprio
Week 4	Baker	Gala	Rawlings	Baker
	UNC Hospice	UNC Hospice	UNC Hospice	UNC Hospice

 

 

Lecture location, to be determined by faculty but unless otherwise indicated will be in Room 3009, Old Clinic Building

Module 1, Pain

Case 1:

Medical management of pain, pathophysiology, pharmacology, and equi-analgesic dosing.-Valgus, Bernard

Non-medical techniques in pain management-Anesthesiology, Radiation Therapy-Blau, Morris

Module 2, Symptom management

Case: 2

Pediatric Issues, Nausea and Vomiting, Management of symptoms in individuals with liver or renal dysfunction-Gold, (? Lindley), Hanson

Cancer Cachexia/ Anorexia, Role of Physical Therapy, Surgical Issues –Bernard, Rosemond, Stafford,

Module 3, Communication

Case 3:

Communication between Health Professional, Patient and Family-Caprio, Winzelberg

Communication between Health Professionals-Winzelberg, Caprio

Module 4, Psychological, Spiritual, and Social Issues

Case 4:

Nursing, Psychiatric and Spiritual concerns in the setting of advanced disease-Baker, Gala, Rawlings

The Role of Hospice: Michelle Parlet, Rob Lewis, and Jan Clark

1. Pain Case

Mrs. Jones has a history of breast cancer. She had surgery 8 years ago and then had hormonal therapy for 5 years which ended 3 years ago. Recently she had pain in her left hip and has been found to have recurrence of her disease. Her evaluation has shown that there are areas that are involved by the breast cancer in the left acetabular area, the T 11 vertebral body, and the left 6 th rib and the right humeral head. She has had radiation to her left hip, but still notes pain when she moves. While her pain is relieved at rest, she still has trouble getting out of bed to go to the bathroom at night. She is active and still does much of her own housework, but she requires some assistance.

What is incidental pain? What therapies are available to relieve this type of pain?

She has now been treated for her left hip pain, but shortly after completing radiation for this pain she begins to experience pain in her left 6 th rib.

Discuss this progression of symptoms in light of the concept developed by Malacca and Wall of how the nervous system processes pain messages.

Radiation to the rib is carried out but she gets only modest relief. What non-medical measure might be of benefit to this individual? What is the mechanism by which this type of approach is thought to work?

Mrs. Jones began additional systemic therapy with another oral agent and does well for 10 months but then experiences moderate weakness in her left leg and mild weakness in her right leg. What is the possible etiology for these symptoms?

After treatment for this problem, she now requires a walker. Her therapy is switched and she does well for the next 2 years.

2. Anorexia Case

Mrs. Jones has now had her treatment changed 3 times over the last 4 years. Recently her doctor has found that she has had increase in the size of her liver metastases despite a switch in her therapy 6 months ago. Mrs. Jones has had increasing side effects with each set of new medicines. She lives with her cat; her family-2 sons-live at a distance and she has not been close to them.

For the last 3 months, despite nutritional supplements, she has been losing weight and is increasingly dependent on a network of friends that she has had for many years. They have also become frailer and are less able to provide her support. Several have moved away to be closer to their families. Today in the doctor’s office she weighs 120 lbs (She is 5 feet 6 inches with a medium frame). She is using a walker for the trip from the parking lot. She is not using the walker at home, but puts her hand on the wall, or holds on to furniture as she moves about her 1 floor house. Someone else is now doing the housework and she has found an agency that will drive her to her physician visits.

What is her ideal weight? What other tests might help to better define her nutritional status?

What other points in the history might help distinguish the etiology of her ongoing weight loss and decline in her activity level?

Her evaluation has shown that she has lost the desire to eat. Certain foods—red meat and highly sweetened food no longer appeal to her. She has no difficulties with early satiety.

Today her physician discusses further therapy with her. She is not certain that she wishes further therapy and wants to speak with her two sons about this discussion.

3. Communication

During the discussion about further therapy by her physician with her what topics would be important to address?

Discuss the way this discussion is held; are there other ways to carry out such a discussion?

How could this news of her disease becoming worse be best described to the 2 sons?

4. Psychosocial

Following her decision to forego any other active treatment, her physician brings up hospice. She speaks with the hospice staff and decides to participate.

Discuss the payment system in the United States for hospice services.

Once she is enrolled on hospice, the nurse makes a home visit. At that visit, she confides that she is increasingly tearful without any obvious precipitant. She has trouble staying asleep but frequently wakes up at 2 or 3 AM and then lies in bed tossing and turning. She may sit up and stare at the window.

How is depression in a cancer patient different from that of a non-cancer patient? Could her anorexia be in part related to depression?