Emil Virtual Patient Palliative Care Online Case Learning Objectives

 Blinded for Peer Review

This online case engages the medical student through a realistic patient visit and subsequent interactions with Emil, a 72 year old male with an 8 month history of non curable non small cell lung cancer.

A)     Palliative Care Symptom Management:

1)      To increase understanding in the assessment of cancer pain including taking a thorough history of a patient's cancer pain given a specific context.

2)      To introduce different types of cancer pain, and features specific to visceral, and somatic types of cancer pain.

3)      To increase understanding of the assessment for the presence of Spinal Cord Compression (including Cauda Equina Syndrome) and its initial investigation and management requirements.

4)      To learn the WHO stepwise approach to treating cancer pain including using opioids and adjuvant pain treatments.

a)      To understand how to initiate opioid dosing in an opioidnaive Palliative Care patient.

b)      To learn how to monitor and titrate opioid treatment.

c)       To identify the features of opioid neurotoxicity as a common cause of acute delirium in a Palliative Care patient and to discuss its initial management approach.

d)      To be introduced to the appropriate use of adjuvant pain treatments.

B)      To explore the different components of a goalsofcare discussion for advance care planning with a Palliative Care patient and his/her family including:

a.       Personal Directives

b.      Code status

c.       Substitute decisionmaker designation and substituted decisionmaking

d.      Family coping and living arrangement choices and wishes

e.      Support for patient and family (spiritual, bereavement, counselling needs)

C)      To increase the comfort level for discussing with the patient and family what to expect as death nears.

a.       How to cope with the question “How much longer”

b.      To increase comfort with discussing possible neardeath symptoms such as terminal delirium, terminal dyspnea, the “death rattle”, and anorexiacachexia, and to explore possible ethical issues surrounding endoflife care.