Planning the Transition to End of Life Care in Advanced Cancer (2 credit hours)

Program Summary:  This course examines research and trends in the transition to end of life care.  The good death is discussed from the patient perspective, the health care provider perspective, and the caregiver perspective.  Factors that influence end of life care decisions are discussed along with barriers.  The course offers strategies to improve patient-oncologist communication and decision making in advanced cancer.

This course is recommended for social workers, counselors, and therapists and is appropriate for beginning and intermediate levels of practice.  

“Book  Open the Course Reading Here.

Publisher:  The National Cancer Institute

Course Objectives:  To enhance professional practice, values, skills, and knowledge by identifying key issues related to the transition to end of life care in advanced cancer.

Learning Objectives:  Describe trends over time in end of life care.  Describe the good death from the patient, caregiver, and provider perspectives.  Describe how age, gender, race, and socioeconomic status affect end of life care.  Identify potential barriers to planning the transition to end of life care.

Review our pre-reading study guide.

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1: Looking at trends over time,  _______________ numbers of patients start a new chemotherapy regimen within 30 days of death or continue to receive chemotherapy within 14 days of death.
 
 
2: Looking at trends over time, the rates of utilization of ICU stays have _______________.
 
 
3: From a healthcare provider perspective, a good death requires turning one's attention away from
 
 
 
 
4: According to a landmark study of patients, families, and health care providers, which of the following attributes was ranked as important by seriously ill patients but less so by physicians?
 
 
 
 
5: From the caregiver perspective, death in the hospital correlated with a _____________ quality of life.
 
 
6: Researchers have described the _______________ outcomes of patients who were resuscitated in the medical ICU.
 
 
 
 
7: Phase I of SUPPORT confirmed there were significant ____________ in patient-physician communication.
 
 
8: SUPPORT demonstrated a correlation between increasing age and ______________ desire for life-prolonging treatment.
 
 
9: Patients of African American or Asian descent are more likely to
 
 
10: Medicare beneficiaries enrolled in a managed care program were ______________ likely to enroll in hospice and to enroll for longer periods of time.
 
 
11: Patients often provide ______________ estimates of the likelihood of survival beyond 6 months.
 
 
12: Patients who are aware of their terminal diagnosis have a
 
 
13: Patients with life-limiting illnesses
 
 
 
 
14: Which of the following factors correlates with increased information needs?
 
 
 
15: Using the Control Preference Scale, which of the following statements would be coded as passive?
 
 
 
16: A study enrolled only patients with advanced cancer and asked patients to rate the relative value of QOL or length of life.  A preference for __________ correlated with older age, male gender, and increased levels of education.
 
 
17: RCOPE scores measure
 
 
 
 
18: Recall of EOL discussions was associated with _____________ rates of mechanical ventilation, resuscitation, or ICU admission.
 
 
19: Hospice discussions increase the rate of hospice enrollment.
 
 
20: A consistent finding over the last two decades is that patients with advanced cancer are typically overly __________ about their life expectancies or the potential for cure with cancer-directed therapies.
 
 
21: One group of investigators analyzed the prognostic estimates of 917 adults with metastatic colorectal or lung cancer who were enrolled in SUPPORT and their physicians.  One notable finding was that
 
 
22: One group of researchers surveyed 236 patients with advanced cancer who participated in a randomized clinical trial of a communication intervention.  The patients and their 38 oncologists were asked to provide an estimate of the chance that the patients would be alive in two years.  The majority of patient-oncologist dyads were
 
 
23: Researchers reported that patients and oncologists agreed less about communication related to
 
 
 
24: In observational studies of patient-oncologist communication, oncologists asked about patient understanding of the disclosed information and decision-making process in
 
 
 
 
25: In observational studies of patient-oncologist communication, ____________ statements were more likely to increase the degree of prognostic agreement.
 
 
26: One study analyzed the survey responses of 729 oncologists.  Three-quarters indicated that they ___________ received formal training in communication of terminal prognoses.
 
 
27: One group of investigators interviewed Australian cancer specialists about their inclusion of patients in decision making.  Patient characteristics that decreased doctors' efforts to involve the patient included
 
 
 
 
 
 
28: Researchers demonstrated that urologists who  ______________ increased their utilization of intensity-modulated radiation therapy (IMRT).
 
 
29: The term palliative care has been identified through surveys as a potential _______________ to referral to a palliative care clinic.
 
 
30: It is noted that the term ________________ may be preferable to the term palliative care.
 
 
 
 
31: For hospice care, a licensed physician needs to certify that the patient is suffering from a life-limiting illness, with a life expectancy of no longer than ____________.
 
 
 
 
32: What legislation guarantees patients the right to accept or refuse treatment and to complete advance medical directives?
 
 
 
 
33: One group of researchers reported that women with metastatic breast cancer were more likely to
 
 
34: Studies funded by the Agency for Healthcare Research and Quality show that patients who discussed their preferences for EOL care
 
 
 
 
35: Which of the following interventions may help support patient-oncologist communication?
 
 
 
 
 

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G.M. Rydberg-Cox, MSW, LSCSW is the Continuing Education Director at Free State Social Work and responsible for the development of this course.  She received her Masters of Social Work in 1996 from the Jane Addams School of Social Work at the University of Illinois-Chicago and she has over 20 years of experience.  She has lived and worked as a social worker in Chicago, Boston, and Kansas City. She has practiced for many years in the area of hospital/medical social work.  The reading materials for this course were developed by another organization.