Self-Assessment of Clinical Competency and Concerns in Palliative Care

1. Adapted from: Weissman DE, Norton A, et al. A survey of competencies and concerns in end-of-life care for physician trainees. J Pain Symptom Manage 1998; 15:82-90

 

I. Please rank your degree of competence with the following patient / family interactions and patient management topics, using the following scale:

4 = Competent to perform independently
3 = Competent to perform with minimal supervision
2 = Competent to perform with close supervision / coaching
1 = Need further basic instruction

1. ____conducting a family conference to discuss important end-of-life decisions.
2. ____giving bad news to a patient or family member.
3. ____discussing DNR orders.
4. ____discussing home hospice referral.
5. ____discussing a shift in treatment approach from curative to comfort care.
6. ____discussing treatment withdrawal (e.g. antibiotics, hydration)
7. ____perform a basic pain assessment
8. ____use of oral opioid analgesics
9. ____use of parenteral opioid analgesics
10. ___ use of adjuvant analgesics (e.g. tricyclics, steroids, anti-convulsants)
11. ____assessment and management of terminal delirium
12. ____assessment and management of terminal dyspnea
13. ____assessment and management of nausea / vomiting
14. ____assessment and management of constipation
15. ____assessing patient decision -making capacity
16. ____discussing advance directives with patients

II. Physicians often have concerns that certain medical decisions may either be contrary to accepted legal, ethical or professional standards or that they may be contrary to their own personal beliefs. For each of the situations listed below, please indicate the type and amount of concern you have, using the following scale:

4 = very concerned
3 = somewhat concerned
2 = somewhat unconcerned
1 = not concerned

A. Decision: Providing maximal pain relief throughout a cancer patient’s illness, even before the terminal phase. Concerns:

1. ___This violates state law
2. ___This violates medical practice standards and represents malpractice
3. ___This violates accepted ethical norms
4. ___This violates my personal religious or ethical beliefs

B. Decision: Withdrawing non-oral feedings (G-tube or NG tube) from a decisional terminal cancer patient who asks for such feeding to be discontinued. Concerns:

1. ___This violates state law
2. ___This violates medical practice standards and represents malpractice
3. ___This violates accepted ethical norms
4. ___This violates my personal religious or ethical beliefs

C. Decision: Withdrawing IV hydration from a terminal cancer patient, who can no longer take oral fluids and who is clearly dying. Concerns:

1. ___This violates state law
2. ___This violates medical practice standards and represents malpractice
3. ___This violates accepted ethical norms
4. ___This violates my personal religious or ethical beliefs

D. Decision: Withdrawing parenteral antibiotics from a non-decisional dementia patient with urosepsis, at the request of their Power for Attorney for Health Care or legal guardian. Concerns:

1. ___This violates state law
2. ___This violates medical practice standards and represents malpractice
3. ___This violates accepted ethical norms
4. ___This violates my personal religious or ethical beliefs

E. Decision: Withdrawing ventilator support from a non-decisional dementia patient at the request of their Power for Attorney for Health Care or legal guardian. Concerns:

1. ___This violates state law
2. ___This violates medical practice standards and represents malpractice
3. ___This violates accepted ethical norms
4. ___7This violates my personal religious or ethical beliefs

Please indicate which of the following topics you would like to have included in future education programs: (1 = Yes, 2 = No)

1. ___pain assessment and management
2. ___assessment and management of nausea and vomiting
3. ___assessment and management of terminal delirium
4. ___assessment and management of terminal dyspnea
5. ___assessment and management of constipation
6. ___end-of-life communication skills—giving bad news, running a family conference, discussing prognosis, discussing treatment withdrawal
7. ___hospice care: the who, why, when and where
8. ___end-of-life ethics: DNR orders, advance directives, decision-making capacity
9. ___use of intravenous hydration and/of non-oral feedings in end-of life care
10.___spirituality in end-of-life care—role of the physician

THE END