Ensuring competency in end-of-life care: controlling symptoms

The EPEC Curriculum was developed to be a comprehensive syllabus including trainer notes, multiple approaches to teaching the material, slides, and videos of clinical encounters to trigger discussion are provided. The content was developed through a combination of expert opinion, participant feedback and selected literature review. Content development was guided by the goal of teaching core competencies not included in the training of generalist and non-palliative medicine specialist physicians.Whole patient assessment forms the basis for good symptom control. Approaches to the medical management of pain, depression, anxiety, breathlessness (dyspnea), nausea/vomiting, constipation, fatigue/weakness and the symptoms common during the last hours of life are described.While some physicians will have specialist palliative care services upon which to call, most in the world will need to provide the initial approaches to symptom control at the end-of-life.A wide range of symptoms produce considerable suffering in patients at the end of their lives. This monograph aims to summarize the core competencies in symptom control needed by any physician, no matter his or her specialty. Many of the approaches will apply much earlier in the course of the illness, not just at the end of life.The monograph does not purport to summarize specialist knowledge. While some practitioners will have specialist palliative care services upon which to call, most in the world will need to provide the initial approaches to symptom control at the end-of-life. This is not a fringe activity, but a core competency for physicians. After an overview of the approaches to whole patient assessment, we summarize the management of several of the more common symptoms that occur at the end-of-life.However, to focus on symptom control skills alone will miss the mark. To be effective in end-of-life care, physicians must also have a broad conceptualization of end-of-life care and the legal issues that support it