Hospice and Palliative Medicine Focused Assessment and Study Tool
This study tool is ideal for preparing for the HPM board certification exam or for independent study to assess your knowledge in key topic areas and earn CME. HPM FAST modules are quick, effective, targeted educational tools to enhance your clinical practice. Each module includes 25 multiple-choice practice test questions to assess and focus your study on four important topics:
HPM FAST Modules
There are four different topic areas featured in the HPM FAST products.
This HPM FAST module includes disease-specific prognostication, communication, and the impact of mechanical interventions
Psychiatry and Cognition
This HPM FAST module includes mental illness, delirium, and decision-making ability
This HPM FAST module includes care of pediatric and adolescent patients and developmentally appropriate care.
This HPM FAST module includes key components of the Hospice Medicare Benefit (HMD), Conditions of Participation, services of Interdisciplinary Group (IDG), and evidence-based prognostic strategies.
Access to HPM FAST
You can access HPM FAST modules in two ways (once in each testing mode):
- Study mode provides the correct answer and explanations throughout the test
- Test mode simulates an examination, with results and explanations delivered after you have completed the practice test.
Each module includes explanations for the correct and incorrect answers and up-to-date references to provide guidance for further study. In addition, each module includes CME and MOC credits.
How You Will Benefit
- Focus your study on key topics: prognostication, pediatrics, psychiatry and cognition, and hospice regulatory.
- Discover areas where you will benefit from further study.
- Gain insight into correct and incorrect answers along with current references.
Daniel is a 12-year-old boy with interstitial lung disease. He has progressive pulmonary failure and is currently pursuing eligibility for lung transplantation. His parents wish for Daniel to be intubated if he develops acute respiratory failure, await a lung transplant, and make further decisions as they arise. While in the hospital, Daniel shares with a nurse, “I’ve lived with this disease for as long as I can remember. I don’t know if I want the transplant, but I do know that if my lungs fail before that happens, I don’t want to have that breathing tube.”
Which of the following is true about Daniel’s ability to participate in medical decision making?
- Daniel can provide consent for medical treatments if he understands the information about the treatment being offered as well as the consequences of alternative treatment approaches.
- Daniel is unable to participate in decision making about his medical care because children typically develop this ability at 14 years of age.
- If Daniel disagrees with the medical decisions that his parents make for him, he can be declared an emancipated minor.
- Daniel can participate in medical decision making and can provide assent for treatments.
The correct answer is D, Daniel can participate in medical decision making and can provide assent for treatments. Assent is considered a child’s agreement to a treatment decision without having the legal capacity to consent. Key features of assent include (a) providing a developmentally appropriate description of the illness and the treatments, (b) assessing the child’s understanding of this information, and (c) soliciting the patient’s willingness to accept treatment decisions made by their parents and doctors. Both consent and assent can be facilitated by tailoring the information to the abilities of the individual, breaking information down into parts, allowing time to process the impact of treatment, and providing emotional support throughout the process.
Option A, Daniel can provide consent for medical treatments if he understands the information about the treatment being offered as well as the consequences of alternative treatment approaches, is incorrect. To provide consent, Daniel must be at least 18 years old or an emancipated minor and have decision-making capacity. Decision-making capacity requires that a person have the ability to (a) understand and remember the relevant information; (b) appreciate the implications of different decisions, including the consequences of different courses of action; (c) demonstrate a consistent set of values that guide a decision; and (d) communicate a decision and the reasoning behind the decision.
Option B, Daniel is unable to participate in decision making about his medical care because children typically develop this ability at 14 years of age, is incorrect. Children younger than 14 years of age often have sufficient understanding to participate in decision making. In general, children older than 14 years are viewed as having the ability to reason as well as a competent adult, but children as young as 9 years have been found to express reasonable preferences regarding treatment that render them capable of participating in decisions about their own health. This may be especially true of children with chronic conditions, resulting in a range of physical and psychological experiences of the burden of treatment preferences.
Option C, if Daniel disagrees with the medical decisions that his parents make for him, he can be declared an emancipated minor, is incorrect. Emancipated minors are persons younger than 18 years who live independently from their parents; who have taken on the responsibilities of an adult, including financial independence, parenthood, or military service; or who are emancipated by court order. Many states recognize “mature minors” by criteria similar to emancipated-minor status. Emancipated-minor laws vary from state to state.
There is growing recognition of a child’s right to be informed about his or her condition and treatment and to be actively involved in decisions pertaining to care. The goal is a supportive environment to allow decisions that are made cooperatively between the older child, physicians, and parents. This is a process of respect for the emerging, autonomous adults they will become and the emotional investment they have in their current values. Support can be given to the adolescent’s preferences and decisions with the parents providing guidance in the role of educator, challenger, and shared decision maker.
Children should have the opportunity to participate in decision making at an age-appropriate level. Some children will be able to understand the risks, benefits, and alternatives of a specific treatment and will be able to provide assent. If a child is an emancipated minor and has decision-making capacity, he or she is able to provide consent.
View the Project Editors along with the Authors and Reviewers of HPM FAST.
Holly Yang, MD FACP HMDC FAAHPM
Kimberly Bower, MD, Section Editor
Julie M. Hauer, MD
Marcia Levetown, MD FAAHPM
Britni L. Lookabaugh, MD
Robert M. Arnold, MD FAAHPM, Section Editor
Christopher M. Blais, MD MPH FACP FAAHPM
Catherine Deamant, MD
Paul Glare, MD
Joseph Shega, MD
Psychiatry & Cognition
Jeremy Hirst, MD, Section Editor
Nathan Fairman, MD MPH
Linda Ganzini, MD MPH
Jane E. Loitman, MD MBA FAAHPM
Kevin Patterson, MD
Holly Yang, MD FACP HMDC FAAHPM, Project Editor
Ruth Thomson, DO FACOI HMDC FAAHPM, Project Editor
Authors and Reviewers
Christopher Jones, MD
Laurel Kilpatrick, MD
Earl Quijada, MD HMDC
Joseph Shega, MD
Ruth Thomson, DO FACOI FAAHPM HMDC
Patrick White, MD
Holly Yang, MD FACP HMDC FAAHPM