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Essential Practices in Hospice and Palliative Medicine

IMPORTANT: We launched a new online learning platform, AAHPM Learn. If you purchased this product prior to July 14, 2021, you will only have access to the online product until July 2022.

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Expand your knowledge in hospice and palliative medicine

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Formerly known as the UNIPAC series, the Essential Practices in Hospice and Palliative Medicine self-study series is comprised of 9 books, each focused on a specific topic in hospice and palliative medicine, with accompanying confidence-based learning modules.

This newly updated and rebranded comprehensive self-study provides a critical foundation for healthcare practitioners and practitioners in training who want to incorporate principles of hospice and palliative medicine into their daily practice.

Each volume was reviewed and updated by subject matter experts to include the latest evidence and best practices in the field.

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Essentials Learning Modules

Instead of traditional posttests, each Essentials book has a corresponding online confidence-based learning module available to order. These learning modules are delivered using an application that analyzes learner confidence to efficiently pinpoint knowledge gaps and areas of misinformation.

The learning modules are designed to test your level of knowledge and confidence in each topic area presented in the book series. You'll continue through each module until you have achieved mastery (ie, when your answers are correct and your level of confidence is absolute). Once you have mastered a module, you'll continue to have access to the content for the life of the product. Physicians may earn continuing education credits and MOC points.

View the technical and browser requirements for the learning modules and find answers to frequently asked questions.

Benefits to You

  • Develop your knowledge in hospice and palliative care by using each revised and peer reviewed volume as a reference or training tool.
  • Prepare for your board certification exam by reviewing the current best practices and literature.
  • Increase your competence in palliative medical interventions for improving your patients' quality of life.
  • Experience online learning modules that evaluate your knowledge of the topic areas in an environment that provides repetition of questions, results, references and links to additional resources.
  • Explore practical clinical scenarios to assist you in assessing and managing components of patient care, communication and your interdisciplinary team.

 CME and MOC credits are available for each amplifire™ module you complete.

©2017, 9 volumes, softcover

Learning Objectives and Book Previews

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Essentials 1: Medical Care of People with Serious Illness

Ruth M. Thomson, DO MBA HMDC FACOI FAAHPM; Chirag Rajni Patel, MD; and Kate M. Lally, MD FACP

Upon completion of this continuing medical education program, a physician should be better able to

  • articulate key aspects and principles of palliative care
  • understand the concept of shared decision making
  • describe the principles of prognostication
  • identify key barriers to providing hospice and palliative care
  • describe models of palliative care in various settings
  • articulate key aspects of hospice care and the Medicare hospice benefit
  • describe the role of the physician, advance practice nurse, and interdisciplinary team (IDT) in hospice and palliative care
  • articulate the common challenges in hospice and palliative care
  • understand other models of delivering hospice and palliative care
  • describe the role of quality assessment and performance improvement in in hospice and palliative care and identify key measurement domains
  • identify key issues in research in hospice and palliative care.
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Essentials 2: Psychiatric, Psychological, and Spiritual Care

Scott Irwin, MD PhD; Nathan Fairman, MD MPH; Lori Montross, PhD; Jeremy Hirst, MD; Janine Siegel, MA PhD

Upon completion of this continuing medical education program, a physician should be better able to

  • identify common reactions to loss
  • use predictors to assess the likelihood of complicated reactions to loss
  • use effective interventions to enhance a patient's sense of efficacy
  • use effective interventions to foster hope
  • assess and manage anxiety and depression with pharmacological and nonpharmacological interventions
  • differentiate complicated and uncomplicated grief reactions
  • assess for spiritual pain and provide effective basic interventions
  • involve other team members in alleviating psychological and spiritual pain.
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Essentials 3: Pain Assessment and Management

Mellar P Davis, MD FCCP FAAHPM; Shalini Dala, MD; Mary Lynn McPherson, PharmD MA BCPS CPE; Paul A. Sloan, MD; Harold Goforth, MD; and Eric Roeland, MD FAAHPM

Upon completion of this continuing medical education program, a physician should be better able to

  • assess the difference between acute and chronic pain in terms of treatment strategies and opioid responses
  • understand the historical evolution and concept of "total pain" and its importance to chronic pain and cancer pain management
  • understand opioid pharmacology and its clinical importance
  • understand pain pathways, phenotypes and the importance of these pathways to cancer pain management strategies
  • understand cancer bone pain and neuropathic pain mechanisms and how these mechanisms relate to targeted pain management
  • better assess pain using multiple pain assessment tools and questionnaires
  • better determine when diagnostic tests should be used in assessing pain syndromes
  • rationally choose an opioid based on patient and clinical characteristics and context
  • convert opioid equivalents and adjust opioids using opioid conversion tables and guidelines
  • understand the limitation of equianalgesic tables
  • convert opioids from oral to alternative routes (intravenous, subcutaneous, rectal, and spinal)
  • understand spinal analgesia and drug choices
  • recite adjuvant and analgesic classes, understand the pharmacology of each class and when each class should be used and not used
  • appropriately tritrate opioids based upon pain intensity
  • identify and tread opioid side effects
  • appropriately treat cancer pain in someone with an addiction disorder
  • choose opioids and no-opioid analgesics for special populations, patients with liver disease, renal insufficiency and the elderly
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Essentials 4: Nonpain Symptom Management

Jennifer Kapo, MD; Felicia Hui, MD; Ryan Giddings-Connolly, MD; Aleksander Shalshin, MD; Andrew Putnam, MD; Catherine Adams, MD PhD; and Rebecca Sands, DO

Upon completion of this continuing medical education program, a physician should be better able to

  • recognize the importance of using symptom assessment tools to ensure comprehensive data collection and objective comparison between patient encounters
  • assess and provide effective interventions for dyspnea, including
    • nonpharmacologic management of dyspnea
    • pharmacologic management of dyspnea
    • management of pulmonary congestion and secretions
  • assess and provide effective interventions for dysphagia, including
    • nonpharmacologic management of dysphagia
    • pharmacologic management of dysphagia
  • assess and provide effective interventions for anorexia-cachexia, including
    • pharmacologic management of anorexia-cachexia
    • role of artificial nutrition and hydration
  • assess and provide effective interventions for fatigue, including
    • pharmacologic management of fatigue
  • assess and provide effective interventions for nausea and vomiting, including
    • pathophysiology and etiology of nausea and vomiting
  • assess and provide effective interventions for malignant bowel obstruction, including
    • managing constipation and fecal impaction
    • pharmacologic management of malignant bowel obstruction
  • assess and provide effective interventions for delirium, including
    • pharmacologic management of delirium
  • assess and provide effective interventions for spinal cord compression
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Essentials 5: Communication and Teamwork

Lara Michal Skarf, MD, Andrew Thurston, MD and Katie H. Stowers, DO

Upon completion of this continuing medical education program, a physician should be better able to

  • demonstrate effective strategies when communicating with patients, families, and other healthcare professionals
  • identify the positive impacts of effective communication
  • identify patient, family and provider barriers to effective communication
  • demonstrate effective techniques when communicating serious news
  • demonstrate effective techniques for eliciting patient goals for medical care and achieving a shared decision
  • utilize a framework for discussing prognosis and assessing prognostic awareness
  • describe family systems theory and counseling techniques to facilitate family conferences
  • describe the roles and functions of team members to interact more effectively as a team member
  • employ conflict-resolution skills to promote effective teamwork
  • utilize a framework to guide decisions about respecting confidentiality
  • demonstrate effective techniques to manage the stress associated with caring for patients with terminal illness.
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Essentials 6: Ethical and Legal Practice

Lisa K. Vig, MD MPH; Judith C. Ahronheim, MD; Christina Bell, MD; and Caroline A. Vitale, MD

Upon completion of this continuing medical education program, a physician should be better able to

  • apply the decision-making process described in this UNIPAC when making ethical decisions
  • apply knowledge of medical ethical principles to clinical situations
  • differentiate instructive and proxy directives
  • provide guidance when obtaining informed consent for care and research in hospice and palliative care settings
  • provide ethical guidance for patients and family members when they
    • express misconceptions about opioids that interfere with optimal pain management
    • make decisions about cardiopulmonary resuscitation
    • make decisions about futile treatment
    • make decisions about the withdrawal of artificial ventilation
    • make decisions about the withdrawal of artificial nutrition and hydration
    • request assisted suicide or euthanasia
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Essentials 7: Pediatric Palliative Care and Hospice

Meaghann Weaver, MD MPH; Brian Carter, MD; Patricia Keefer, MD; David N. Korones, MD FAAHPM; and Elissa G. Miller, MD

Upon completion of this continuing medical education program, a physician should be better able to

  • define pediatric palliative care (PPC) and related concepts, including patient demographics and hospice eligibility criteria
  • identify similarities and differences between adult palliative care and PPC
  • identify barriers to providing comprehensive palliative care for pediatric patients from the time of diagnosis of a life-threatening condition and strategies to circumvent those barriers
  • use effective communication techniques when discussing palliative care, chronic conditions, terminal illness, and death with children and their families
  • recognize anticipatory, normal, and pathologic grief and initiate effective interventions to help families through their bereavement
  • initiate effective management of psychological issues, including practical concerns, related to children with life-threatening conditions
  • identify and explain ethical and legal issues related to palliative care for pediatric patients
  • assess pain in pediatric patients
  • manage pain and opioid-related side effects in pediatric patients
  • assess and manage nonpain symptoms in pediatric patients
  • assess and manage refractory symptoms in pediatric patients
  • anticipate and manage the physical, psychosocial, and spiritual suffering surrounding a child's death.
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Essentials 8: COPD, Heart Failure, and Renal Disease

Jay Vanston, MD HMDC FAAHPM; Nina O'Connor, MD FAAHPM; Grace Huffman, MD CMD and Niharika Ganta, MD MPH

Upon completion of this continuing medical education program, a physician should be better able to

  • Heart Failure (HF)
    • list HF classifications (New York Heart Association [NYHA] class and American College of Cardiology/American Heart Association [ACC/AHA] staging)
    • describe the disease course and illness trajectory in HF 
    • discuss when to initiate palliative care for HF
    • list difficulties in predicting prognosis in HF
    • discuss the prognosis for a patient with HF, including the differences in prognosis and therapies for patients with preserved ejection fraction
    • describe medical and invasive therapies for HF and how they translate to the palliative care setting
    • discuss symptom burden in HF
    • describe when it is appropriate to refer patients with HF to hospice.
  • Chronic Obstructive Pulmonary Disease (COPD)
    • list the most common etiologies, prevalence, burden, and mortality of COPD
    • describe the disease trajectory for patients with COPD
    • describe the neurophysiology of dyspnea 
    • demonstrate the assessment and treatment of COPD and dyspnea, including pharmacologic approaches, oxygen, opioids, and nonpharmacologic approaches
    • discuss the indications for noninvasive ventilation (NIV) for patients with end-stage COPD
    • refer appropriate patients with COPD to palliative care and hospice
    • communicate effectively with patients about end-of-life (EOL) care options for patients with COPD
    • describe the impact of anxiety and depression on patients with COPD
    • educate patients and families on home care and self-management of COPD.
  • Renal Disease
    • Define the five stages of chronic renal disease
    • Describe three potential disease trajectories for renal disease
    • List common causes of pain in patients with renal failure
    • Discuss safe opioid prescribing in renal failure including best practices for opioid selection and dosing
    • List common non-pain symptoms In renal failure and treatment options
    • Discuss barriers to adequate advance care planning in renal disease
    • Explain how the Medicare hospice benefit applies to patients on dialysis
    • Discuss prognostication for patients who discontinue dialysis
    • Describe the management of symptoms that commonly occur after dialysis discontinuation

 

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Essentials 9: HIV, Dementia, and Neurological Conditions

Chris Blais, MD MPH FAAHPM; Jennifer Gabbard, MD; Susan Nelson, MD FACP FAAHPM; Sonia Malhotra, MD

Upon completion of this continuing medical education program, a physician should be better able to

Dementia

  • identify the most common etiologies of dementia and their pathogenesis in the United States
  • understand the prevalence of dementia in the United States and its age-related variation
  • describe the typical disease course for a person with Alzheimer’s dementia
  • describe the currently available pharmacologic therapies for the treatment of Alzheimer’s disease, including their mechanisms of action, indications, and common side effects
  • develop a strategy to assess pain in people with mild-to-moderate and severe-to-end-stage dementia
  • list the behavioral and psychological symptoms of dementia (BPSD)
  • describe the difference between depression and apathy and understand the unique features of depression in people with dementia, including prevalence, alternative presentations, and treatment options
  • list the most commonly used atypical antipsychotics, with dosage recommendations and possible adverse effects
  • identify contributing causes to agitation in people with dementia
  • recognize frequent complications in patients with end-stage dementia and an approach to their treatment
  • review hospice eligibility guidelines for dementia and summarize their limitations
  • appreciate the impact of caregiving on people with dementia compared to other life-limiting illnesses.

HIV

  • improve the quality of life of patients with human immunodeficiency virus (HIV) disease
  • identify behaviors that increase the risk of HIV disease progression
  • assess prognosis
  • help patients set realistic goals
  • manage selected HIV-specific symptoms
  • identify the short- and long-term side effects of antiretroviral therapy
  • discuss the withdrawal of antiretroviral therapy
  • identify methods for coping with multiple losses
  • describe recommendations for caring for HIV patients safely.

Neurological Conditions

  • Recognize common neurological disease presentations
  • Understand disease trajectories and prognostic factors for common neurological conditions
  • Understand treatment options for common neurological conditions
  • Be familiar with end stage issues for common neurological conditions 
  • Understand when hospice referral is appropriate for common neurological conditions