POWERPOINT PRESENTATIONS

The following Powerpoint slides from the ENEC curriculum were modified from the American Medical Association’s Educational Program for Physicians on End-of-Life Care (EPEC) and expanded by the Education Subgroup of the ESRD Peer Workgroup. Nephrologists who participated on this subgroup included Drs. Richard Dart, Michael Germain, Jean Holley, Alvin Moss, Marilyn Pattison, Mohammed Abed Sekkarie, and Richard Swartz. The slides may be viewed individually by nephrologists or nephrology nurses or used in conjunction with local or regional educational programs for nephrology clinicians. The ESRD Workgroup recommends that dialysis units incorporate renal palliative care incrementally. It may be easiest to start with pain assessment and management and add other components gradually.

The Special Relevance of End-of-Life Care to the Nephrology Community

OVERVIEW -- This module addresses the relevance of palliative care to the practice of nephrology because of the limited life expectancy of dialysis patients and their frequent comorbid conditions. It also describes renal palliative care and the recommendations of the RPA, ASN, and the Robert Wood Johnson Foundation ESRD Workgroup with regard to providing quality end-of-life care for dialysis patients.

PRESENTER -- Alvin H. Moss, MD, is a Professor of Medicine in Nephrology at West Virginia University School of Medicine. His areas of research include dialysis ethics and end-of-life care for dialysis patients. He chaired the Renal Physicians Association and American Society of Nephrology workgroup that developed the clinical practice guideline, Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis.

Communicating Bad News

OVERVIEW -- This module describes the six-step process for breaking bad news and its application to common situations in nephrology practice. The module addresses communication involved in starting a patient on dialysis, advance care planning, dialysis withdrawal, and resolving conflicts with families.

PRESENTER -- Michael J. Germain, MD, is an Associate Professor of Medicine in Nephrology at Tufts University School of Medicine and a practicing nephrologist with Western New England Renal and Transplant Associates at Baystate Medical Center in Springfield, MA. He chaired the Education Subgroup of the Robert Wood Johnson Foundation Promoting Excellence in End-of-Life Care ESRD Peer Workgroup.

Advance Care Planning Presentation

OVERVIEW -- Advance care planning (ACP) is a process of communication among patients, their families, and physicians and often results in the completion of an advance directive. This module addresses the purposes, participants, and documents involved in ACP in the ESRD population.

PRESENTER -- Jean Holley, MD was a member of the RWJF ESRD Peer Work Group on End-of-Life Care and has participated in multiple studies of advance directives in dialysis patients. She is a Professor of Medicine in Nephrology at the University of Virginia.

Pain Management Presentation

OVERVIEW--This module addresses the assessment and management of nociceptive and neuropathic pain in the chronic kidney failure patient, including opioid pharmacokinetics and drug selection.

PRESENTER -- Richard Dart, MD, is a practicing clinical nephrologist at the Marshfield Clinic in Marshfield, WI and a certified AMA EPEC Trainer with interests in the development of the "EPEC-style" system for broad application in many fields of specialty medicine. Dr. Dart is presently involved in developing and presenting EPEC modules for the specialties of nephrology and pulmonary medicine.

Common Physical Symptoms

OVERVIEW -- This module describes symptom assessment of dialysis patients and includes a discussion of symptom management of uremic pruritus, restless leg syndrome, and cramps.

PRESENTER -- Michael J. Germain, MD, is an Associate Professor of Medicine in Nephrology at Tufts University School of Medicine and a practicing nephrologist with Western New England Renal and Transplant Associates at Baystate Medical Center in Springfield, MA. He was a co-investigator in the Robert Wood Johnson-funded project, the Renal Palliative Care Initiative.

Incorporating Palliative Care into Your Dialysis Unit

OVERVIEW -- This module describes how to implement the six components of a palliative care program into dialysis patient care: 1) palliative care inclusion in regular conferences, Quality Improvement activities, and in-services; 2) pain and symptom assessment and management protocols; 3) systematized advance care planning; 4) psychosocial and spiritual support for patients and families; 5) terminal care protocols including use of hospice as appropriate; and 6) bereavement support including a memorial service for deceased patients.

PRESENTER -- Alvin H. Moss, MD is a Professor of Medicine in Nephrology at West Virginia University School of Medicine. He chaired the Robert Wood Johnson Foundation Promoting Excellence in End-of-Life Care ESRD Peer Workgroup that wrote the report, Completing the Continuum in Nephrology Care, which presents 44 recommendations to improve end-of-life for dialysis patients.

To view/download a copy of RPA/ASN Position on Quality Care at the End of Life, RPA members need log into the members only section. Non RPA members can click here to order a copy of the position paper.