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3 Psycho-social issues
1) Attitudes
a) Recognize that everyone has psycho-social problems
b) Consider a patient's psycho-social and spiritual issues as well as physical symptoms
c) Do not criticize patients' and his or her family's psychological response
2) Skill
a) Apply the basic communication skill
b) Assess a patient's and his or her family's emotional change from their expression
c) Distinguish between normal and pathological grieving
d) Assess a patient's and his or her family's social role change or loss
e) Realize one's own emotional change when interacting with a patient and his or her family
f) Express one's own emotion precisely
g) Join a team approach to psycho-social issues
3) Knowledge
a) Describe typical psychological responses: a patient's and his or her family's anxiety, fear, anger, depression, indifference, sense of isolation, etc.
b) Describe the death-accept process
c) Describe relation between psycho-social and spiritual issue
d) Describe normal grieving
e) Describe a patient's and his or her family's social role loss during a disease progress
4 Ethical issues in palliative care (medicine)
1) Attitudes
a) Respect a patient as a autonomous person
b) Respect a patient's family's role and function
c) Respect a patient's and his or her family's way of living, beliefs, creeds, and faiths even if it is different from those of one's own
d) Interact with a patient and his or her family sincerely and honestly
e) Respect of a patient's and his or her family's decision
f) Respect a medical team's role and function
g) Develop understanding the issue on euthanasia
h) Consider the indication of palliative medicine from a patient's early clinical phase
2) Skill
a) Plan a patient's treatment on the following points: medical indication, a patient's and family's QOL, autonomy, and social situation
b) Discuss and review frankly with a patient and his or her family
c) Discuss and review frankly with team members
3) Knowledge
a) Describe clinical ethical 4 principles: respect of autonomy, beneficence, non maleficence, and justice
b) Describe family dynamism importance
c) Describe concepts of active euthanasia, passive euthanasia, natural death, mercy-killing, and sedation
d) Describe the 4 conditions for euthanasia in Japan
e) Describe what DNAR (Do-not-attempt resuscitation orders) is
5 Service delivery
1) Attitude
a) Try to get the most out of available services
b) Discuss available services with a social worker
c) Understand and respect the service providing professionals' roles and functions
2) Skill
a) Share service information with the relating agencies
3) Knowledge
a) Describe the local available medical and social services
b) Describe the healthcare system on palliative care
c) Describe the social resources on palliative care: palliative care units, self-help groups, and voluntary groups, etc.
6 Team approach
1) Attitude
a) Understand and respect team members' roles, and their differences
b) Consider information sharing with team members
c) Recognize the limitation of one's own skill and expertise, and develop oneself accepting different view points
2) Skill
a) Listen to other team members' view points actively
b) State plainly one's own view points to other team members
c) Realize one's own emotional change when interacting with other team members
d) Consult with other disciplines whenever it is necessary
3) Knowledge
a) Describe a team members' each professional role
1. Family doctor
2. Nurse, and home care nurse
3. Physical therapist
4. Occupational therapist
5. Pharmacist
6. Dietitian
7. Social worker
8. Clinical psychotherapist
9. Dentist
10. Dental hygienist
11. Religionist
12. Others
Care manager
Home helper
Lawyer
b) Describe team dynamism
c) Volunteers' role and function in a team
7 Communication
1) Attitude
a) Interact with a patient and his or her family sincerely and honestly
b) Consider a patient's and his or her family's needs and hope
c) Take care on the emotional interaction between a patient and his or her family
d) Try to think from a patient's and his or her family's stand point
2) Skill
a) Assess a patient's and his or her family's needs
b) Apply the basic communication skill
c) Inform a patient and his or her family of the diagnosis and prognosis (especially bad news) adequately
3) Knowledge
a) Describe a patient's and his or her family's response when they are informed of bad news
b) Describe the appropriate time and way to inform of bad news (suitable information amount and using words which a patient and his or her family can accept)
c) Describe the risks of medical staffs excessive emotional involvement with a patient and his or her family
d) Distinguish the difference between sympathy and empathy
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