HU Credits: 3

Degree/Cycle: 2nd degree (Master)

Responsible Department: Medicine

Semester: 1st Semester

Teaching Languages: Hebrew

Campus: Ein Karem

Course/Module Coordinator: Dr. ADIR SHAULOV

Coordinator Email: adir@hadassah.org.il

Coordinator Office Hours:

Teaching Staff:
Dr. omer or,
Dr. Ohad Avny,
Ms. hila Elmashaly,
Dr. Amir Haze,
Ms. Livnat Wieder,
Dr. Batsheva Werman,
Dr. Eran Zimran,
Ms. Ofra Kahana,
Ms. shirli Carmi,
Dr. Irit Mor Yosef Levy,
Dr. Ofra Maimon,
Dr. yaffa stokar,
Dr. iris fried,
Dr. Ruth Kannai,
Ms. anna Kochin,
Dr. Yaarit Ribak,
Dr. ADIR SHAULOV,
Ms. chani stoffer,
Ms. merav spiegel,
Dr. eyal mizrahi,
Dr. Grinshpun ALBERT,
gideon lifshitz,
Dr. Lisandro Luques,
Mr. Meir Cherniak,
Dr. Shlomzion Aumann,
Ms. Adi Nitzan-Luqu,
Shani Breuer,
Ms. Smadar Goldfarb,
Ms. Liat Sheffer,
Dr. Sahar Tali,
Dr. Shimrit Tzvi Behr,
Dr. Yisrael Katz,
Talia Alster,
Ms. Miki Kovalyo,
Dr. michal Bloch,
Dr. Daniel Dayan,
Ms. Hani Itenberg,
Ms. Suzanne Csorba,
Ms. Ela Caine,
Ms. Bassi Adina Fuchs,
Ms. Dvora Kirshenboma,
Ms. ruthie zeligman,
Ms. Ayala Montag,
Ms. Shlomit Chaim,
Ms. Kim Meidan,
Ms. Yaara Friedman dolan,
Dr. Yael Weintraub

Course/Module description:
Palliative care is a therapeutic approach designed to improve the quality of life of those facing serious illnesses. During the course of a serious illness and its treatment, symptoms such as pain, nausea, anxiety, depression, constipation and more can appear. In the palliative approach, emphasis is placed on improving the patient's quality of life, which is sometimes lost during the aggressive treatments designed to eradicate the disease and prolong life. Palliative care has been proven to improve the quality of life of patients, and in some cases also to prolong life.
Globally, palliative medicine is a significant part of the medical treatment of patients with life-threatening diseases and an important part of medical school training. As part of the course, students will learn to manage symptoms such as pain, nausea, constipation and delirium. In addition, they will learn about the law in Israel and advance directives as well as about the experience of the patient and his family, about dealing with grief and the experience of the end of life in cultural worlds.
The course includes three study days that require students to be present on Sunday, Tuesday and Thursday and two days of online study on Monday and Wednesday.
The days on which the students' presence is required include lectures and discussions in small groups. Each group has two moderators; A doctor and another participant from the multi-professional team.

Course/Module aims:

Learning outcomes - On successful completion of this module, students should be able to:
At the end of the course the student -
Apply a palliative approach throughout the course of the disease, from the moment of diagnosis of a short-lived disease to the end of life.
2. Describe the patient's experience and coping with the end of life in the patient and his family member
3. Conduct complex and difficult conversations with patients, their families and other caregivers in palliative care and end-of-life care while expressing empathy and sensitivity, maintaining the patient and family respect and respecting the patient's religion and culture.
4. Identify and evaluate symptoms and other needs of the patient and build an appropriate treatment plan in the various frameworks (emergency department, ward, intensive care, hospice, home hospice)
5. Identify and address ethical challenges in palliative care and end-of-life care
6. Describe the law of the dying patient and its use in various clinical situations
7. Will act as part of a multidisciplinary team (medicine, nursing, social work, spiritual guidance) in the treatment of patients with short-term illnesses and their families
8. Analyze his experience and personal confrontation with the end of life and the impact of these on patient care

Attendance requirements(%):
100%

Teaching arrangement and method of instruction:

Course/Module Content:
Introduction to Palliative Medicine
Meeting with a family member of a deceased patient
Religious and cultural panel
Introduction to Pain Medicine
Studying the law of the dying patient
Ethics in treating dying patients
Panel of the dying patient law - problems and struggles in practice
Nutrition and hydration at the end of life
Preliminary instructions
Important conversations at the end of life
Treatment of gastrointestinal symptoms
Treatment of shortness of breath
Delirium treatment
Palliative care for children
Spiritual accompaniment
Last hours
Palliative sedation
Authorized Lectures:
Medical Cannabis
Euthanasia
Palliative care in the days of Corona

Required Reading:
The law of the dying patient

Additional Reading Material:
1. Arnold RL, Egan K. Breaking the “bad” news to patients and families: preparing to have the conversation about end-of-life and hospice care. Am J Geriatr Cardiol. 2004 Dec;13(6):307–12.
2. Blinderman CD, Billings JA. Comfort Care for Patients Dying in the Hospital. N Engl J Med. 2015 Dec 24;373(26):2549–61.
3. Curtis JR, Rubenfeld GD. Improving palliative care for patients in the intensive care unit. J Palliat Med. 2005 Aug;8(4):840–54.
4. Gawande A. Quantity and Quality of Life: Duties of Care in Life-Limiting Illness. JAMA. 2016 Jan 19;315(3):267–9.
5. Kloke M, Cherny N, ESMO Guidelines Committee. Treatment of dyspnoea in advanced cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2015 Sep;26 Suppl 5:v169-173.
6. Lamba S, Nagurka R, Zielinski A, Scott SR. Palliative care provision in the emergency department: barriers reported by emergency physicians. J Palliat Med. 2013 Feb;16(2):143–7.
7. Lazris A. Geriatric Palliative Care. Prim Care. 2019 Sep;46(3):447–59.
8. McIlvennan CK, Allen LA. Palliative care in patients with heart failure. BMJ. 2016 Apr 14;353:i1010.
9. Murray SA, Kendall M, Mitchell G, Moine S, Amblàs-Novellas J, Boyd K. Palliative care from diagnosis to death. BMJ. 2017 27;356:j878.
10. Portenoy RK, Ahmed E. Principles of opioid use in cancer pain. J Clin Oncol. 2014 Jun 1;32(16):1662–70.
11. Delirium in adult cancer patients: ESMO Clinical Practice Guidelines. - PubMed - NCBI [Internet]. [cited 2019 Aug 10]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29992308
12. ESMO Clinical Practice Guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation. - PubMed - NCBI [Internet]. [cited 2019 Aug 10]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term&eq;ESMO+Clinical+Practice+Guidelines+for+the+management+of+refractory+symptoms+at+the+end+of+life+and+the+use+of+palliative+sedation
13. European Resuscitation Council Guidelines for Resuscitation 2015: Section 11. The ethics of resuscitation and end-of-life decisions. - PubMed - NCBI [Internet]. [cited 2019 Aug 10]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term&eq;European+Resuscitation+Council+Guidelines+for+Resuscitation+2015+Section+11.+The+ethics+of+resuscitation+and+end-of-life+decisions
14. Overview of managing common non-pain symptoms in palliative care - UpToDate [Internet]. [cited 2019 Aug 10]. Available from: https://www.uptodate.com/contents/overview-of-managing-common-non-pain-symptoms-in-palliative-care?search&eq;Overview%20of%20managing%20common%20non-pain%20symptoms%20in%20palliative%20care&source&eq;search_result&selectedTitle&eq;1~150&usage_type&eq;default&display_rank&eq;1

Grading Scheme :
Active Participation / Team Assignment 20 %
Submission assignments during the semester: Exercises / Essays / Audits / Reports / Forum / Simulation / others 40 %
Attendance / Participation in Field Excursion 40 %

Additional information: