End-of-Life Conversations

CAFP’s End-of-Life Conversations is an educational and outreach program focused on integrating end-of-life, advanced care planning and palliative care into family medicine and primary care practices. Working with a diverse task force of family and internal medicine physicians, we have created an array of educational activities to support individual physicians, physicians’ teams and offices, and physician-patient conversations.
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Podcast Episodes

Ease the difficult conversations around prognosis and end-of-life care by listening to fellow family physicians’ stories about what it's like to have the conversation. Learn how to communicate effectively and compassionately with patients about their treatment options, including possible medical interventions and palliative care. CAFP is dedicated to ensuring that both family physicians and patients feel comfortable discussing these difficult topics and hopes to continue to gather physician voices. 

Episode 1

Palliative Care
Alongside the common fear of dying alone, many patients fear suffering at the end of life. This first episode of The Talk, produced by Deirdre Kennedy, looks at the often misunderstood field of palliative care as an option for addressing pain and helping patients define their goals of care. Physicians discuss common misperceptions about what palliative care offers and suggestions for initiating earlier conversations with patients and families about the benefits of palliative care during the complete trajectory of an illness.

Episode 2

Advance Care Planning and Advance Directives
There is often confusion about the various advance care planning forms available, including advance directives, Do Not Resuscitate (DNR) forms and Physician Orders for Life Sustaining Treatment (POLST) forms. In this episode of The Talk, family physicians discuss the differences between these documents and how they can help patients understand and complete them, as well as contemplate and make clear their medical wishes in advance of a terminal diagnosis or health care crisis.

Episode 3

Patient and Family Communication
When communicating with patients and families about serious illness and end of life, family disagreements are common, often because of different understandings about what the best course of treatment may be. In this episode of The Talk, physicians share techniques for navigating complicated family dynamics, including the mechanics of family meetings, and discuss cultural humility and helpful phrases and questions.

Episode 4

California's End-of-Life Option Act
California’s End-of-Life Option Act, signed by Governor Jerry Brown on October 5, 2015, went into effect on June 9, 2016. Family physicians throughout the state may face increased inquiries from patients about aid-in-dying drugs. This episode of The Talk explores the law and how physicians can have meaningful conversations with patients about all the care options available at the end of life.
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Additional Resources

A wide array of educational activities are available including an instructional monograph guiding physicians on how to implement palliative care services into their practice and an ABFM Part IV performance improvement project on shared decision making.

ABFM Part IV Improving Performance in Practice Module

CAFP, in partnership with Interstate Postgraduate Medical Association, has developed an ABFM Part IV Improving Performance in Practice module. This module is designed to increase the numbers of patients with advance directives in place, to enhance physician-patient communication, and to improve end-of-life care. The module is approved for ABFM Part IV credit, includes 30 AAFP Prescribed credits upon completion and is based on a team-approach [AMA PRA Category 1 ™ credit is also available]. The Part IV module is appropriate for any family physician, family medicine resident, or other primary care physician. The module is also approved for any ABMS board Part IV credit.
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A Guide for Family and Primary Care Physicians and Their Practice Teams

CAFP has teamed with the California Healthcare Foundation to produce a workbook and practical guide to incorporate palliative care services into your practice. This workbook is offered free to CAFP members. With the completion of the assessments and evaluation, you can also earn up to 3 AAFP Prescribed CME credits.
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Article: A Calling, and a
Call to Physicians
End-of-Life Option Act Offers Patients Dignity in Death

Originally published in the May/June 2019 edition of the Sierra Sacramento Valley Medicine magazine
by Nathan Hitzeman, MD
SINCE CALIFORNIA ASSEMBLY BILL 15, the End-of-Life Option Act (EoLOA), was passed in 2015 and enacted in 2016, hundreds of patients with terminal illnesses have received lethal medications by physicians to end their
suffering.
Notice that I didn’t say “by their physicians.” Very few physicians are participating
in the end-of-life services enabled by the bill, especially in senior-dense areas like Roseville and some outlying rural communities. In fact,
the chance of one’s own physician participating
is quite low...
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Connect with your local CAFP chapter

Find fellow family physicians in your neighborhood.
MEET YOUR LOCAL CHAPTER
cafp@www.familydocs.org
(415) 345-8667
1520 Pacific Avenue, San Francisco, CA 94109
© 2019 California Academy of Family Physicians. All Rights Reserved.
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