CME Hours/Accreditation Information:
This activity is being sponsored by Boston University School of Medicine.
Boston University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Boston University School of Medicine designates this educational activity for a maximum of 2.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Each module will require about 45 minutes per week for about 2-3 weeks, plus time aside to complete the clinical assignment. Participation includes reading and listening to online presentations, reading and responding to in-depth case studies, and applying the knowledge you have learnt into practice on you patients. Upon completion, you will be required to complete a post-survey that includes self-evaluation.
Term of Approval
Date of Release: June, 2009
Expiration Date: May, 2012
Course Director
John M. Wiecha, MD, MPH,
Associate Professor
Director, Distance Education for Health
Director of Predoctoral Education
Department of Family Medicine
Boston University School of Medicine
Faculty Member has nothing to disclose with regards to commercial interests.
Course Faculty
Laura N. Goldman, MD
Assistant Professor
Department of Family Medicine
Boston University School of Medicine
Faculty Member has nothing to disclose with regard to commercial interests.
Disclosure Policy
Boston University School of Medicine asks all individuals involved in the development and presentation of Continuing Medical Education (CME) activities to disclose all relationships with commercial interests. This information is disclosed to CME activity participants. Boston University School of Medicine has procedures to resolve apparent conflicts of interest. In addition, faculty members are asked to disclose when any discussion of unapproved use of pharmaceuticals and devices occurs.
Unlabeled/investigational uses of commercial products are not discussed in this activity.
Target Audience
Primary care physicians, nurse practitioners, and physician assistants.
Educational Needs Addressed
The Patient Self-Determination Act of 1991 gave patients the right to deny medical care and preserved that right even when they are not capable of making medical decisions. 1 By law, all patients are asked on admission to the hospital if they have an advance directive. In addition, studies have shown that patients want control of medical decisions at the end of life, and that they would like their primary care physicians to discuss the topic with them when they are still healthy.2 However, we know that fewer than 10% of elderly individuals in the US have completed advance directives, which plan for end-of life care in the future when the individual is too ill to make decisions. Furthermore, even when they do, the forms are often inadequate in that they focus on procedures (such as CPR) and do not address many other common decisions.
There is a large body of end of life literature which attempts to shift the discussion away from procedures toward goals of care at the end of life. This module is designed to supply the primary care practitioner with the information and the skills they need to have these discussions with their patients in the office and complete advance directives.
Educational Objectives
At the conclusion of this activity, participants will be able to:
- Explain the legal ramifications of the Patient Self-Determination Act of 1991
- List three goals of advance directives
- Use goals of care in negotiating advance directives with patients
- Present an evidence-based approach to the completion of advance directives in the outpatient office setting
Disclaimer
THESE MATERIALS AND ALL OTHER MATERIALS PROVIDED IN CONJUNCTION WITH CONTINUING MEDICAL EDUCATION ACTIVITIES ARE INTENDED SOLELY FOR PURPOSES OF SUPPLEMENTING CONTINUING MEDICAL EDUCATION PROGRAMS FOR QUALIFIED HEALTH CARE PROFESSIONALS. ANYONE USING THE MATERIALS ASSUMES FULL RESPONSIBILITY AND ALL RISK FOR THEIR APPROPRIATE USE. NEITHER TRUSTEES OF BOSTON UNIVERSITY NOR THE DEVELOPERS OF THE MATERIALS MAKE ANY WARRANTIES OR REPRESENTATIONS WHATSOEVER REGARDING THE ACCURACY, COMPLETENESS, CURRENTNESS, NONINFRINGEMENT, MERCHANTABILITY, OR FITNESS FOR A PARTICULAR PURPOSE OF THE MATERIALS. IN NO EVENT WILL THE TRUSTEES OF BOSTON UNIVERSITY OR THE DEVELOPERS OF THESE MATERIALS BE LIABLE TO ANYONE FOR ANY DECISION MADE OR ACTION TAKEN IN RELIANCE ON THE MATERIALS. IN NO EVENT SHOULD THE INFORMATION IN THE MATERIALS BE USED AS A SUBSTITUTE FOR PROFESSIONAL CARE.
Funding
This project was made possible through a grant from the Physicians'
Foundation for Health Systems Excellence.
1. Bradley, EH, et al. The Patient Self-Determination Act and Advance Directive Completion in Nursing Homes. Archives of Family Medicine, 1998. 7: 417.
2. Jackson, JM, et al. Knowledge, Attitudes, and Preferences Regarding Advance Directives Among Patients of a Managed Care Organization. The American Journal of Managed Care, 2009. 15(3):177.
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