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Ensuring competency in end-of-life care: controlling symptoms

Frank D Ferris1, Charles F von Gunten1 and Linda L Emanuel2*

Author Affiliations

1 Center for Palliative Studies, San Diego Hospice, San Diego, USA

2 Buehler Center on Aging, Northwestern University, Chicago, USA

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BMC Palliative Care 2002, 1:5  doi:10.1186/1472-684X-1-5

Published: 30 July 2002



Palliative medicine is assuming an increasingly important role in patient care. The Education for Physicians in End-of-life Care (EPEC) Project is an ambitious program to increase core palliative care skills for all physicians. It is not intended to transmit specialty level competencies in palliative care.


The EPEC Curriculum was developed to be a comprehensive syllabus including trainer notes, multiple approaches to teaching the material, slides, and videos of clinical encounters to trigger discussion are provided. The content was developed through a combination of expert opinion, participant feedback and selected literature review. Content development was guided by the goal of teaching core competencies not included in the training of generalist and non-palliative medicine specialist physicians.


Whole patient assessment forms the basis for good symptom control. Approaches to the medical management of pain, depression, anxiety, breathlessness (dyspnea), nausea/vomiting, constipation, fatigue/weakness and the symptoms common during the last hours of life are described.


While some physicians will have specialist palliative care services upon which to call, most in the world will need to provide the initial approaches to symptom control at the end-of-life.