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MCC End-of-Life Care Priority  
Information for Providers

MCC Resources

  • End of Life in Michigan: Needs Assessment Report (published April 2005)
    This report presents the findings of an assessment of end-of-life needs and services in Michigan. The impetus for the project was two-fold. First, public health consultants in the Michigan Department of Community Health Cancer Prevention and Control Section recognized end of life as a legitimate state public health issue, having participated with a variety of partners in a number of efforts to advance end-of-life care in Michigan. They shared the common concern about the impact of unstable funding sources on program sustainability. Second, research scientists at the Centers for Disease Control and Prevention validated end of life as a national public health issue (Rao, Anderson, & Smith, 2002).

    Special Note:     This MCC project is supported by the Michigan Department of Community Health and Michigan Public Health Institute with funding from the Centers for Disease Control and Prevention. Reproduction of the report in its entirety is permitted. If a portion of the report is used or any of the content is altered, all logos and references must be removed.

Download the entire report (available as an Adobe Acrobat PDF document; file is 2.39 MB)*

Download sections of the report as individual files:

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State of Michigan Resources

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  • Michigan Physician Guide to End-of-Life Care
    www.michigan.gov/som/0,1607,7-192-29942-3388--,00.html
    In a collaborative effort, the Michigan State Medical Society, the Michigan Osteopathic Association, the American Physicians Assurance, and the Michigan Department of Community Health created this 48-page booklet to help physicians, patients and families deal more effectively with dying and death. Chapters include: "Communication at the End of Life;" "Advanced Care Planning;" "Pain and Other Physical Symptoms;" "Palliative Care;" and "Withdrawing or Withholding Care."

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  • Michigan Circle of Life
    www.michigan.gov/mdch/0,1607,7-132-2940_3183_
    4895---,00.html
    Michigan Circle of Life focuses on preserving the dignity and the rights of people who have a terminal or chronic illness. Find facts about the Michigan Circle of Life, Michigan's Dignified Death Act, Michigan's Do-Not-Resuscitate Procedure Act, and hospice care in Michigan.

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  • MDCH — Pain and Symptom Management
    www.michigan.gov/painmanagement
    This Web site, a recommendation of the Governor's Advisory Committee on Pain and Symptom Management, was developed to increase the general public's and health professional's awareness of pain and symptom management. It provides information in the form of related Michigan statutes, professional papers, articles, and links to numerous organizations with expertise in the area of pain and symptom management. The Web site also includes information on the Governor's Advisory Committee on Pain and Symptom Management. The committee, reconvened in 2006, was originally a subcommittee of the Michigan Commission on End-of-Life Care. Its charge is to deal with issues pertaining to pain and symptom management, particularly in regard to public policy, public education, and professional education.

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  • Michigan Office of Services to the Aging
    www.michigan.gov/miseniors
    The Michigan Office of Services to the Aging provide leadership, innovation, advocacy, and supportive services on behalf of Michigan's 1.6 million older adults and their caregivers.  Its mission is to promote independence and enhance the dignity of Michigan's older adults and their families.

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Organizational Resources

  • Medscape CME/CE Activity for Medical Professionals: "End-of-Life Care in the Setting of Cancer: Withdrawing Nutrition and Hydration" (valid for credit through Jan. 29, 2009)
    www.medscape.com/viewprogram/8617
    This educational activity discusses approaches to determining and implementing treatment preferences in regard to the withholding or withdrawing of interventions. First, general principles and approaches are covered. Next, specific issues of artificial nutrition and hydration are covered in more detail. These issues frequently present a challenge in routine practice, and they also provide an example of how to discuss withholding or withdrawing treatments in general. Upon completion of this activity, participants will be able to:

    • discuss the principles for withholding or withdrawing therapy at the end of life;
    • describe the evidence base for artificial nutrition and hydration;
    • use a seven-step approach to discuss the withholding or withdrawing of artificial nutrition or hydration;
    • assist families and professionals with their need to give care; and
    • discuss hospice care with patients and caregivers.

    Physicians who complete the course will be eligible for a maximum of 1.5 AMA PRA Category 1 Credit(s); nurses will be eligible for 1.5 nursing contact hours; and pharmacists will be eligible for 1.5 ACPE continuing education credits (0.15 CEUs). All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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  • Medscape CME/CE Activity for Medical Professionals: "The Last Hours of Living: Practical Advice for Clinicians" (valid for credit through Aug. 28, 2008)
    www.medscape.com/viewprogram/5808
    This activity is intended for physicians, physician assistants, nurse practitioners, nurses, students, and other clinicians who care for patients during their last hours of life. The goal of this activity is to provide a comprehensive overview of the last hours of life, focusing on the assessment and management of common physical symptoms and syndromes near the time of death. Upon completion of this activity, participants will be able to:
    • assist families to prepare for the last hours of life;
    • assess and manage the pathophysiologic changes of dying; and
    • pronounce a death and notify the family.

Physicians who complete the course will be eligible for a maximum of 1.75 AMA PRA Category 1 Credit(s)*; nurses will be eligible for 2.1 nursing contact hours (0.3 of them in pharmacology). All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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  • Medscape CME/CE Activity for Medical Professionals: "Pain Numeric Rating Scale May Be Only Moderately Accurate for Pain Screening"
    (Note: This course can be taken any time, but it will not be valid for CME/CE credit after Sept. 20, 2008.)
    www.medscape.com/viewarticle/563080
    Physicians who complete the course will be eligible for a maximum of 0.25 AMA PRA Category 1 Credit(s)*; family physicians will be eligible for 0.25 AAFP Prescribed credits; and nurses will be eligible for 0.25 nursing contact hours (none of which is in the area of pharmacology). All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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  • Medscape CME/CE Activity for Medical Professionals: "Principles of Effective Pain Management at the End of Life" (valid for credit through Oct. 11, 2008)
    www.medscape.com/viewprogram/6079
    This activity is intended for physicians, advanced practice and registered nurses, pharmacists, physician assistants, social workers, and other healthcare professionals who care for patients with far-advanced illness. The goal of this activity is to provide readers with a current and comprehensive overview of pain management at the end of life, offering guidance and detailed resources to practicing clinicians. Upon completion of this activity, participants will be able to:

    • describe the prevalence and significance of pain at the end of life;

    • identify techniques to assess pain in patients, including those unable to provide verbal reports;

    • list differential features of nociceptive and neuropathic pain states;

    • describe effective nonpharmacological means to relieve pain; and

    • recognize the therapeutic benefits and potential adverse effects associated with opioid and nonopioid pharmacotherapy for acute and chronic pain states at end of life.

    Physicians who complete the course will be eligible for a maximum of 2.0 AMA PRA Category 1 Credit(s)*; nurses will be eligible for 2.4 nursing contact hours (none of these credits is in the area of pharmacology). All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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  • Medscape CME/CE Activity for Medical Professionals: "Principles of Effective Pain Management at the End of Life"
     (valid for credit through Oct. 11, 2008)
    www.medscape.com/viewprogram/6079
    This activity is intended for physicians, advanced practice and registered nurses, pharmacists, physician assistants, social workers, and other healthcare professionals who care for patients with far-advanced illness. The goal of this activity is to provide readers with a current and comprehensive overview of pain management at the end of life, offering guidance and detailed resources to practicing clinicians. Upon completion of this activity, participants will be able to:

    • describe the prevalence and significance of pain at the end of life;
    • identify techniques to assess pain in patients, including those unable to provide verbal reports;
    • list differential features of nociceptive and neuropathic pain states;
    • describe effective nonpharmacological means to relieve pain; and
    • recognize the therapeutic benefits and potential adverse effects associated with opioid and nonopioid pharmacotherapy for acute and chronic pain states at end of life.

    Physicians who complete the course will be eligible for a maximum of 2.0 AMA PRA Category 1 Credit(s)*; nurses will be eligible for 2.4 nursing contact hours (none of these credits is in the area of pharmacology). All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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  • American Society of Clinical Oncology — EPEC-O Educational Tool
    www.asco.org/epecocd
    The American Society of Clinical Oncology has partnered with the National Cancer Institute, the U.S. Department of Health & Human Services, the National Institutes of Health, and the Hospice & Palliative Nurses Association to develop a continuing education tool in palliative and end-of-life care for oncologists and palliative care nurses. The CD- and DVD-based course, "Education in Palliative and End-Of-Life Care for Oncology" (EPEC-O), may be ordered free of charge by visiting www.asco.org/epecocd.

MCC members and partners are encouraged to forward this information to appropriate colleagues who are working on pain and symptom management, palliative care, and end-of-life issues. They also are encouraged to conduct in-service presentations and/or include a session at their annual meeting on palliative and end-of-life care. The "Materials for Trainers" section includes all of the necessary materials, PowerPoint slides, handouts, etc. The curriculum is divided into three plenary sessions and 15 content modules on the CD. On the DVD, there are video vignettes for some sessions. The only thing left to do is to choose a module or session, print out your materials, and invite a presenter.

For more information on the EPEC-O CD and DVD materials, contact CME Program Coordinator Jennifer Taylor at aylorjd@asco.org.

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  • Michigan Hospice and Palliative Care Organization www.mihospice.org
    MHPCO serves as an advocate for terminally ill people and their families by promoting access to quality hospice and palliative care throughout Michigan. The MHPCO Web site contains information on hospice care that will be useful for those personally facing a terminal illness and their loved ones. In addition to the physical care of the person, other topics covered include social and spiritual issues, grief and bereavement, and practical matters such as payment for hospice care and legal needs for advance planning (advance directives). It also provides answers to common questions about death and dying. A Reference Library section includes information of interest to providers involved in hospice care.

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  • Michigan Cancer Pain Initiative
    www.mipain.org
    This site, which was made possible through funding from the Lance Armstrong Foundation and the Alliance of State Pain Initiatives, offers resources for those suffering from pain, as well as for health care providers and policymakers. While it does not provide individualized health care advice, it equips patients and families to ask the right questions and advocate for relief of their pain more effectively. The Web site provides links to numerous resources, including those dealing with various palliative care options, patients’ rights, and complementary and alternative medicine. It also offers valuable information for all health care providers. The MCPI is an association of health professionals, patient advocates, and representatives of clergy, government, and higher education dedicated to addressing the problem of unrelieved pain from cancer.

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  • Michigan Partnership for the Advancement of End-of-Life Care: Caring Choices: A Guide to End-of-Life Decisions and Care
    Published in 2002 by the Michigan Partnership for the Advancement of End-of-Life Care, this guide is designed to help people to think about what they want in end-of-life care, ask for what they need, and understand some of the steps they need to take to make sure they receive the care they desire.     It is available in English, Spanish and Arabic versions. To order it, contact the Michigan Hospice and Palliative Care Organization at 800-536-6300 (e-mail: mihospice@mihospice.org).

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  • Michigan State University: Completing a Life: A Resource for Taking Charge, Finding Comfort, and Reaching Closure
    http://commtechlab.msu.edu/sites/completingalife/
    An interactive CD-ROM and Web site inviting patients and families to learn about the practical, emotional, spiritual and medical issues faced by those dealing with advanced illness. Completing a Life offers more than one hundred separate topic pages linked by easy-to-use navigation tools. The material contained in Completing a Life covers a wide range of concerns, addressing such areas as getting good pain relief, talking with health professionals, family communication, writing advance directives, and finding answers to spiritual questions. Completing a Life was created at Michigan State University by the Communication Technology Laboratory and the Palliative Care Education & Research Program. It was supported by Michigan State University Cancer Center and Office of Libraries, Computing and Technology, the Henry Ford Health System, Robert Wood Johnson Foundation and the Michigan Department of Community Health.

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  • American Academy of Hospice and Palliative Medicine
    www.aahpm.org
    The American Academy of Hospice and Palliative Medicine is an organization of physicians and other medical professionals dedicated to excellence in palliative medicine and the prevention and relief of suffering among patients and families by providing education and clinical practice standards; fostering research; facilitating personal and professional development of its members; and public policy advocacy.

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  • Journal of Palliative Medicine
    www.liebertpub.com/publication.aspx?pub_id=41
    This bimonthly interdisciplinary journal, which is the official journal of the American Academy of Hospice and Palliative Medicine, reports on the clinical, educational, legal, and ethical aspects of care for seriously ill and dying patients. It includes coverage of the latest developments in drug and non-drug treatments for patients with life-threatening diseases including cancer; AIDS; cardiac disease; and pulmonary, neurologic, and respiratory conditions.

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  • Center for Practical Bioethics
    www.practicalbioethics.org/index.aspx
    The Center for Practical Bioethics is a nonprofit, free-standing and independent organization nationally recognized for its work in practical bioethics. Since 1984, the center has helped patients and their families, healthcare professionals, policymakers, and corporate leaders grapple with ethically complex issues in medicine and research. 

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  • University of Wisconsin Pain & Policy Studies Group
    www.painpolicy.wisc.edu/
    The Pain & Policy Studies Group's mission is to "balance" international, national and state policies to ensure adequate availability of pain medications for patient care while minimizing diversion and abuse, and to support a global communications program to improve access to information about pain relief, palliative care, and policy. Its Web site has information and links to U.S. and international resources.

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  • University of Wisconsin Pain & Policy Studies Group Report: Achieving Balance in State Pain Policy: A Progress Report Card (2007)
    www.painpolicy.wisc.edu/Achieving_Balance/PRC2007.pdf (available as an Adobe Acrobat PDF file)*
    Improving state policy is a necessary complement to the many ongoing state-level initiatives designed to educate healthcare professionals about the appropriate use of pain medications and to inform the general public about the availability of pain treatment options. Most importantly, improving state policy will remove barriers and enhance appropriate access to pain medications for people who experience severe cancer pain during the course of their illness and beyond. This report, which is in its second year, evaluates state-level pain management policies across the country. It was prepared by the University of Wisconsin Pain & Policy Studies Group (PPSG) and jointly funded by the American Cancer Society, the Lance Armstrong Foundation, and Susan G. Komen for the Cure. The 2007 report card shows that California and Wisconsin had the greatest grade improvement. Other states whose grades improved from last year were Arizona, Colorado, Connecticut, Kansas, Massachusetts, and New Hampshire. In addition, Kansas and Wisconsin now join Michigan and Virginia as having the most balanced pain policies in the nation.

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Other Resources


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last updated: 07/11/08

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