The EPEC Project

A History:

This year, 2009, marks the 10th anniversary of the Education in Palliative and End of Life Care (EPEC) Project’s teaching efforts. EPEC’s development began in 1997 when medicine had generated increased capacity in palliative care and symptom management but struggled to capture the proper balance between curative approaches and the need to ameliorate suffering due to chronic or incurable disease.

Linda L. Emanuel, MD, PhD, Charles F. von Gunten, MD, PhD and Frank D. Ferris, MD, along with nationally-respected palliative care leaders from across the country, developed the EPEC Curriculum to help achieve the balance. Until then, many medical education interventions seemed to have had little impact, perhaps because many were limited to a ritualized process of information presentation. From the start, the EPEC Project was designed as a train-the-trainer program to teach both content and educational approaches to palliative care. Through the use of adult education theory emphasizing interactive techniques as well as through application of social science principles that can drive changes in social expectations and behavioral norms, the stage was set for greater project impact.

In its initial development and implementation, the EPEC Project benefitted from being situated in the American Medical Association where it could reach physicians from all disciplines and a national and international audience. The success of the EPEC Project over the first decade was also due to the generous support of the Robert Wood Johnson Foundation and the National Cancer Institute and others who embarked on a national strategy to improve and sustain palliative care.

Ultimately, EPEC has evolved from being solely grant funded to an ongoing institution molded by its participants and their needs. The core Become an EPEC Trainer conference in which participants learn palliative care content and teaching approaches began in 1999 and continues to be offered twice per year. Responding to the needs of Trainers who sought to increase their teaching skills and become master facilitators, the annual Professional Development Workshop with its own defined curriculum was developed in 2001.

In more recent years, the EPEC Project has actively collaborated with many partners to create adaptations that extend palliative care into new settings and help to move it “upstream” from the end of life to include the entire spectrum of illness. Our medical specialty partners include EPEC-Oncology; EPEC-Emergency Medicine and EPEC-Geriatrics/Long term care. We have also sought to extend the EPEC model by working with partners to adapt our curriculum to the needs of specific populations. This effort has led to the development of APPEAL (A Progressive Palliative Care Education Curriculum for the care of African Americans at Life’s End); EPEC-Roman Catholic; EPEC for Veterans; EPEC-Caregiver (communication and navigation topics for patients and family caregivers) and EPEC- India.

In addition to being taught as a live conference, EPEC is also available via distance learning, including the core EPEC Curriculum and EPEC-Oncology.

The dissemination of the EPEC Curriculum was evaluated by an external group after one year of its initial training. At that time, 90% of trainers were found to be actively using the EPEC Curriculum to teach; a sample of 184 of the initial trainers were estimated to have taught 120,000 professionals of all disciplines. Today, there are more than 2,000 EPEC Trainers in all 50 states and 16 other countries. By extrapolation, EPEC’s trainers may have taught over a million professionals.

In our next decade, we plan to continue to support the efforts of our trainers, continue to adapt our curriculum to the needs of interdisciplinary audiences and continue to work to measure the impact of training on the experiences of patients and families.

What People Have Said About The EPEC Project:

“As the Palliative Care Coordinator at a mid-sized teaching hospital, the EPEC train-the-trainer program has given me the confidence and knowledge to teach about end of life care.  I have also been providing the curriculum our entire Hospitalist Service, and work as a resource to my colleagues on palliative and end of life care.  The Professional Development Workshop was a wonderful experience and strengthened my teaching skills.  The EPEC Program is very useful in all disciplines and across many settings.  I am grateful to be a participant of multiple EPEC Programs! Thank You!” – Karen Mulvihill, Danbury Hospital

“Yesterday, I had to speak to the wife and family of a pt who had a serious problem in the Recovery Room--all I could think about was how the role play helped me deal with it, and how well I was received by the family. All turned out well, and now the family thinks I hung the moon! What an immediate benefit.  I cannot remember any meeting where the tools I learned were so easily incorporated into my practice and my teaching.” – James A. Ramsey, Vanderbilt School of Medicine

"I took EPEC in Charleston a few years ago. We use it all the time...it is the backbone of our education for physicians and for social workers." – Laurie Lybrand Busby, Roper St. Francis Healthcare

“Just back from India, and writing to say how impressed I am with EPEC India. Congratulations.” - Robert Twycross, palliativedrugs.com Ltd.

What Attendees Have Said About Our Conferences

“This has been one of the best conferences I have attended.”

“I think all physicians should be required to attend such a conference. I believe it would make them better practitioners. We would see an increase in family and patient satisfaction.”

“I think it would be hard to attend [the conference] and not be changed by it.”

“The course and material have given me the motivation to get out of my busy office and share with my colleagues from a fund of knowledge I’ve obtained in hospice care for the past 10-12 years.”