"The information that I gained from these modules has completely changed my thinking on how palliative care can be used and integrated into the care and management of my patients with symptomatic chronic disease and not reserved only for the end of their life."

Continuing Education » Module 2 Overview

Module 2: Ethical and Clinical Decision-Making in Advanced Disease

  • Pamela Lynn Mahan DSN, RN
  • Catherine Gilbert EdD, RN


The predictable dynamics that occur in advanced disease are similar to those found in acute illness. However, the distinction comes from the understanding of when to consider advanced disease as being non-reversible or beyond a "cure" (i.e. post curative). Acute illness often responds favorably to aggressive traditional bio-medical interventions. Yet, these same interventions when used in advanced or chronic disease can often be burdensome and/or problematic for the patient with little or no therapeutic benefit. This is not to say that advanced disease cannot be treated, but rather treatment options require a shift in focus. This shift occurs from the aggressive management of the disease itself to one that manages the clinical manifestations (symptoms) of the disease which often raise many ethical issues for health care providers when considering clinical decisions. For example, a patient with stage-four lung cancer with metastatic liver disease may be better served by managing the side effects of his or her treatment and the associated symptoms from the disease such as pain, shortness of breath, anxiety and/or pruritus.

This module will discuss the concept of the disease trajectory and when to consider integrating palliative interventions into the patient's plan of care and the ethical issues that may occur when considering course of treatment and care alternatives for patients receiving or in need of palliative care.


Upon completion of this module, the reader will be able to:

  1. Discuss a case example that describes the difficulties surrounding a life-limited diagnosis and the integration of palliative interventions
  2. Describe how the "disease trajectory" impacts upon clinical decision-making
  3. Describe how bioethics impacts clinical decision making in advanced disease and palliative care
  4. Explain the differences between traditional bio-medical interventions and palliative care.

Average Test Duration: 1.25 hrs

  1. Begin Ethical and Clinical Decision-Making in
    Advance Disease Module
  2. Take Test