Original Release Date: 11/02/2021
REVIEWED: 12/31/2022
Expires: 12/30/2025
Credit claim for this activity will end at 11:59 PM 12.30.25

Overview: Medical treatment in the last chapter of life is characterized by three major deficits: 

  • Poorly treated pain with up to 50% of patients experiencing poor pain control in the last days and weeks of life 
  • High treatment variability with some patients receiving 3 —6 x as much intensive treatment as others without being sicker or having a better outcome. Those patients receiving this excess treatment are in essence receiving ineffective treatment. There is even some data to support the notion that outcomes are worse in parts of the country with the highest utilization of health care resources in the last 6 months of life. 
  • High costs for this painful and ineffective treatment with approximately of all health care dollars spent in the last year of life. 

Physicians and nurses are directly responsible for trying to improve all three areas of deficit will benefit from participation in this internet enduring series.

Target Audience:  All healthcare workers within the Baylor Scott & White Healthcare System

For further study: JAMA 1995; 274:1591-98e  Riley GF,LubltzJD. Long-Term Trends in Medicare Payments in the Last Year of Life. Health Serv. Res. 2010 45 (2):565576 

Planners/Authors:  This activity was planned, reviewed, edited, and approved for use as the curriculum for the Baylor Scott & White Health organization by: Dr. Robert Fine.

Disclosure of Relevant Financial Relationships: This content is not related to products or business lines of an ACCME-defined commercial interest

Objectives: After participating in this activity, the learner should be able to: 

  • Define culture and the relationship between culture and end of life decisions
  • Follow a framework for cultural understanding in health care
  • Articulate the relationship between faith, spirituality and religion
  • Articulate the relationship between religious and /or spiritual practices and illness or health
  • Use simple questions to learn about a patient's spirituality and faith
  • Use the unique religious or spiritual world view of each patient or family in a respectful manner to better care for the patient at life's end


Accreditation: The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation: The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Meets Texas Requirements for 1.0 Hour of Ethics/Professional Responsibility Credit(s)

Method of Participation & Request for CME Credit:

•Read all instructions and activity information
•View the slides in their entirety
•Complete the post-activity quiz with 100% accuracy.
•Instructions to evaluate and claim credit(s) for the activity will be provided on the final slide of the activity.
•Post activity, Click on the link to be taken to evaluation and credit claim for the course or follow the link sent in an email from  to complete all questions on the evaluation and claim credit.

This CME activity type is an enduring material.  Physicians who complete the enduring material may claim the full amount of credit designated for the activity, regardless of the amount of time it took the physicians to complete the activity.