Palliative Care

Core Generalist#

Knowledge#

CG.K.1#

Discuss the aims of Palliative Care

CG.K.2#

Describe the range of terminal illnesses where a palliative approach is appropriate, including malignancy, neurodegenerative disease, organ failure, frailty, dementia, HIV/AIDs

CG.K.3#

Identify patients at risk of dying in the next 12 months who may benefit from a Palliative Care approach

CG.K.4#

Identify Medicare benefit schedule items to sustainably practise equitable palliative care

CG.K.5#

Identify features of a patient who is actively dying at the end-of-life

CG.K.6#

Know how to access specialist palliative care support for patients

CG.K.7#

Identify bereavement support organisations, within their community, the role of specialist, psychological services and indicators for their referral.

CG.K.8#

Explain definitions, physiology and concepts of pain and pain management

CG.K.9#

Discuss Wills, Advanced Care Directives, Power of Attorney financial/medical, Enduring Guardian

CG.K.10#

Identify the legal requirements for the certification of death, including burial, cremation and reporting of death to the Coroner

CG.K.11#

Identify the legal (and ethical) provision of terminal care at end of life, including the ‘doctrine of double effect’, the illegal status of euthanasia, and the status of voluntary assisted dying (legal status differs in different States/Territories)

Skills#

CG.S.1#

Use appropriate tools to identify patients who may benefit from palliative care (‘surprise question’, indicators of decline, SPICT, GSF-PIG, RADPAC)

CG.S.2#

Anticipate and minimise potential problems caused by either the disease or treatments

CG.S.3#

Undertake a comprehensive pain assessment including assessment of types of pain: nociceptive, non-nociceptive, acute, chronic; and the impact of psychological factors on the pain experience

CG.S.4#

Manage pain in palliative care patients, appropriately utilising:

pharmacological options:
- non-opioid analgesics
- opioids
- adjuvants
- NSAIDS
- antidepressants
- local anaesthetic agents
- corticosteroids
- antispasmodics
- anticonvulsants
- antiarrhythmics
- anxiolytics
- nerve-blocking procedures, epidural/spinal injections
non-pharmacological options
physical therapies (eg massage, heat and cold therapy, transcutaneous electrical nerve stimulation [TENS], physiotherapy)
mind-based techniques (eg relaxation, meditation, mindfulness, psychologist)
optimising environment (positioning, aromatherapy, music therapy, occupational therapy, diversional therapy)
radiotherapy

CG.S.5#

Use opioid conversion guidelines when changing opioid drug therapy

CG.S.6#

Recognise and provide support for the psychosocial and spiritual needs of patients and their family

CG.S.7#

Assist patients with establishing Advanced Care Directives

CG.S.8#

Determine the cause of, and manage common problems experienced by palliative care patients

CG.S.9#

Perform the following:

CPAP/BIPAP
Spirometry and peak flow measurement
Nebulisation therapy
Supplemental oxygen delivery devices
Oxygen concentrators

CG.S.10#

Continue to be responsible for the patient after death and be an advocate for the family and friends during their time of grief

Attributes#

At.6#

Compassion

At.7#

Empathy

At.5#

Commitment

Advanced Specialised#

Knowledge#

AS.K.1#

Discuss indicators of disease progression

AS.K.2#

Discuss implications of hepatic and renal impairment

AS.K.3#

Identify potential treatment interactions

AS.K.4#

Discuss dose adjustment and de-prescribing principles for commonly used medications with frail, elderly, children, altered metabolism, organ failure, end of life

AS.K.5#

Describe commonly used palliative care medications: routes of administration, absorption, excretion, metabolism, half-life, usual frequency of administration, toxicity and adverse effects and their management, use in syringe drivers, interactions with other medications, possibility of tolerance, dependence, addiction and discontinuation syndromes

AS.K.6#

Discuss the prevention and management of overdose

AS.K.7#

Compare pain types, including somatic, visceral, neuropathic and incident

AS.K.8#

Discuss pain syndromes including plexopathies, central sensitisation

AS.K.9#

Explain principles of spinal analgesia and use of epidural and intrathecal catheters and infusion pumps

AS.K.10#

Describe common nerve blocks and neurosurgical procedures

AS.K.11#

Discuss emotional issues involved in pain management

AS.K.12#

Discuss Palliative Surgery/ Radiotherapy/ Chemotherapy

AS.K.13#

Describe the management of biochemical abnormalities in the terminally ill

AS.K.14#

Describe management of the emergencies that occur in the palliative care setting: severe pain/pain ‘crisis’, acute dyspnoea, airway obstruction, acute anxiety, acutely suicidal patient, cardiac tamponade, massive haemorrhage, superior vena caval obstruction, spinal cord/cauda equina compression, fractures, sepsis, seizures, brain herniation/coning, acute dystonia, substance overdose, opioid toxicity, acute withdrawal syndromes, Addisonian crisis, carer’s crisis – unable to cope

AS.K.15#

Discuss the signs of approaching death

AS.K.16#

Identify the needs of patients and families in regards illness, death and bereavement

AS.K.17#

Detail therapeutic interventions in minimising psychological distress including counselling, behavioural therapy, group activities, relaxation/meditation, imagery/visualisation and creative therapies

Skills#

AS.S.1#

Integrate a supportive component into all aspects of providing palliative care

AS.S.2#

Communicate the benefits and burdens from investigations, interventions and non-intervention to patient and carers

AS.S.3#

Order and/or perform diagnostic tests where required to confirm disease progression, monitor medical care and/or exclude treatable conditions

AS.S.4#

Respect the need for maintenance of autonomy by giving the patient and family a central role in determining treatment

AS.S.5#

Formulate a management plan for symptom management in concert with the patient and/or carer, judiciously applying best evidence and the advice of expert colleagues

AS.S.6#

Respond appropriately to any negative outcomes of terminal illness on patients and carers, including the loss of independence, role, appearance, sexuality and perceived self-worth

AS.S.7#

Use validated assessment tools for symptoms and pain

AS.S.8#

Set realistic pain management goals in consultation with the patient and their family

AS.S.9#

Ensure safe and appropriate prescribing of pharmacological and non–pharmacological treatment options in the palliative care context

AS.S.10#

Respond to and explore emotional cues/concerns with patients and their families, including fear, anger, guilt, uncertainty, sadness and despair

AS.S.11#

Respect the patient’s and carer’s beliefs, needs and wishes regarding the end of life care

AS.S.12#

Maintain a plan of food and fluids relevant to patient condition and patient and family wishes

AS.S.13#

Manage stomas, tracheostomies, gastrostomies, nasogastric tubes, urinary and suprapubic catheters, implanted ports, PICC and central venous lines

AS.S.14#

Recognise and respond early to the deteriorating patient to ensure patient and carer’s end of life wishes may be accommodated

AS.S.15#

Interpret the complete clinical picture to estimate prognosis

AS.S.16#

Stabilise critically ill patients and provide primary and secondary care if consistent with Advanced Care Directives

AS.S.17#

Develop and apply strategies for self-care, to manage the challenges of dealing with death and grief