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Domain – Palliative care (guiding topics)
- Have a comprehensive understanding of important medico-legal issues concerning palliative care, end-of-life care and terminal illness relevant to your state or territory, including:
- advance care planning and advance care directives
- informed consent and substitute decision-makers
- substitute decision-makers and processes of healthcare decision-making
- medical certification of cause of death (death certificates) and cremation certificates
- prescription, administration and storage of Schedule 8 medications (eg opioids).
- Initiate advance care planning conversations with patients, to empower patients to have autonomy and dignity throughout their lives, wherever possible, and to have a say in what happens to their bodies after and around death.
- Perform an assessment of a person living with a serious, life-limiting illness to identify their care needs, and using shared decision-making, design and document a care plan, including (but not limited to):
- community palliative care
- pastoral care
- tertiary palliative care services
- allied health
- other appropriate non-GP specialist care; for example, oncology services, renal services
- grief and bereavement services.
- Perform a comprehensive pain assessment of a person with palliative care needs, including identifying the likely mechanisms underlying the pain, and any aetiological, precipitating and exacerbating factors. And identify potential management and treatment options for the pain, and collaboratively decide on a treatment plan with the patient. These options may include:
- opioid medication
- non-opioid and adjuvant medication
- physical therapies
- psychological treatments and therapies
- radiotherapy and other disease-modifying treatments.
- Assess a person receiving palliative care experiencing agitation, anxiety and/or existential distress or suffering, including identifying any possible predisposing, precipitating and perpetuating factors for the distress, and also what self-coping and protective/supportive factors are being employed or are already in place.
- Be mindful of and consider the person’s cultural, spiritual and religious beliefs, values and background and their community context, appreciating the difference between religion and spirituality and the wide diversity of cultural perspectives between and within communities.
- Identify potential management and treatment options for the distress, including both pharmacological and non-pharmacological strategies, and collaboratively decide on a treatment plan with the patient, involving their support network where appropriate and with consent.
- Assess a person receiving palliative care experiencing nausea or vomiting, including identifying the likely underlying mechanisms involved, and any aetiological, precipitating and exacerbating factors that can be ascertained.
- Identify potential management and treatment options for the nausea/vomiting, including both pharmacological and non-pharmacological strategies, and collaboratively decide on a treatment plan with the patient.
- Assess a person receiving palliative care experiencing other symptoms, including those that are complex and difficult to treat, and identify when to refer to specialist palliative care services. These other symptoms might include:
- dyspnoea or shortness of breath
- restlessness or agitation
- cough
- cachexia and anorexia
- fatigue
- excessive secretions
- pruritis/itch
- Develop an understanding of foundational palliative medicine skills and knowledge when caring for children with terminal illness, and an awareness of paediatric palliative care services.
- Demonstrate effective and advanced communication skills using compassion, empathy and respect for human dignity, privacy and autonomy, and involve family and caregivers appropriately and sensitively, with consent. This includes challenging and difficult conversations and consultations in palliative care; for example:
- shared decision-making (eg advance care planning)
- discussing prognosis
- breaking ‘bad news’
- facilitating end-of-life decisions
- supporting people experiencing grief and loss
- supporting people experiencing existential distress or anxiety.
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