Curriculum standards
Knowledge guides
LG 13: Symptom management
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They may order initial investigations, and will be able to interpret the reported results of each investigation or procedure, including those arranged by the primary treating team.
Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.
Presentations
- Agitation
- Breathlessness
- Nausea / Vomiting
- Pain
- Secretions
Conditions
- Gastrointestinal, including:
- anorexia / cachexia
- bowel obstruction, malignant
- constipation
- diarrhoea
- feeding intolerance
- hiccups
- mouth care
- mucositis
- nausea and vomiting
- xerostomia
- Neurological, including:
- agitation
- delirium
- dystonia
- headaches
- increased intracranial pressure (ICP)
- irritability
- muscle spasm
- myoclonus
- seizures
-
Other, including:
- fatigue
- insomnia
- sweating
-
Pain, including:
- background
- bone, malignant
- breakthrough versus incident
- crises
- neuropathic
- nociceptive:
- somatic
- visceral
- nociplastic
- spinal cord compression
- total
-
Psychological, including:
- anxiety
- depression
- low mood
-
Respiratory, including:
- breathlessness
- cough
- secretions
-
Skin, including:
- breakdown:
- epidermolysis bullosa
- itch
- tumour involvement and fungation
- wounds:
- pressure ulcers
- breakdown:
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Presentations
- Haemorrhage, catastrophic
- Hypercalcaemia, malignant
- Pain crisis
- Seizure
- Spinal cord compression, malignant
- Superior vena cava obstruction
- Terminal restlessness / delirium
- Upper airways obstruction
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Pharmacology
- Analgesic agents, including:
- adjuvant:
- alpha adrenergic agonists
- dexamethasone
- gabapentinoids
- ketamine
- paracetamol
- selective serotonin noradrenaline reuptake inhibitors
- tricyclic antidepressants
- non-steroidal anti-inflammatory agents
- opioids:
- fentanyl
- hydromorphone
- methadone
- morphine
- opioid rotations
- oxycodone
- adjuvant:
- Anti-emetic agents
- Anti-secretory agents
- Anxiolytic / Sedative agents
- Bisphosphonates
- Non-pharmacological symptom management options
Clinical assessment tools
- Tailored to pathophysiology, prognosis, and goals of care
- Symptom assessment scales for verbal and nonverbal patients:
- face, legs, activity, cry, and consolability (FLACC) scale
- numerical rating
- Wong–Baker Faces
Investigations
- Blood tests
- Imaging
- Tailored to pathophysiology, prognosis, and goals of care
Symptom-related procedures
- Pain control procedures, including:
- intrathecal analgesia
- nerve root injection
- Patient-controlled analgesia
- Radiotherapy
- Subcutaneous infusion
Disease- or syndrome-specific procedures (understanding of the indications, benefits, and burdens of disease-related procedures, including the following)
- Cardiac:
- disease
- surgery for congenital cardiac disease
- ventricular assist device insertion
- Gastrointestinal:
- nasogastric insertion
- percutaneous gastrostomy
- Neurological:
- baclofen pump insertion
- cerebrospinal fluid diversion
- Orthopaedic
- Renal:
- renal replacement therapy
- Respiratory:
- non-invasive ventilation
- oxygen therapy
- tracheostomy
- video-assisted thoracic surgery (VATS) and pleurodesis in the setting of recurrent malignant pleural effusions
- Surgical interventions:
- fracture fixation in the setting of osteopenia of disability
- scoliosis surgery in the setting of severe neurodisability
Clinical considerations
- Anticipatory prescribing
- Complex family discussions, encompassing the priorities and goals of care of patients, their families, whānau, and/or carers
- Investigations and monitoring in the context of illness stage and goals of care
- Options for place of care
- Patients’ and their families’, whānau, and/or carers’ preferences for communication and degree of:
- information shared
- involvement in decision making
- Uncertainty in prognosis and trajectory
- Understanding and having treatment strategies for the psychosocial effects and psychosocial drivers of symptoms
Ethical and legal issues
- Advance care planning
- Capacity assessment in the young person
- Disagreement between families and clinicians about treatment decisions
- Disagreement within families about treatment decisions
- Nutrition and hydration in the context of illness stage and goals of care
- Terminal sedation
- Withdrawal and/or withholding of life-sustaining treatment
Procedures
- The understanding and ability to communicate the relative risks and burdens to children and families
- Informed consent
Self-care in palliative care
- Personal impact of dealing with incurable illness, death, and dying
- Physician burnout