Curriculum standards
Entrustable Professional Activities
LG 12: End-of-life care
End-of-life care
Plan for and manage the end-of-life and after-death care of patients
This activity requires the ability to:
- diagnose the deteriorating and terminal palliative care phases
- assess patients’ readiness to have conversations about the end-of-life stage
- support patients to plan for end-of-life care through prognostic and advance care planning conversations
- develop management plans in anticipation of the deteriorating and terminal phases of illnesses
- assess patients’ and their families’, whānau, and/or carers’ preferences for location of end-of-life care, and the planning required and feasibility of these preferences
- assess families’ coping and support levels, and tailor additional supports as needed in the last weeks of patients’ lives
- support psychosocial assessments of families’ capacity to integrate grief into their lives, i.e. assess risk and protective factors for complicated grief after the death of a child
- formulate plans for bereavement follow-up, in particular who or which organisation will do this, and when it will occur
- consult families about after-death options for care
- adapt one’s own reactions to death and loss
Professional practice framework domain
Medical expertise
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- incorporate medical acumen and experience in advance care planning conversations to elucidate patients' preferences for end-of-life care
- use medical acumen and experience to assess patients’ stages of illness to diagnose when they may be, or are, in the last weeks of life
- incorporate medical knowledge about disease processes and anticipated symptoms, along with an understanding of resources and local options, to consider and plan for the appropriate location for end-of-life care, such as home, hospice, or hospital
- formulate goals of care and resuscitation plans in conjunction with patients, family members, and other health professionals as appropriate, to ensure that care is aligned with illness stage and prognosis
- formulate holistic care and symptom management plans that encompass emotional, physical, psychological, and social needs
- tailor management plans to the site of care, ensuring end-of-life care can be expertly managed across a variety of clinical settings, including home, hospice, and hospital
- incorporate the needs of significant others in care planning for the end of life, including parents, siblings, grandparents, peers, schools, and the community
- recognise and manage the terminal phase (last days of life) in a timely manner, recognising that this can be particularly challenging in non-malignant illness contexts
- manage the potential risks and provide support during times of loss and grief
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- demonstrate an understanding of the principles of care for patients at the end of their lives
- provide timely assessment and document patients’ care plans
- manage physical symptoms in alignment with patients’ wishes
- take steps to alleviate patients’ symptoms and distress
- correctly identify patients approaching the end of life
- adequately manage patients in their terminal phase
Communication
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- identify family preferences and communication styles to inform who should be involved in discussions about end of life
- explore patients’, their families’, whānau, and/or carers’ wishes and readiness to inform about prognosis, dying, and after-death processes
- provide bereaved families with written information about access to bereavement support in accordance with local and institutional guidelines and resources
- collaborate and communicate with other health professionals, including community palliative care services or other treating teams, to ensure safe, quality, and timely care is provided to patients
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- discuss with patients the goals of care and treatment, and document these in patients’ clinical records
- ensure consistent messages are given to patients about treatment options, their likelihood of success, risks, and prognosis
- provide honest and clear clinical assessment summaries of situations, using plain language and avoiding medical jargon
- discuss with family or carers appropriate support and bereavement care
Quality and safety
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- contribute to quality assurance and evaluation strategies around end-of-life care, including clinical audits and death reviews
- participate in morbidity and mortality meetings
- develop strategies to obtain feedback about the provision of end-of-life care from multidisciplinary team members and patients
- review technological systems and processes that support safe and high-quality end-of-life care
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- collect and review data on the safety and effectiveness of end-of-life care delivery
- communicate the content of discussions about prognosis and advance care planning to multidisciplinary teams
- ensure that actual care is aligned with patients’ documented wishes
Teaching and learning
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- regularly self-evaluate personal clinical practice around end-of-life care
- seek feedback from colleagues on their own clinical practice
- address gaps in knowledge and skills about end-of-life care through self-directed learning and continuing professional development
- supervise junior colleagues in managing end-of-life care
- use teaching opportunities arising from the provision of end-of-life care
- participate in education development and provision about end-of-life care for non-paediatric palliative care professionals, including adult-based community palliative care services, and generalist paediatric, nursing, and allied health teams
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- participate in education on disease-specific symptom assessment and evidence-based symptom management
- participate in upskilling in best practice end-of-life care management
- encourage junior colleagues to participate in multidisciplinary case reviews, mortality and morbidity meetings, and adverse event reviews
Research
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- apply relevant literature and evidence-based guidelines to the provision of end-of-life care
- support and participate in research to build the paediatric end-of-life care evidence base
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- recognise that the evidence may be insufficient to resolve uncertainty and make definitive decisions
Cultural safety
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- practise culturally responsible end-of-life care based on understanding preferences and priorities of patients and their families, whānau, and/or carers
- develop strategies for supporting culturally appropriate decision making in end-of-life care, such as obtaining input from cultural or religious community leaders
- incorporate cultural and religious preferences in end-of-life and after-death care plans
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- understand, respect, and respond to individual preferences and needs of patients, regardless of their culture and religious beliefs
- support patients with communication difficulties associated with cultural and linguistic diversity
Ethics and professional behaviour
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- identify and employ ethical principles in the provision of end-of-life care, such as autonomy, beneficence, justice, and non-maleficence
- incorporate ethical and legal considerations into end-of-life care plans
- identify and address moral distress and burnout when providing end-of-life care, both for self and colleagues
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- share information on advance care plans, treatment plans, goals of care, and patients’ treatment preferences with wider care teams
- ensure patients’ dignity is preserved
- respond appropriately to distress or concerns of colleagues and patients
Judgement and decision making
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- explain reasoning behind decision making in the provision of end-of-life care
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- define and document patients’ goals and agreed outcomes
Leadership, management, and teamwork
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- work effectively with health professionals from all disciplines to provide optimal end-of-life care, both within and external to the palliative care team
- delegate roles and responsibilities for the provision of end-of-life care among health professionals, both within and external to the palliative care team
- coordinate care and support to provide end-of-life care in patients’ and their families’, whānau, and/or carers’ preferred place of care, as feasible
- coordinate and appropriately delegate bereavement care
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- document multidisciplinary care plans, including the terminal phase
Health policy, systems, and advocacy
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- participate in developing frameworks for organisational policies and procedures about end-of-life care, such as advance care planning procedures and prescribing medications at the end of life
- allocate resources according to the organisational strategic plan to support systems for effective delivery of end-of-life care
- advocate for the needs of individual patients, social groups, and cultures within the community who have specific needs or inequitable access to tailored high-quality and safe end-of-life care
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- allocate scarce health care resources effectively
- support community-based service providers to build capacity for people to be cared for in their preferred place of death