Common symptoms
- Anorexia / Cachexia
- Constipation
- Delirium
- Diarrhoea
- Dry mouth
- Dyspnoea
- Fatigue
- Nausea
- Pain
- Secretions – terminal
- Sleep disturbance
- Vomiting
Emergencies at the end of life
- Agitation, severe
- Airway obstruction, terminal
- Haemorrhage, terminal
- Opioid toxicity
- Seizures
- Severe pain, acute
- Spinal cord compression
- Superior vena cava obstruction
Uncommon symptoms
- Hiccups
- Itch
- Neoplastic fever
Psychosocial and spiritual considerations
- Existential distress
- Family response to illness
- Grief and bereavement, such as:
- anticipatory
- complicated reactions
- Psychological response to illness, such as:
- anxiety
- complicated grief
- depression
- existential distress
- suffering
- Religious needs at the end of life, such as:
- decision making in accordance with religious beliefs
- religious beliefs about death and afterlife
- various religious rituals and practices
- Spiritual concerns, such as:
- loss of meaning and purpose
- spiritual distress and suffering
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
Clinical considerations
- Anticipatory prescribing at the end of life
- Complex family discussions at the end of life
- Investigations at the end of life
- Monitoring at the end of life
- Options for place of care at the end of life
- Practical aspects of syringe drivers and other subcutaneous infusion devices
- Supplemental oxygen at the end of life
Self-care in palliative care
- Managing own emotion and grief
- Personal impact of dealing with incurable illness, death, and dying
- Physician burnout
Ethical and legal issues
- Advance care planning and advance care directives
- Capacity and capacity assessment
- Consent
- Coroner’s cases and the Coroners Act
- Legal protections for administration of pain relief and sedation at the end of life
- Nutrition and hydration at the end of life
- Palliative sedation
- Quality-of-life decision making at end of life
- Substitute decision making and legal requirements under guardianship legislation
- Treatment refusal
- Veracity and duty of disclosure
- Verification and certification of death
- Voluntary assisted dying
- Withdrawal and/or withholding of treatments, including:
- futile therapies
- life sustaining treatments, such as:
- artificial feeding
- blood product transfusions
- dialysis
- oxygen and/or ventilatory support
