Entrustable Professional Activities

LG13: End-of-life care

Learning Goal 13

End-of-life care

Manage the care of patients in the terminal phase / last days of life

This activity requires the ability to:

  • diagnose dying
  • support patients to plan for end-of-life care
  • plan for end-of-life care, taking into account preferences for location of care, cultural and spiritual needs, and the feasibility of these preferences
  • assess families’, whānau, and carers’ needs, and tailor additional supports in the last weeks of patients’ lives
  • facilitate assessment of bereavement risks as part of the multidisciplinary team, and formulate plans for bereavement follow-up
  • adapt one’s own reactions to death and loss

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • formulate comprehensive management plans for care at the end of life, including physical, psychosocial, and spiritual domains
  • plan for and manage end-of-life care across a variety of clinical settings, including home, hospital, and residential aged care
  • diagnose dying across a range of malignant and non-malignant conditions
  • ensure support for family members and/or carers and significant others is incorporated into management plans for end-of-life care
  • discuss requests for voluntary assisted dying

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • manage common symptoms at the end of life
  • manage common psychosocial and spiritual issues at the end of life
  • require supervisor input to comprehensively manage end-of-life care, including uncommon and complex issues

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • discuss end-of-life care with patients in line with their wishes for information, and document this in clinical records
  • communicate with other health professionals and members of the multidisciplinary team regarding end-of-life care as needed
  • discuss with family and/or carers appropriate support and bereavement care
  • facilitate family meetings
  • respond to verbal and nonverbal cues and emotions

direction
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 this in clinical records
  • provide honest and clear clinical assessment summaries of situations, using plain language and avoiding medical jargon
  • identify proxy decision makers and patients’ wishes for them to be involved in discussions about their end-of-life care
  • explore patients’ concerns at the end of life across cultural, physical, psychological, and spiritual domains

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • contribute to monitoring and evaluation strategies around the provision of end-of-life care, including clinical audits
  • analyse adverse incidents and sentinel events to identify system failures and contributing factors
  • identify evidence-based practice gaps using clinical indicators, and implement changes to improve patients’ outcomes
  • contribute to multidisciplinary mortality and morbidity meetings

direction
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

confident
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 and learners on their own clinical practice
  • address gaps in knowledge and skills 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
  • facilitate education on end-of-life care for non-palliative care specialists

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • encourage junior colleagues to participate in multidisciplinary case reviews, mortality and morbidity meetings, and adverse event reviews

Research

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • apply relevant research literature and evidence-based guidelines to clinical practice in end-of-life care
  • support clinical research to build the end-of-life care evidence base

direction
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

confident
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
  • identify culturally appropriate decision makers
  • offer support to patients to include cultural or religious practices in their care

direction
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

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • recognise the complexity of ethical issues related to human life and death
  • identify and address moral distress and burnout

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • respond appropriately to distress or concerns of colleagues and patients

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • exercise sound judgement in providing end-of-life care, making decisions that uphold the dignity, comfort, and preferences of patients and their families within the limitations of available resources

direction
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

confident
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 the multidisciplinary team and other clinicians to provide optimal end-of-life care
  • provide support in patients’ preferred place of care
  • coordinate end-of-life care to minimise fragmentation of care

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • document multidisciplinary care plans

Health policy, systems, and advocacy

confident
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 advance care planning
  • advocate for the needs of individual patients, social groups, and cultures within the community who have specific palliative care needs or inequitable access to palliative care services
  • allocate health care resources effectivelys

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • support community-based service providers to build capacity for people to be cared for in their preferred place of death