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:
- nociplastic
- spinal cord compression
- total
-
Psychological, including:
- anxiety
- depression
- low mood
-
Respiratory, including:
- breathlessness
- cough
- secretions
-
Skin, including:
- breakdown:
- itch
- tumour involvement and fungation
- wounds:
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
- 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
