Knowledge guides

LG 15: End-of-life and after-death care

Clinical sciences

Advanced Trainees will describe the principles of the foundational sciences.

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Eligibility considerations

Advanced Trainees will assess the patient’s current condition and plan the next steps.

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Less common or more complex patient considerations

Advanced Trainees will understand the resources that should be used to help manage patients.

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Undertaking therapy

Advanced Trainees will monitor the progress of patients during the therapy.

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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.

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  • Agitation / Restlessness
  • Breathing changes, including:
    • breathing pattern
    • secretions
  • Changes in conscious state
  • Changes in perfusion
  • Changes specific to clinical conditions, including:
    • terminal airway obstruction (e.g. secondary to mediastinal mass)
    • terminal haemorrhage (e.g. secondary to coagulopathy)
  • Incontinence and changes in bowel habit
  • Reduced enteral intake
  • Seizures (e.g. Batten disease)
  • Children’s understanding and response to illness and grief
  • Existential distress, including emotional and psychological aspects of grief
  • Family contexts and communication styles, including:
    • mutual pretence
    • open versus closed awareness contexts
  • Grief and bereavement risk assessment and care
  • Spiritual needs and concerns, such as religious needs at end of life
  • Meaning-making and legacy creation
  • Anticipatory prescribing for potential ‘catastrophic events’:
    • sedation for terminal bleeding
  • Medication administration at end of life:
    • continuous subcutaneous infusions
  • Non-pharmacological management for symptoms at end of life, including:
    • aromatherapy
    • massage
  • Pharmacological management for symptoms at end of life:
    • agitation / restlessness:
      • anti-psychotics
      • benzodiazepines
    • breathlessness:
      • benzodiazepines
      • opioids
    • pain:
      • adjuvant agents
      • opioids
    • nausea / vomiting:
      • 5HT3 antagonists
      • dopamine antagonists
    • secretion, such as anticholinergics
  • Cultural and/or religious considerations, including:
    • rituals for washing
    • timing of burial
  • Local services and resources to assist with finances, including:
    • funeral funds
  • Options for location of care post-death, including:
    • processes to have a child remain at home for a period post-death
    • temperature regulated room in a hospice
  • Organ and tissue donation if available / appropriate
  • Physical changes that occur post-death
  • Role of the coroner, including reportable and reviewable deaths
Clinical considerations
  • Anticipatory prescribing
  • Complex family discussions, encompassing 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
  • Coroner’s cases and the Coroners Act
  • Disagreement between families and clinicians about treatment decisions
  • Disagreement within families about treatment decisions
  • Terminal sedation
  • Verification and certification of death
  • Withdrawal and/or withholding of life-sustaining treatment
Self-care in palliative care
  • Personal impact of dealing with incurable illness, death, and dying
  • Physician burnout