Entrustable Professional Activities

EPA 12: Comprehensive conservative care

EPA 12

Comprehensive conservative care

Manage the care of patients with kidney failure

This activity requires the ability to:

  • document patients’, families’ and/or carers’ wishes for supportive care
  • support patients, families and/or carers to plan for their advance care and document their own wishes
  • support the transition of patients between treatment modalities based on their care
  • manage symptoms and psychosocial distress to optimise patients’ quality of life
  • preserve residual kidney function and manage non-dialysis pathways and withdrawal from dialysis care
  • manage end-of-life care plans.

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:

  • accurately assess patients’ symptoms, including physical, psychological, and spiritual aspects
  • estimate prognosis and communicate this appropriately, if requested, including the uncertainties around such estimates
  • provide appropriate prescribing and deprescribing of medications based on the patients’ treatment goals
  • work with a multidisciplinary team to treat and reduce the symptoms of kidney failure
  • develop and clearly document individualised advance care plans, including patients’, families and/or carers preferences for treatment options, resuscitation plans, preferred place of care, and preferred place of death
  • provide holistic symptom management focusing on physical and psychological distress according to patients’, families’ and/or carers’ wishes
  • avoid unnecessary investigations or treatments, ensuring physical and psychosocial support
  • review the goals of care and treatment plans with patients, family and/or carers if significant changes in patients’ conditions or circumstances occur
  • recognise and manage the terminal phase in a timely way

direction
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 who are not undertaking kidney replacement therapies
  • provide timely assessment and document patients’ care plans
  • manage physical symptoms in alignment with patients’, families and/or carers’ wishes
  • take steps to alleviate patients’ symptoms and distress
  • correctly identify patients approaching the end of life, and provide symptomatic treatment
  • adequately manage patients in their terminal phase

Communication

confident
Ready to perform without supervision

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

The trainee will:

  • establish supportive relationships with patients and their families and/or carers based on understanding, trust, empathy, and confidentiality
  • explore thoughtfully patients’ concerns across physical, psychological, and cultural domains
  • identify opportunities to discuss end-of-life care, aligning it with the values and preferences of patients, their families and/or carers Communication PCH
  • identify proxy decision makers patients’ wish to be involved in discussions about end-of-life care
  • identify and document lists of close family members and/or carers, and develop support plans for them
  • provide bereaved families and/or carers with written information about access to bereavement support
  • communicate effectively and in a timely manner with other health professionals involved in patients’ care, including GPs and other consultants
  • discuss the withdrawal of dialysis with patients and their families and/or carers

  • PCH

    • recognise when a follow-up consultation is required following the death of a child

direction
Requires some supervision

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

The trainee may:

  • discuss with patients, families and/or carers the goals of care and treatment, and document this in patients’ clinical records
  • discuss with patients, families and/or carers the benefits and risks of conservative kidney management for appropriate patients
  • ensure consistent messages are given to patients, families and/or carers about treatment options, their likelihood of success, risks, and prognosis
  • provide an honest and clear clinical assessment summary of the situation using plain language, avoiding medical jargon
  • discuss with family and/or carers appropriate support and bereavement care

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:

  • conduct medication chart safety audits, multidisciplinary mortality and morbidity reviews, and provide feedback to colleagues
  • develop monitoring and evaluation strategies to capture feedback about the quality of care from multidisciplinary team members, patients, families and/or carers
  • review all deaths to determine the safety and quality of patients’ end-of-life care and how it could be improved
  • review technological systems and processes that support safe, high-quality end-of-life care

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 documented wishes of patients, families and/or carers

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:

  • provide supervision, support, and teaching to develop the skills of junior colleagues on end-of-life care
  • recognise feelings of moral distress and burnout in themselves and colleagues
  • reflect on personal practice and use this process to guide continuing professional development
  • ensure all members of multidisciplinary teams receive education on their roles and responsibilities for managing end-of-life care
  • promote education covering:
    • ethical and medicolegal issues
    • relevant legislation in the state, territory, or region
    • competencies for providing culturally responsive end-of-life care to Aboriginal and Torres Strait Islander and Māori peoples, and to people from other cultural backgrounds

direction
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 of end-of-life care management
  • 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:

  • ensure that quality end-of-life care management processes are evidence based and outcome focused
  • use systematic reviews or personal reviews and appraisal of the literature, as evidence for the appropriate management
  • support clinical trials 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 medicine based on understanding the personal, historical, and cultural influences on patients, families and/or carers
  • develop strategies for identifying culturally appropriate decision makers and the role of family, obtaining their input into discussions of patients’ end-of-life care
  • offer support to patients, families and/or carers to include cultural or religious practices in 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, families and/or carers, regardless of their culture and religious beliefs
  • support patients, families and/or carers 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:

  • ensure all team members discuss end-of-life care with patients, families and/or carers, and act on expressed preferences
  • enhance the quality of life for patients before death by minimising pain and suffering caused by ineffective treatments
  • recognise the complexity of ethical issues related to human life and death, when considering the allocation of scarce resources

direction
Requires some supervision

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

The trainee may:

  • ensure that information on advance care plans, treatment plans, goals of care, and patients’ treatment preferences is available to all involved in patients’ care
  • ensure patients’ dignity is preserved
  • respond appropriately to distress or concerns from patients, families and/or carers, or colleagues

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:

  • maximise patients’ autonomy and their best interests when making treatment decisions
  • liaise with other relevant services and provides referral as necessary
  • tailor care in older persons’ chronic kidney disease (CKD)

direction
Requires some supervision

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

The trainee may:

  • define and document patients’, families’ and/or carers’ goals and agreed outcomes
  • assess adherence to treatment and monitoring plans
  • assess the health literacy of patients, families and/or carers

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:

  • ensure care plans are communicated to all teams involved in patients’ care, including relevant community care providers
  • define the roles and responsibilities of team members involved in patients’ care
  • achieve agreement between multidisciplinary teams about patients’ treatment options
  • coordinate care and support to be provided in patients’ preferred place of care
  • effectively manage personal challenges of dealing with death and grief

direction
Requires some supervision

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

The trainee may:

  • coordinate end-of-life care to minimise fragmentation of care
  • document multidisciplinary care plans, including the terminal phase

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
  • manage 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 palliative care needs or with inequitable access to palliative care services

direction
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 in their preferred place of death