Key presentations and conditions
Basic Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Presentations
- Constipation
- Dyspnoea
- Nausea
- Pain
- Tracheobronchial secretions
- Vomiting
Conditions
- End-of-life phase
- Terminal delirium
- Terminal restlessness
For each presentation and condition, Basic Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, pathophysiology, and clinical science
- take a relevant clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients1 and their quality of life
Manage
- provide evidence-based management
For less common or more complex presentations and conditions the trainee must also seek expert opinions - 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
Less common or more complex presentations and conditions
Basic Trainees will understand these presentations and conditions. Basic Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Presentations
- Seizures
Conditions
- Bowel obstruction, malignant
- Depression in patients nearing end of life
For each presentation and condition, Basic Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, pathophysiology, and clinical science
- take a relevant clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients1 and their quality of life
Manage
- provide evidence-based management
For less common or more complex presentations and conditions the trainee must also seek expert opinions - 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
Epidemiology, pathophysiology and clinical sciences
Basic Trainees will describe the principles of the foundational sciences.
- Blood chemistry changes that occur during dying phase
- Conversion calculations between opioids, including but not limited to:
- fentanyl
- morphine
- oxycodone
- Indications for use of corticosteroids in situations, such as:
- bowel obstruction
- cerebral oedema from metastatic disease
- hypercalcaemia and bone pain
- wellbeing and appetite stimulation
- Opioid dose conversions from parenteral to oral or transdermal routes
- Pathophysiology of pain:
- neuropathic
- nociceptive
- non-nociceptive
- Pharmacology of analgesics and other agents used to treat major symptom complexes
- Symptoms and signs of opioid toxicity and opioid induced hyperalgesia
Investigations, procedures and clinical assessment tools
Basic Trainees will know the indications for, and how to interpret the results of these investigations, procedures, and clinical assessments tools. Basic Trainees will know how to explain the investigation, procedure, or clinical assessment tool to patients, families, and carers.
Procedures
- Subcutaneous infusion pump (know how and when to prescribe)
Clinical assessment tools
- Tools to assess pain or distress in an unconscious or reduced level of consciousness in patients, such as the Abbey Pain Scale
Important specific issues
Basic Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management.
- Assessment of psychological, cultural and spiritual needs of the patients, families, and carers
- Compassion towards those who can no longer be ‘cured’
- Cultural aspects related to death, dying, and handling of the deceased in different cultures and religions, such as Māori and Aboriginal and Torres Strait Islander peoples, Muslim people, Buddhist people, and Hindu people
- Ethical principles involved in care of dying patients, particularly in relation to:
- advanced care directives
- advocacy
- beneficence versus non-maleficence
- organ donation
- Importance and meaning of resuscitation orders
- Importance of recognising disease trajectories and anticipating when patients are nearing end-of-life phase
- Importance of respecting patients’ dignity at the end of their life
- Importance of respecting the wishes of patients, families, and carers
- Medicolegal aspects of end-of-life care:
- consent
- futility
- proxy decision makers
- Withdrawal of life-prolonging treatments, such as artificial nutrition and hydration, antibiotic treatment, or supplemental oxygen
- References to patients in the remainder of this document may include their families or carers.