University Of Calgary Postgraduate Medicine

Palliative Care & End of Life Care Rotation Objectives

1. Identify and effectively manage pain and symptoms in palliative patients

  • Elicit a comprehensive symptom history and perform a relevant and focused physical examination. (CanMEDS-FM Medical Expert and Communicator)
  • Describe the role for symptom screening and performance assessment tools. (CanMEDS-FM Medical Expert)
  • Order and review appropriate lab work and/or imaging and use the information to further individualize the symptom management plan. (CanMEDS-FM Medical Expert)
  • Describe the concepts of function, quality of life and total pain in the context of pain assessment. (CanMEDS-FM Medical Expert)
  • Accurately describe ethics and law that should guide the care of patients at end of life. (CanMEDS-FM Medical Expert and Scholar)
  • Accurately describe ethics and law that should guide the care of patients at end of life. (CanMEDS-FM Medical Expert and Scholar)

2.  Demonstrate an approach to the appropriate and effective use of opioids for pain management and to manage expected opioid-related side effects. (CanMEDS-FM Medical Expert)

  • Incorporate basic principles of opioid prescribing in the development of a pain management plan
  • Prescribe a laxative routinely.
  • Consider prescribing a nausea prevention regimen.
  • Educate patients and families about other possible common side effects and serious toxicities including sedation, myoclonus and delirium.
  • Educate patients and families and identify concerns around issues of opioid addiction, use and misuse, diversion and myths.
  • Recognize: delirium, sedation, respiratory distress.
  • Demonstrates familiarity with the principles of opioid rotation.

3.  Demonstrate an awareness of the role for adjuvant therapies in the management of pain. (CanMEDS-FM Medical Expert and Collaborator)

  • Appropriately utilize the classes of medications commonly used as adjuvants in the management of pain (eg. NSAIDs, anti-convulsants, TCAs)
  • Describe, utilize and/or refer as appropriate for non-pharmacological adjuvant therapies when appropriate (eg. radiotherapy, surgery, spinting, physiotherapy, etc.).

4.  Recognize and appropriately address (initial management) the following palliative care emergencies (CanMEDS-FM Medical Expert)

  • Spinal cord compression
  • Malignant bowel obstruction
  • Hypercalcemia
  • Acute airway obstruction
  • Pain crisis
  • Seizures
  • Urinary obstruction
  • Hemorrhage.

5. Recognize signs and symptoms of impending death, and the care for the imminently dying patient & their family members. (CanMEDS-FM Medical Expert)

6. Demonstrate a patient-family centered approach and management plan for pain and other symptoms ( ie. nausea, constipation, delirium, dyspnea, mood). (CanMEDS-FM Medical Expert and Communicator)

7.  Identify patients' needs within the spiritual or existential domains and address total suffering (physical, psychological, social, spiritual domains of suffering). (CanMEDS-FM Communicator, Medical Expert, Manager)

8. Demonstrate an effective approach to advance care planning. (CanMEDS-FM Communicator and Collaborator)

  • Participate in discussion with patients and families that will identify patients and family's values, goals and priorities and use this to define goals of care.
  • Identify the elements that define "quality of life" for an individual patient living with advanced disease.
  • Identify and address that family members may differ in opinion from the patient when prioritizing these elements.
  • Initiate advance care planning discussions with patients and families and participates in the development of highly specific and detailed advance care plan documents that clearly outline the patient's wishes that will serve to direct care in the event of certain clinical conditions.
  • Describe the elements of substitute decision-making, power of attorney, and living wills.
  • Initiate discussions with patients and their families (treatment choices, location of care and resuscitations decisions).
  • Refer for specialty consultation those patients with complex issues, conflict, questionable cognitive status as appropriate).

9. Demonstrate appropriate skills around family meetings in palliative care. (CanMEDS-FM Communicator and Collaborator)

  • Identify when a family meeting is needed.
  • Identify appropriate glaos for the family meeting.
  • Demonstrate a step-wise approach in leading the meeting.
  • Demonstrate techniques for mediating intra-family or family-health care team conflict.
  • Document the course & outcome of the family meeting in the medical record

10.  Communicate and collaborate effectively with other members of the health care team, including interdisciplinary team members to develop a holistic management/care plan. (CanMEDS-FM Communicator, Collaborator)

  • Recognize the role of the family physician in the interdisciplinary team in hospice and palliative care.
  • Recognize how and when to collaborate with other allied health professionals.
  • Link the patient and the family to the appropriate resources when necessary

11. Demonstrate skills in self-reflection on the personal impact of patients' illness, dying and death. (CanMEDS-FM Manager)