Palliative Care

  • Explain the modern model of palliative care as it applies to those living with life-threatening or life-limiting illness (non-malignant or malignant)
  • Explain to patients/families the concepts of Advance Care Planning, Goals of Care and DNR
  • Identify early signs of the patient entering the last year of life
  • Demonstrate an approach to assessing a patient at end of life including the use of the  Edmonton Symptom Assessment Scale and Palliative Performance Scale
  • Be aware of the challenges when discussing prognosis of chronic diseases
  • Demonstrate basic principles in assessing two common symptoms in palliative care: pain control and dyspnea
  • Address patient’s and families’ views around life sustaining therapies and nutritional care at end of life 
  • Identify local resources to support palliative patients and their families
  • Accurately complete a death certificate

Core Resources

Palliative Care.pdf

Fauteux J, Keegan DA, Braun T. Palliative Care. Canadian Family Medicine Clinical Card. 2010. Available at: https://sites.google.com/site/sharcfm/

Gold Standards Framework 2016

GSF PIG 6thEdition Dec 2016 K Thomas,Julie Armstrong Wilson and GSF Team, National Gold Standards Framework Centre in End of Life Care http://www.goldstandardsframework.org.uk

Uncertainty: the other side of prognosis

Smith AK et al., 2013. Uncertainty: the other side of prognosis, NEJM 368(26):2448-2450.

ESAS - Edmonton Symptom Assessment System

Regional Palliative Care Program.  Guidelines for using the Edmonton Symptom Assessment System (ESAS). 2001.

Palliative Performance Scale

Victoria Hospice Society. Palliative Performance Scale (PPSv2). Copyright 2001. http://www.npcrc.org/

2018 Speak Up ACP Workbook

Advance Care Planning Workbook. Ontario Edition. Speak Up Ontario. 2018. Available at: http://www.speakupontario.ca/

How to discuss goals of care with patients

Dunlay SM & Strand JJ, 2016. How to discuss goals of care with patients. Trends in Cardiovascular Medicine, 26:36-43. doi: 10.1016/j.tcm.2015.03.018

Sunnybrook Guide

Jackson L, Yang D. A Medication Dosing Guide for Management of Pain and Dyspnea in Palliative Care. Sunnybrook Health Sciences Centre. Jan 2018

Improving the accuracy of death certification

Myers KA, Farquhar DR. Improving the accuracy of death certification. CMAJ: Canadian Medical Association Journal. 1998;158(10):1317-1323.

Supplemental Resources

The “surprise question” for predicting death in seriously ill patients: a systematic review and meta-analysis

Downar J et al., 2017. The “surprise question” for predicting death in seriously ill patients: a systematic review and meta-analysis, CMAJ 189: E484-493. doi:10.1056/NEJMp1303295.

An eLearning module on Goals of Care from Mount Sinai Hospital

Steinberg L, Soong C, Safavi N, & Daly A. Improving your goals of care conversation. Sinai Health System. 2019. Available at: http://www.goalsofcaremodule.com

Discussing resuscitation preferences with patients: Challenges and rewards

Chittenden EH, Clark ST, Pantilat SZ, Discussing Resuscitation Preferences. J. Hosp. Med 2006;4;231-240. doi:10.1002/jhm.110

Pharmacologic management of chronic neuropathic pain: Review of the Canadian Pain Society consensus statement 2017

Mu et al. Pharmacologic management of chronic neuropathic pain: Review of the Canadian Pain Society consensus statement 2017. Can Fam Physician 2017;63:844-52

A recent and overarching guide to symptom management in Palliative Care in Canada

BC Centre for Palliative Care (2019). B.C. Inter-professional Palliative Symptom Management Guidelines. Avaialble at: https://www.bc-cpc.ca/cpc/wp-content/uploads/2019/03/BCPCClinicalBestPractices-PrintVersionColourFull.pdf.pdf

2017 Province of BC guideline for completing Death Certificates

British Columbia Vital Statistics Agency, Ministry of Health. Medical Certification of Death and Stillbirth – A handbook for Physicians, Nurse Practitioners and Coroners. Revised 2017. Available at: https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/vsa051.pdf

2010 Province of Ontario guideline for completing Death Certificate

Ministry of Government and Consumer Services. Handbook on Medical Certification of Death. 2010. Available at: https://www.publications.gov.on.ca/handbook-on-medical-certification-of-death