Department of Family & Community Medicine

Enhanced Skills Program: Care of the Elderly Chronic Non-Malignant Palliative Care Rotation Goals and Objectives

By the completion of the rotation, the resident will be able to:

Medical Expert

  • Perform a complete palliative care consultation, including assessing the physical, social, psychological, spiritual and functional parameters for a patient with a chronic non-malignant illness (COPD; CHF; CVA; CRF; Dementias; ALS, other progressive neuromuscular diseases) referred to a palliative care service
  • Understand and demonstrate the components of a comprehensive pain and symptom assessment, including the use of validated assessment tools, appropriate history and physical examination skills, appropriate ordering/interpretation of investigations for a patient with a chronic non-malignant illness receiving a palliative approach to care.
  • Appropriately and effectively prescribe and titrate opioids and adjuvant medications for pain management for chronic non-malignant conditions. Manage serious and complex side effects of these medications
  • Develop and implement appropriate management plans for common symptoms relevant to patients receiving palliative approach to care for chronic non-malignant conditions (i.e nausea, dyspnea, constipation, pruritis, cachexia, edema)
  • Effectively manage issues pertaining to de-escalation of therapy, withdrawing therapy, palliative sedation and MAiD.

 

Communicator

  • Conduct an interview or family meeting with multiple participants to gather information about factors affecting the patient and about a patient and family’s beliefs, concerns, expectations and illness experience.
  • Accurately convey needed information and explanations to patients and families.
  • Facilitate goals of care discussion with patients and families to come to a shared plan of care including a discussion of prognosis of condition.    

 

Collaborator

  • Participate in a collaborative inter-professional palliative care consultation. Understands, recognizes and respects the diversity of roles, responsibilities and competencies of other professionals in relation to their own.
  • Work with others to assess, plan, provide and integrate care for patients with advanced medical illness receiving palliative approach to care and/or are approaching end of life.
  • Work collaboratively with other health care professionals and community organizations to provide coordinated care for patients in hospital and in the outpatient setting in the last year of life.
  • Respect differences, misunderstandings and limitations in oneself and other professional. Reflects on inter-professional team function.  

 

Leader

  • Manage their practice and career effectively. Sets priorities and manages time to balance patient care, practice requirements, outside activities and personal life.
  • Describe how the models of palliative care delivery for patients with chronic non-malignant illnesses fit into the broader healthcare system. 

 

Health Advocate

  • Describe the societal, environmental and resource allocation factors that are relevant to the care of the dying
  • Act as an effective advocate for the rights of the patient and family across clinical settings
  • Describe the barriers to the effective care of patients with advanced non-malignant illness in the last year of life and those dying patients in different care settings across a community.   

 

Scholar

  • Maintain and enhance professional activities through ongoing learning based on reflective practice
  • Critically evaluate medical information and its sources and apply appropriately to care for older patients at the end of life    

 

Professional

  • Demonstrate a commitment to their patients, profession and society through ethical practice.
  • Appreciate the professional, legal and ethical obligations required of current practice, including obligations around death and requests for MAiD.
  • Demonstrate a commitment to physician health and sustainable practice in caring for dying patients. Strives to heighten personal and professional awareness and insights around caring for dying patients and their families.
  • Demonstrate a commitment to reflective practice: gathers information about personal performance, knowing one’s own limits and seek help appropriately. Reflect on practice events, especially critical incidents, to deepen self-knowledge.