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:

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.

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.

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.

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.

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.

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

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.