Enhanced Skills Program: Care of the Elderly In-Patient Palliative Care

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

Perform a complete palliative consultation including the physical, psychological, social, spiritual and functional needs of patient and family.
Appropriately and effectively use opioids and adjuvant medications in pain management. Manage serious complex side effects of these medications.
Develop and implement appropriate management plans for common symptoms relevant to patients receiving a palliative approach to care (i.e nausea, dyspnea, constipation, cachexia) including patients with advanced non-malignant diseases.
Appropriately use symptom screening and performance assessment tools in implementing end-of-life care.
Demonstrate knowledge and skills in the management of symptoms and issues arising in the last days and hours of life, including nutrition and hydration, terminal delirium and terminal respiratory secretions.
Demonstrate proficiency in addressing grief and bereavement.
Demonstrate proficiency in addressing psychosocial, cultural, religious, spiritual and existential issues associated with death and dying.
Assess level of suffering for a patient, family member or caregiver and determines the appropriate intervention.
Effectively manage issues pertaining to de-escalation of therapy, withdrawing therapy, palliative sedation and MAiD.
Understand the special issues in the assessment of pain in patients with cognitive impairment.

Develop rapport, trust and ethical therapeutic relationships with patients and families.
Accurately elicit and synthesize information from, and perspectives of, patients and families about factors affecting the patient and about a patient and family’s beliefs, concerns, expectations and illness experience.
Develop a common understanding of issues, problems and plans with patients and families, colleagues and other professionals to develop, provide and follow-up on goals of care and a shared plan of care.
Respect diversity and difference, including but not limited to the impact of gender, religion and cultural beliefs on decision making at end-of-life.

Participate effectively in a collaborative inter-professional palliative care team. Understand, recognize and respect 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 at the end of life.

Manage their practice and career effectively. Set priorities and manage time to balance patient care, practice requirements, outside activities and personal life.

Respond to individual patient health needs and issues as part of patient care. Advocate for individual patients around relevant health matters at the end of life.

Maintain and enhance professional activities through ongoing learning based on reflective practice.
Critically evaluate medical information and its sources and apply appropriately to care of 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.
Demonstrate commitment to physician health and sustainable practice in caring for dying patients. Strive 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.