- Consider the palliative care needs of all patients with advanced, life-limiting illnesses, such as:
- Metastatic cancer
- Any diagnosis of end-stage organ failure (eg, congestive heart failure, chronic obstructive pulmonary disease, chronic renal failure) with increasing disability, frequent hospitalisation, and/or decreasing benefit from therapies
- Advanced degenerative neurological conditions.
- A palliative approach should be considered for any patient when you would not be surprised if they died within the next twelve months, ie, the 'surprise' question.
- Consider the need for, and timing of, advance care planning conversations, recognising that:
- Many patients are waiting for their doctor to raise this topic, and the setting of a GP consultation is an appropriate opportunity
- Many patients appreciate the willingness of their doctor to discuss their concerns and values, with the goal of improving their quality of life
- For many patients advance care planning is not a single set of decisions, but an ongoing conversation, which needs to be appropriately documented and reviewed
- It is important for the patient to identify a substitute decision maker, and to talk to that person about their wishes and concerns.
- Discuss and review the goals of care for current medical conditions, recognising that there are common transition points that will affect these goals of care, including:
- Diagnosis of a new condition, or worsening of a pre-existing condition
- Burden of treatment starting to outweigh benefits
- Increase in dependency, decreasing performance state
- Increase in suffering and distress.
- Where symptoms or distress do not respond to initial management, consider early referral to specialist palliative care services.
- Be aware that referral for specialist palliative care is not limited to a particular diagnosis or life expectancy, but to the patient’s level of need.
- Where carer burden or distress is high, or there are complex psychosocial needs, consider early referral to specialist palliative care service.
Tools and Resources for professionals
The 'surprise' question - Identification of patient approaching the end-of-life
RADPAC - Identification of patient requiring palliative care approach
PEPSI COLA - Holistic patient assessment tool
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Last updated 25 May 2015*