Planning and Coordinating Care Resources

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Planning and Coordinating Care
Planning and Coordinating Care Resources

Resources that can help nurses with palliative care planning

Advance care planning
- Clinicians involved in advance care planning (ACP) conversations and medical interpreters can watch this webinar Advance Care Planning for CALD Communities: iCanPlan Program to learn more about ACP with culturally and linguistically diverse communities affected by cancer.
- Visit Advance Care Planning Australia for information for health professionals and forms.
- Read the Digital Health Australia guidelines on using My Health Record for advance care planning and goals of care documents (pdf).
- End of Life Law for Clinicians has an open-access module on advance care planning.
- For practice tips on advance care planning, visit the Marie Curie website.
- Share with patients, families and carers the information and advice on the Marie Curie website:
  - Planning ahead
  - Planning your care in advance.
Anticipatory care
- The National Core Community Palliative Care Medicines List (the List) identifies four medicines for use by home-based palliative patients in the terminal phase who require urgent symptom relief.
- Use Talking End of Life (TEL) to better understand how to talk with people with intellectual disability about end of life.
- Use the resources and training offered by The Advance Project for advance care planning in general practice and primary care.
- For practice guidance, read Anticipatory prescribing from Scottish Palliative Care Guidelines.
- For practice tips on Anticipatory medicines go to the Marie Curie website.
- Read the article from Canadian Virtual Hospice about Remaining at home: Things to consider (for nurses, patients, families, and carers).
- Share with patients, family and carers the information on the Marie Curie website: Just in case medicines.
Care coordination
- Advance Care Planning Australia host resources to help people record your choices.
- My Health Record stores health information that authorised healthcare providers can use to view and add health information.
- CarerHelp hosts useful resources for carers to record and share important information:
  - medication lists (pdf)
  - contact information (pdf).
- palliAGED hosts a series of forms for your practice including:
  - emergency contact list (pdf)
  - medicines list (pdf)
  - forms to help medication safety
  - forms to prepare, conduct and record discussions from a case conference.
- Palliative care protocols for ambulance services SA. Where such arrangements do not exist, a written plan of care for the ambulance can relieve paramedics of the obligation to perform CPR on a palliative care patient who is actively dying, or to transport them to an emergency department.
Goals of care
- Do the PCC4U Module 4 Activity 3: Goals of Care to learn about the process of establishing goals of care for people in your care.
- Read the Digital Health Australia guidelines on using My Health Record for advance care planning and goals of care documents (pdf).
- Implementing the Comprehensive Care Standard Identifying goals of care from the Australian Commission on Safety and Quality in Health Care provides practical advice for clinicians and health service organisations about goal setting.
Person-centred care
- Patient-centred care: Improving quality and safety through partnerships with patients and consumers from the Australian Commission on Safety and Quality in Health Care provides background information, resources, and examples of how to take a more person-centred approach to healthcare delivery.
- In this video, Dr Paresh Dawda and palliative care nurse practitioner Nikki Johnston discuss Challenges of delivering a person centred palliative care model.
- To know more about key barriers and promising approaches for improving access to and experience of palliative care for 9 population groups within Australia read Exploratory Analysis of Barriers to Palliative Care reports.
- To better understand how aged care services can meet the needs of people from diverse backgrounds, read the Aged Care Diversity Framework.
Shared decision-making and supported decision-making
- Explore the information and resources from the Cognitive Decline Partnership Centre to help you support people living with dementia to be involved in decisions that affect their care.
- Visit Finding your way, a shared decision-making model created to help Aboriginal people.
- The Disability Services supported decision making: A quick reference guide for disability support workers (pdf) can help you support people with a disability who are making decisions.
Working with families
- CareSearch Patient and Carers section has a section on How to Care.
- CareSearch Diversity section hosts culturally appropriate resources in palliative care.
- CarerHelp host online education and resources about what to expect and what you can do as a life-limiting illness progresses.
- Marie Curie website provides practice guidance on Supporting family and friends in palliative care.
Planning and coordinating care
- The ACSQHC Delivering and Supporting Comprehensive End-of-Life Care: a user guide (pdf) provides practical strategies that health service organisations and clinicians can use to provide safe and high-quality end-of-life care.
- On the palliAGED website Care Coordination provides a concise synopsis with a companion page with practical information.
- Read the article from Canadian Virtual Hospice about Remaining at home: Things to consider (for nurses, patients, families, and carers).

Last updated 24 September 2026

Planning and Coordinating Care Resources

Resources that can help nurses with palliative care planning

Advance care planning

Anticipatory care

Care coordination

Goals of care

Person-centred care

Shared decision-making and supported decision-making

Working with families

Planning and coordinating care