Patient assessment is a critical step in identifying palliative care needs. Assessment should address prognosis, current and anticipated symptoms, distress, and the availability and support needs of family and caregivers.
GPs need to consider the palliative care needs of all patients with advanced life-limiting illnesses including metastatic cancer, end stage organ failure and advanced degenerative neurological conditions. Assessment should address prognosis, current and anticipated symptoms, distress, and the availability and support needs of family and caregivers. Identifying which other members of the multidisciplinary team might be valuable is also important.
Consider the palliative care needs of all patients with advanced, life-limiting illnesses, such as:
Prognostic Indicator Guidance - the surprise question (367kb pdf)
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:
Download the PEPSI COLA aide memoire (128kb pdf)
PEPSI COLA aide memoire
Use a simple tool to methodically review symptoms in palliative care patients e.g. the PEPSI COLA tool and the Distress thermometer.
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. Check local HealthPathways for referral processes.
Download the NCCN Distress Thermometer (167kb pdf)
NCCN Distress thermometer (167kb pdf)
Where carer burden or distress is high, or there are complex psychosocial needs, consider early referral to specialist palliative care service
Download Interactive SPICT Tool (298kb pdf)
Read the RACGP Silver Book
Download the PEPSI COLA Aide Memoire (128kb pdf)
Last updated 20 February 2023