Principles of palliative care

From Oncology for Medical Students
Ideal oncology curriculum > Principles of palliative care

Objective 5.5

At graduation, the student should be able to:

a) demonstrate an understanding of the importance of the patient in decision making processes and the influences that affect their choices
b) explain the role and structure of palliative and supportive care in the multidisciplinary management of advanced cancer
c) explain considerations of when and how palliative care should be introduced
d) demonstrate the assessment of pain and other symptoms, including nausea, fatigue, confusion, drowsiness and cachexia
e) discuss principles of both pharmacological and non-pharmacological pain relief and the palliative management of other symptoms
f) demonstrate an understanding of "end of life" issues that confront patient, family and physician:
  • physical effects of advanced cancer;
  • psychosocial aspects of terminal cancer, support (religious, cultural, spiritual, existential), loss and bereavement;
  • ethical aspects of “end of life” decision-making
g) demonstrate understanding of the Palliative Care Act(s)
h) demonstrate appreciation of cultural aspects of end of life care
i) demonstrate adequate communication skills, including breaking bad news and discussion of end of life care
j) demonstrate understanding of utility of procedures to relieve symptoms, e.g. ascitic and pleural taps.

Prerequisite knowledge

  • History of palliative care in the health care system (1950 to present)

Representative questions that suggest the required depth of knowledge

1. Discuss who would be appropriate members of a palliative care team at an acute hospital.

Essential in answer:

  • Palliative care doctor (liaison with hospice), palliative care nurse, social worker, psychiatrist, oncologist, nursing liaison (community liaison), pastoral care worker.
  • Mention should be made of the multidisciplinary nature of care

2. During regular use of morphine for chronic pain control, what is the oral equivalent to 10mg of subcutaneous morphine sulphate?

(a) 60mg

(b) 30mg

(c) 10mg

(d) 3.3mg

Answer: (b)

Note: The answer requires an understanding that oral morphine has only about one-third of the bioavailability of parenteral morphine when used regularly -- i.e. three times the dose is required. The required oral dose for a one-off dose is six times.